Preclinical and observational studies have suggested a potential role for physical activity in improving cancer outcomes. The CHALLENGE trial is the first international randomised controlled trial to formally assess whether a structured exercise intervention can improve disease-free survival (DFS) in patients with colon cancer who have completed adjuvant chemotherapy.1
The phase III CHALLENGE trial enrolled patients with resected stage III or high-risk stage II colon cancer who had completed adjuvant chemotherapy within the previous 2 to 6 months. Patients were randomised in a 1:1 ratio to a structured exercise programme (behavioural support sessions and supervised exercise sessions) or to receive health education materials alone over a 3-year period. The primary endpoint was DFS.
Between 2009 and 2024, 889 patients were enrolled across 55 centres. The median patient age was 61 years. At a median follow-up of 7.9 years, DFS was significantly longer in the exercise group than in the health education group (HR[95% CI]: 0.72[0.55-0.94], p= 0.02). The 5-year DFS rate was 80.3% in the exercise group and 73.9% in the health education group. The 8-year overall survival was 90.3% in the exercise group and 83.2% in the health education group (HR[95% CI]: 0.63[0.43-0.94]).
Musculoskeletal adverse events were more common in the exercise group than in the health education group (18.5% vs 11.5%).
Among patients who had recently completed adjuvant chemotherapy for colon cancer, participation in a 3-year structured exercise programme led to significant improvement in DFS compared to health education alone. These results provide the strongest evidence to date that exercise can be a meaningful component of survivorship care, potentially improving long-term outcomes in early-stage colon cancer.
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