Neoadjuvant FOLFOXIRI chemotherapy with or without camrelizumab in the treatment of locally advanced rectal cancer: a retrospective cohort study

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Standard neoadjuvant chemoradiotherapy for locally advanced rectal cancer (LARC) is associated with significant toxicity and limited pathological responses. We retrospectively compared a radiotherapy‑free regimen of camrelizumab plus modified FOLFOXIRI versus modified FOLFOXIRI alone in consecutive patients with clinical stage II-III LARC treated from 2022-2025 (n = 146). All patients received ≥3 cycles of neoadjuvant therapy; surgery or watch‑and‑wait was determined by a multidisciplinary team. Baseline characteristics were well balanced. Among surgical patients, pCR rates were 29.8% with camrelizumab plus FOLFOXIRI and 19.6% with FOLFOXIRI alone. Radiologic objective response rates were 70.7% and 53.5%, respectively, and mean neoadjuvant rectal scores were lower with camrelizumab (13.95 vs 23.77; P < 0.02). Disease‑free survival was significantly improved in the camrelizumab group, while overall survival was similar at current follow‑up. Grade 3-4 hematologic and gastrointestinal toxicities were comparable, and no unexpected immune‑related events occurred. Camrelizumab plus FOLFOXIRI appears to be an active, tolerable radiotherapy‑free neoadjuvant option for LARC.

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