CHALLENGE Trial: Structured Exercise after Adjuvant Chemotherapy for Colon Cancer
- Phil Hanwright
- Jul 16
- 2 min read
Updated: Oct 20
Paper Info
Background
Despite curative surgery and modern adjuvant chemotherapy, 20 – 40 % of stage III or high-risk II colon-cancer survivors recur. Observational data link higher post-treatment physical activity with superior outcomes, but randomized evidence has been lacking.
Methods
Study design & scale: Multicenter (55 international sites), phase-3, open-label RCT; 889 patients randomized 1:1 (2009-2024).
Population: Adults with completely resected stage III or high-risk II colon cancer, 2-6 mo after finishing FOLFOX or CAPOX; ECOG 0–1; <150 min wk⁻¹ baseline exercise.
Intervention: Three-year, behavior-supported aerobic program targeting ≥ 10 MET-h wk⁻¹ above baseline
A MET (Metabolic Equivalent of Task) is the energy you use at rest. Moderate-intensity activities such as brisk walking are about 3–5 METs; vigorous activities like jogging are 6–8 METs.
Goal of 150–180 minutes of brisk walking per week (∼30 min on most days) in addition to one’s usual activity.
Control: Health-education materials alone.
Outcomes & follow-up:
Primary: Disease-free survival (DFS).
Key secondaries: Overall survival (OS), SF-36 physical-functioning domain, predicted VO₂, 6-min walk, safety; median follow-up 7.9 y.
Results
5-year DFS: 80.3 % (exercise) vs 73.9 % (control).
8-year OS: 90.3 % (exercise) vs 83.2 % (control).
Quality of life: SF-36 physical-functioning improved ~6–7 points in the exercise arm vs 1–3 points in controls at every 6-mo interval through 3 y.
Functional fitness: Sustained mean gain of 5–7 MET-h wk⁻¹ plus parallel VO₂ and 6-min-walk improvements.
Safety: Grade ≥3 AEs 15.4 % (exercise) vs 9.1 %; musculoskeletal events 18.5 % vs 11.5 % (10 % exercise-related).
Conclusion
A rigorously supported, moderate-volume aerobic exercise program initiated soon after adjuvant chemotherapy meaningfully improves long-term disease-free and overall survival while enhancing functional quality of life, with tolerable risk. These data provide level-1 evidence to integrate structured exercise into routine survivorship care for colon-cancer patients.
Clinical Relevance
Level I evidence shows that a modest, structured aerobic program improves survival. Plastic surgeons should investigate prescribe exercise in other reconstructive pathways to enhance outcomes.
Comments