Colorectal Cancer Metastasis – Shaping Anti-Tumor Immunity by Oxaliplatin

METIMMOX is the latest project undertaken by the Acredit Network. The study is looking into the possibility of supporting and stimulating the immune system during chemotherapy in patients whose cancer originated in the large bowel but has moved on to other organs of the body.

Due to an ageing population, colorectal cancer (cancers that start in the large bowel) is a common disease within our society today, and the number of cases diagnosed is growing every year. There are almost 4,300 new cases of colorectal cancer diagnosed in Norway each year, and of those new cases, about half will go on to suffer from cancer that moves from its original location to a site or sites somewhere else in the body (metastasis). Right now, there is no perfect treatment for patients suffering from colorectal cancer that has metastasised to many different places within their body. New therapies are being developed, and the METIMMOX trial is looking into how well one of these therapies works, an immune-boosting drug called nivolumab.

Using the Nordic FLOX regimen (a standard option for treating metastatic colorectal cancer in Norway today) as a foundation, the use of nivolumab to improve the effectiveness of the Nordic FLOX treatment will be tested. The Nordic FLOX treatment uses well-known chemotherapy drugs oxaliplatin (the OX in METIMMOX), 5-fluorouracil (5-FU) and Leukovorin (folinic acid) to interrupt the ability of cancer cells to reproduce; oxaliplatin and 5-fluorouracil act on the ability of the cell to create copies of themselves (replicate), and Leukovorin helps to boost the effect of the 5-fluorouracil, which reduces the number of cancer cells in the body through (when a cell dies, and another cell does not replace it). However, while this is an effective treatment method, some cancer cells are able to survive because the immune system sees them as normal cells, which can help cancer to progress (get worse). The METIMMOX study will look at whether the immune system can be helped in its mission to find and destroy more of the remaining cancer cells. Oxaliplatin is able to change the cancer from being made of cells that are easily missed by the immune system to being made of cells that are more easily identified by it. It is hoped that nivolumab will help the way oxaliplatin works by giving the immune system of patients a boost, helping the body to eliminate more of the cancerous cells.

To test the effectiveness and safety of nivolumab, the METIMMOX project will invite patients with metastatic colorectal cancer to take part in the study. The patients will be placed in one of two different groups. Neither the patients nor their doctors will know which arm of the study the patients will be placed in at the beginning of the study – a special computer program will decide which patients will receive either the standard treatment, or the standard treatment plus nivolumab. This is called randomisation, and it is an important part of medical research studies (read why randomisation is important here). The study accepted its first patient in May 2018 and will run until approximately December 2019, and is supported by funding from Bristol Myers Squibb, Norwegian Cancer Society, Helse Sør-Øst, University of Oslo, and Akershus University Hospital. The project is being managed by Anne Hansen Ree (Akershus University Hospital) and Kjersti Flatmark (Oslo University Hospital) in Oslo, Norway.


The participating hospitals are:


The METIMMOX project is supported through the kind assistance of: