# AMICO: aerobic or resistance exercise to improve outcome in metastatic colorectal cancer

Source: https://onco.cc/trials/rejuv-trial-amico/  
OnCo record `rejuv-trial-amico` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

CHALLENGE showed exercise improves survival after curative treatment for colon cancer. AMICO asks the next question, in advanced disease, with chemotherapy dose modification and progression-free survival as its primary endpoints, and uses an adaptive design to drop an ineffective exercise prescription early.

## Summary

The trial's own stated rationale is the one this front keeps returning to: evidence from randomised trials shows that exercise during cancer treatment benefits physical fitness, fatigue and quality of life, and because the effect on clinical outcome was unknown, exercise is not included as an integral part of standard cancer care. AMICO tests clinical outcome directly in a different setting from CHALLENGE, during palliative chemotherapy rather than after curative treatment.

Three arms: continuous aerobic exercise with resistance training, continuous aerobic exercise with high-intensity aerobic intervals, and usual care with an exercise-guidelines brochure. The two exercise arms are two supervised 60-minute sessions a week with a physiotherapist. The hypothesis is that exercise reduces chemotherapy dose modifications, which the protocol notes occur in about 40 per cent of patients with metastatic colorectal cancer and may reduce the benefit of treatment, and secondarily that it improves natural killer cell function. Co-primary endpoints are the number of patients requiring dose modifications and progression-free survival.

The design is the part worth noting for the field. It is a Bayesian adaptive multi-arm multi-stage trial with interim analyses that can drop an ineffective arm early, which is the efficiency the survivorship platform-trial proposal on this front generalises. Comparing two exercise prescriptions head to head, rather than exercise against nothing, is also the dose-finding question that exercise oncology has mostly skipped.

The registry records no phase for this study, as it tests a behavioural intervention rather than a drug; it is filed here as phase 3 because OnCo's schema has no value for an unphased randomised trial, and the registry entry is linked so the reader can check. Registry dates, read on 2 October 2026: start 2 March 2021 (actual), primary completion March 2026 (estimated), completion December 2026 (estimated). Enrolment of 228 is the registry's estimate.

## Fields

- Kind: Trial
- Status: recruiting
- Last checked: 2026-10-02
- Also known as: AMICO; NCT04754672
- Tags: rejuvenation; survivorship; open-problem; exercise; trial-design
- Registry id: NCT04754672
- Phase: 3
- Setting: Adults with metastatic colorectal cancer receiving palliative chemotherapy, Netherlands, 13 collaborating centres
- Sponsor: Radboud University Medical Center
- Enrolled: 228

## Sources

- ClinicalTrials.gov NCT04754672: https://clinicaltrials.gov/study/NCT04754672
- Courneya et al., Structured exercise after adjuvant chemotherapy for colon cancer, the CHALLENGE trial (NEJM 2025;393:13-25): https://doi.org/10.1056/NEJMoa2502760

## Connected records

- trials: [CHALLENGE (CCTG CO.21)](https://onco.cc/trials/challenge/)
- technologies: [Exercise & lifestyle oncology](https://onco.cc/technologies/exercise-oncology/), [Structured exercise programmes after curative treatment](https://onco.cc/technologies/structured-exercise-survivorship/), [The exercise prescription after cancer: the dose the guidelines state](https://onco.cc/technologies/exercise-prescription-after-cancer/)
- ideas: [A dose-finding trial for exercise after cancer](https://onco.cc/ideas/idea-nl-exercise-dose-finding/), [Give survivorship interventions a shared control arm](https://onco.cc/ideas/idea-rejuv-survivorship-platform-trial/)
- roadmaps: [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](https://onco.cc/roadmaps/rejuvenation-roadmap/)
- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/)
- fronts: [Recovery & Rejuvenation](https://onco.cc/fronts/rejuvenation/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)

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