S716
Clinical – Lower GI
ESTRO 2026
Patients achieving cCR were offered a watch and wait (W&W) protocol and those without cCR were recommended surgery. Group A patients with pathological positive circumferential margins were arranged for adjuvant chemoradiotherapy. The primary endpoint is CR (pathological complete response [pCR] plus cCR) rate. The secondary endpoints include organ preservation rate, anorectal functions, adverse effects, survival outcomes, etc. Results: Up to 2025/10/15, 192 patients were recruited and 116 patients completed the treatment (Group A 56, Group B 60). The baseline characteristics were balanced between two groups, 97.4% (113/116) of them showing one of the following features: lower location ( ≤ 5cm), cT4, cN2, MRF+ or EMVI+. There were 2 patients in Group A and 15 patients in Group B who achieved cCR and adopted W&W. Forty-eight and 43 patients in Group A and B underwent surgery, of which 19 (39.6%, 19/48) and 21 (48.8%, 21/43) cases achieved pCR. Five and one non-cCR patients in Group A and B refused surgery or were still under treatment. There was one patient in each group experienced disease progression. The total CR rates were 37.5% (21/56) in Group A and 60.0% (36/60) in Group B. The most common grade 3-4 toxicity was thrombocytopenia (14.3% and 11.7% in Group A and B). Conclusion: Our study represents the first comparative analysis of two iTNT regimens in LARC. Unprecedentedly, our preliminary findings reveal that neoadjuvant CAPOX plus PD-1 inhibitor achieved a promising CR rate even in pMMR LARC, and this CR rate can be further enhanced with the addition of SCRT prior to immunochemotherapy. Further follow-up is required for the comparison of efficacy and functional endpoints. References: 1. Xia F, Wang Y, Wang H, et al. Randomized Phase II Trial of Immunotherapy-Based Total Neoadjuvant Therapy for Proficient Mismatch Repair or Microsatellite Stable Locally Advanced Rectal Cancer (TORCH). J Clin Oncol 2024; 42: 3308-18. Keywords: immunochemotherapy with or without radiotherapy Digital Poster 2989 Health-related quality of life of people with metastatic or recurrent / persistent anal cancer receiving radical chemoradiotherapy Daniel David Aze 1 , Samantha Claire Sodergren 1 , Waleed Alrjoub 2 , Tara Chalk 3 , Shruti Chandnani 4 , Peter Christensen 5 , Catherine Coltart 6 , Rowan Edwards 1 , Loukia Georgiou 7 , Alexandra Gilbert 8 , Duncan Gilbert 9 ,
2/27 patients with detectable ctDNA at baseline had persistent ctDNA at the end of treatment and subsequently developed distant metastases, while the remaining patients did not have measurable ctDNA loads at the end of treatment. Conclusion: The majority of patients with an initially measurable HPV16 ctDNA undergo clearance during CRT. Patients with elevated ctDNA levels at the end of treatment have a poor prognosis and a high risk of developing distant metastases. Additionally, high ctDNA loads at baseline are associated with the diagnosis of distant metastases during follow up. In conclusion, monitoring HPV16 ctDNA could be useful to identify patients that could benefit from potential additional treatments or a closer follow up to detect recurrences or distant metastases earlier. Keywords: anal cancer, hpv, ctdna Immunotherapy based total neoadjuvant therapy with or without short-course radiotherapy for locally advanced rectal cancer (TORCH-iTNT NCT06281405) Yaqi Wang 1 , Lijun Shen 1 , Juefeng Wan 1 , Hui Zhang 1 , Yan Wang 1 , Yajie Chen 1 , Ruiyan Wu 1 , Menglong Zhou 1 , Wang Yang 1 , Shujuan Zhou 1 , Zhiyuan Zhang 1 , Jingwen Wang 1 , Sanjun Cai 2 , Xinxiang Li 2 , Fan Xia 1 , Zhen Zhang 1 1 Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China. 2 Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China Purpose/Objective: For proficient mismatch repair (pMMR) locally advanced rectal cancer (LARC), total neoadjuvant chemoradiotherapy combined with immunotherapy (iTNT) has increased the possibilities of complete response (CR) and organ preservation1. However, patients who receive radiotherapy and surgery are more likely to experience functional loss compared to either treatment alone. Combining chemotherapy with immunotherapy may also improve tumor downstaging and allow sphincter sparing surgery without radiation- induced damage. This trial aimed to compare both Proffered Paper 2846 oncological and functional outcomes of two iTNT regimens: CAPOX plus PD-1 inhibitor with or without short-course radiotherapy (SCRT) for pMMR LARC. Material/Methods: TORCH-iTNT is a prospective, multicenter, randomized phase II trial. A total of 192 patients with pMMR LARC (T3-4/N+M0) were randomly assigned to Group A (6 cycles of immunochemotherapy [CAPOX+Toripalimab]), or Group B (SCRT [25Gy/5Fx] followed by 6 cycles of immunochemotherapy).
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