OnCo
ideasIdea

A dose-finding trial for exercise after cancer

CHALLENGE proved exercise works in colon cancer but not how much is needed. A trial comparing doses, as we would for a drug, would tell health systems what to fund.

Drugs get dose-finding; exercise got a single dose (about 10 MET-hours/week above baseline) chosen from cohort data. Cohorts suggest a dose-response with benefit continuing beyond 18 MET-hours/week, but also that the first few hours matter most. Health systems deciding what to reimburse need to know whether a cheaper, lower-dose or unsupervised programme retains most of the benefit.

Hypothesis
In colon or breast cancer survivors, disease-free survival improves in a dose-dependent manner across 5, 10 and 20 MET-hours/week of supervised activity, with most of the benefit achieved at 10 MET-hours/week, and objectively measured adherence (wearables) rather than prescribed dose predicts outcome.
Rationale
Dose-response evidence converts a single positive trial into a prescribable intervention, defines the minimum effective dose for resource-limited settings, and lets wearables substitute for self-report as the exposure measure.
What would test it
Three-arm randomised trial (n about 1,500) in stage II-III colon cancer after adjuvant chemotherapy with wearable-verified MET-hours, DFS primary endpoint, embedded cost-effectiveness and a biomarker sub-study (insulin, CRP, ctDNA).
Maturity
early clinical
Who has to act
research
Cost to try
Medium ($1M to $50M)
Years to first evidence
6
Bottlenecks it attacks

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