Irinotecan Plus Anlotinib or Further in Combination With Penpulimab for Second-line Treatment of mCRC

This trial is testing whether adding the drugs anlotinib (a targeted anti-angiogenesis drug) and/or penpulimab (an immunotherapy drug) to standard irinotecan chemotherapy improves outcomes for patients with colorectal cancer that has spread and stopped responding to first-line treatment. **You may be eligible if...** - You have confirmed metastatic or recurrent colorectal adenocarcinoma - Your cancer progressed after a first-line treatment that included oxaliplatin and fluorouracil - You are in reasonably good general health - You have not received irinotecan previously **You may NOT be eligible if...** - You have had more than one prior line of chemotherapy for metastatic disease - You have uncontrolled brain metastases - You have serious heart, liver, or kidney problems - You have active autoimmune disease requiring treatment Talk to your doctor to see if this trial is right for you.