New EU project aims to improve treatment of early colorectal cancer

The Early Colorectal Cancer: Patient-Targeted and Organ Preserving Treatment (ECOPOP) project has received NOK 75 million from the EU's HORIZON-HLTH-2024-DISEASE program.

"I am very pleased and quite excited about this," says Michael Bretthauer, project leader and Professor at the University of Oslo and the Department of transplantation medicine at Oslo University Hospital.

ECOPOP focuses on improving early-stage bowel cancer treatment.

"We aim to determine if new, less invasive treatment methods can be as effective as traditional surgery in treating bowel cancer," he explains.

Screening programs have greatly improved detection of colorectal cancer

Colorectal cancer is one of the most common cancers in Europe, and the second leading cause of cancer-related deaths.

"The introduction of current screening programs in most European countries has increased the detection of early-stage cancer. This provides various treatment possibilities and excellent prognosis for the patients," Bretthauer says.

Surgery may be too invasive for many patients

The current standard treatment for early-stage colorectal cancer is surgical tumour removal. During the procedure, the affected part of the bowel and nearby lymph nodes where cancer might spread are removed, then the intestine is repaired. This treatment requires hospitalization and anaesthesia and poses risks of complications, like infections or intestine suture failures.

"We question whether surgical treatment is overly invasive for many patients with early colorectal cancer, particularly for the growing number of elderly and frail patients," Bretthauer says.

Is colonoscopy a better treatment option?

The use of flexible endoscopy is expanding the technical possibilities of local tumour removal. The project aims to explore whether the use of colonoscopy makes it possible to avoid surgery and, thereby, improve patients’ quality of life.

"By this method, the tumour can be removed without taking out sections of the bowel and without requiring hospitalization or anaesthesia," he explains.

However, high-quality, long-term oncological outcome data of endoscopic removal as compared to surgery are lacking, and precise oncological risk criteria prior to the start of therapy are urgently needed.

Comparing colonoscopy and traditional surgery

ECOPOP will conduct three randomized studies comparing the new method with the current standard surgical treatment. These studies are the first of its kind worldwide.

"We assume that the new method is as effective as surgery and has fewer side effects and complications. The ECOPOP project will verify if our assumption is correct," Bretthauer states.

Do less invasive treatments have a lower carbon footprint?

Medical treatment significantly contributes to carbon emissions. The project will evaluate whether the two treatment types have differing carbon footprints.

"The hypothesis is that less invasive treatments will be better for the environment," the professor says. "In this randomized context, we aim to measure the environmental impact of this treatment," he adds.

This is a new and very progressive approach that has not been done before.

Mapping new biomarkers and the use of AI

The project also aims to identify new biomarkers that could be used prognostically for different patients.

"Are there biomolecular markers that can help differentiate patients needing surgery from those treatable with colonoscopy?" Bretthauer asks.

The researchers will develop AI-based software to collect and analyse images and videos taken during treatment.

"We aim to create software that assists doctors in assessing the best treatment for each patient," Bretthauer explains.

Prestigious project for the University of Oslo

Research Dean Jan Bjaalie expresses great satisfaction with the Institute for Clinical Medicine's role as host for the ECOPOP project:

"Coordinating an EU project showcases high competence, trust within the research community, and entrepreneurship. Coordinator roles provide international visibility and influence. The grant acknowledges the research group’s work and innovative plans”, he says.

Contact

• Michael Bretthauer

• Clinical Effectiveness Research