Genotype-driven Weekly Irinotecan Liposomes in Combination With Capecitabine-based Neoadjuvant Chemoradiation for Locally Advanced Rectal Cancer

This study tests whether adjusting the dose of a chemotherapy drug called irinotecan (in a liposomal form) based on a patient's genetic makeup can improve treatment for locally advanced rectal cancer before surgery and radiation. Different patients process this drug differently based on their genes, so tailoring the dose could improve safety and effectiveness. **You may be eligible if...** - You are between 18 and 70 years old - You have been diagnosed with rectal adenocarcinoma by biopsy - Your cancer is locally advanced (stage T2–T4 and/or lymph node involvement) and not suitable for upfront surgery - Your tumor is within 10 cm of the anal opening - There is no sign of cancer spread to distant organs - You are in good health (ECOG score 0–1) - You have not received chemotherapy or other anti-cancer treatment before **You may NOT be eligible if...** - Your cancer has spread to other organs - You have already received chemotherapy or radiation for this cancer - You have serious heart, liver, or kidney problems Talk to your doctor to see if this trial is right for you.