{"entity":{"id":"challenge","kind":"trial","name":"CHALLENGE (CCTG CO.21)","aka":[],"tldr":"The first randomised trial to show that a coached exercise programme after cancer treatment reduces recurrence and death, in colon cancer.","summary":"889 patients across Canada, Australia, UK, Israel and the US were randomised within 2-6 months of completing adjuvant chemotherapy to a structured exercise programme delivered by physical activity consultants (behavioural support sessions and supervised exercise, tapering over three years, targeting an increase of 10 MET-hours/week) or to health-education materials. Median follow-up 7.9 years. Disease-free survival at 5 years 80.3% vs 73.9% (HR 0.72, 95% CI 0.55-0.94); overall survival at 8 years 90.3% vs 83.2% (HR 0.63, 95% CI 0.43-0.94). Physical functioning and VO2 improved in the exercise arm; musculoskeletal adverse events were more common (18.5% vs 11.5%). The effect size is comparable with adding oxaliplatin to fluoropyrimidine adjuvant therapy. Limitations: one disease, open-label, participants were relatively fit volunteers, and the intervention required a trained workforce.","status":"positive","asOf":"2026-09-08","links":[{"label":"ClinicalTrials.gov NCT00819208","url":"https://clinicaltrials.gov/study/NCT00819208"},{"label":"Courneya et al. (NEJM 2025)","url":"https://doi.org/10.1056/NEJMoa2502760"}],"tags":[],"related":["idea-exercise-as-adjuvant","idea-bio2-exercise-reimbursement"],"cancers":["colorectal"],"sections":["nutrition-lifestyle"],"technologies":["structured-exercise-survivorship","exercise-oncology"],"targets":[],"drugs":["folfox"],"companies":["cctg"],"institutions":["princess-margaret"],"pathways":[],"terms":["met-hours","energy-balance","efs","os"],"trials":["idea-collaboration","mosaic"],"people":["kerry-courneya","christopher-booth"],"bottlenecks":["b-survivorship","b-prevention-adoption"],"keyPapers":["paper-challenge-exercise-nejm-2025"],"journals":[],"dependsOn":[],"notes":[],"nct":"NCT00819208","phase":"3","setting":"Resected stage III or high-risk stage II colon cancer after adjuvant chemotherapy: 3-year structured exercise programme vs health-education materials","sponsor":"Canadian Cancer Trials Group","result":"DFS HR 0.72; OS HR 0.63; 8-year OS 90.3% vs 83.2%.","started":"2009-06-02","startedType":"actual","yearReported":2025,"enrolled":889,"enrolledBasis":"registry","outcomes":[{"endpoint":"Disease-free survival at 5 years","primary":true,"unit":"%","arms":[{"name":"Structured exercise","n":445,"value":80.3},{"name":"Health education","n":444,"value":73.9}],"hr":0.72,"ci":[0.55,0.94],"p":"0.02","source":"https://doi.org/10.1056/NEJMoa2502760"},{"endpoint":"Overall survival at 8 years","unit":"%","arms":[{"name":"Structured exercise","value":90.3},{"name":"Health education","value":83.2}],"hr":0.63,"ci":[0.43,0.94],"source":"https://doi.org/10.1056/NEJMoa2502760"}],"replication":"None yet; CHALLENGE-design trials in breast and prostate cancer are being planned. Consistent with decades of cohort data on physical activity and colon cancer survival."},"route":"/trials/challenge/","neighbours":{"idea":[{"id":"idea-nl-exercise-dose-finding","kind":"idea","name":"A dose-finding trial for exercise after cancer","route":"/ideas/idea-nl-exercise-dose-finding/"},{"id":"idea-bio2-exercise-reimbursement","kind":"idea","name":"Pay for supervised exercise the way we pay for drugs","route":"/ideas/idea-bio2-exercise-reimbursement/"},{"id":"idea-exercise-as-adjuvant","kind":"idea","name":"Structured exercise prescribed like a drug in all curative-intent cancer care","route":"/ideas/idea-exercise-as-adjuvant/"}],"cancer":[{"id":"colon-cancer","kind":"cancer","name":"Colon cancer (adenocarcinoma of the colon)","route":"/cancers/colon-cancer/"},{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"early-onset-colorectal","kind":"cancer","name":"Early-onset colorectal cancer (under 50)","route":"/cancers/early-onset-colorectal/"}],"section":[{"id":"nutrition-lifestyle","kind":"section","name":"Diet, Exercise & Lifestyle","route":"/fronts/nutrition-lifestyle/"}],"technology":[{"id":"exercise-oncology","kind":"technology","name":"Exercise & lifestyle oncology","route":"/technologies/exercise-oncology/"},{"id":"structured-exercise-survivorship","kind":"technology","name":"Structured exercise programmes after curative treatment","route":"/technologies/structured-exercise-survivorship/"},{"id":"exercise-prescription-after-cancer","kind":"technology","name":"The exercise prescription after cancer: the dose the guidelines state","route":"/technologies/exercise-prescription-after-cancer/"}],"drug":[{"id":"folfox","kind":"drug","name":"FOLFOX (5-FU, leucovorin, oxaliplatin)","route":"/drugs/folfox/"}],"company":[{"id":"cctg","kind":"company","name":"Canadian Cancer Trials Group (CCTG)","route":"/companies/cctg/"}],"institution":[{"id":"canadian-cancer-society","kind":"institution","name":"Canadian Cancer Society","route":"/institutions/canadian-cancer-society/"},{"id":"princess-margaret","kind":"institution","name":"Princess Margaret Cancer Centre","route":"/institutions/princess-margaret/"}],"term":[{"id":"absolute-benefit","kind":"term","name":"Absolute versus relative benefit (number needed to treat)","route":"/terms/absolute-benefit/"},{"id":"decentralised-trial","kind":"term","name":"Decentralised trial","route":"/terms/decentralised-trial/"},{"id":"energy-balance","kind":"term","name":"Energy balance","route":"/terms/energy-balance/"},{"id":"efs","kind":"term","name":"Event-free / disease-free survival (EFS, DFS, iDFS, RFS)","route":"/terms/efs/"},{"id":"hazard-ratio","kind":"term","name":"Hazard ratio (HR)","route":"/terms/hazard-ratio/"},{"id":"met-hours","kind":"term","name":"MET-hours per week","route":"/terms/met-hours/"},{"id":"os","kind":"term","name":"Overall survival (OS)","route":"/terms/os/"},{"id":"pragmatic-trial","kind":"term","name":"Pragmatic trial","route":"/terms/pragmatic-trial/"},{"id":"randomised-trial","kind":"term","name":"Randomised trial","route":"/terms/randomised-trial/"}],"trial":[{"id":"rejuv-trial-amico","kind":"trial","name":"AMICO: aerobic or resistance exercise to improve outcome in metastatic colorectal cancer","route":"/trials/rejuv-trial-amico/"},{"id":"idea-collaboration","kind":"trial","name":"IDEA collaboration","route":"/trials/idea-collaboration/"},{"id":"mosaic","kind":"trial","name":"MOSAIC","route":"/trials/mosaic/"}],"person":[{"id":"christopher-booth","kind":"person","name":"Christopher M. Booth","route":"/people/christopher-booth/"},{"id":"kerry-courneya","kind":"person","name":"Kerry S. Courneya","route":"/people/kerry-courneya/"}],"bottleneck":[{"id":"b-prevention-adoption","kind":"bottleneck","name":"Prevention we already have is not deployed","route":"/bottlenecks/b-prevention-adoption/"},{"id":"b-survivorship","kind":"bottleneck","name":"Survivorship and late effects are neglected","route":"/bottlenecks/b-survivorship/"}],"paper":[{"id":"paper-challenge-exercise-nejm-2025","kind":"paper","name":"CHALLENGE: a structured exercise programme after chemotherapy improves survival in colon cancer","route":"/key-papers/paper-challenge-exercise-nejm-2025/"}],"roadmap":[{"id":"nutrition-lifestyle-roadmap","kind":"roadmap","name":"Diet, exercise and lifestyle roadmap: causes established → interventions that disappointed → exercise proven as treatment","route":"/roadmaps/nutrition-lifestyle-roadmap/"},{"id":"rejuvenation-roadmap","kind":"roadmap","name":"Recovery and rejuvenation roadmap: cure is not enough → survivorship gets a name → the cohorts that measured the cost → exercise proven as treatment → biological ageing measured and sold → repair, if anyone funds it","route":"/roadmaps/rejuvenation-roadmap/"},{"id":"survivorship-roadmap","kind":"roadmap","name":"Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards","route":"/roadmaps/survivorship-roadmap/"},{"id":"trial-modernisation-roadmap","kind":"roadmap","name":"Trial modernisation roadmap: the randomised trial → platforms and adaptive designs → decentralised, pragmatic and always-on","route":"/roadmaps/trial-modernisation-roadmap/"}]}}