FOLICOLOR TRIAL: Following Therapy Response Through Liquid Biopsy in Metatstatic Colorectal Cancer Patients (FOLICOLOR)

The FOLICOLOR trial aims to evaluate whether a liquid biopsy-guided follow-up strategy can improve outcomes in patients with unresectable, metastatic colorectal cancer (mCRC) receiving first-line systemic treatment. The approach uses NPY methylation-based circulating tumor DNA (ctDNA) analysis from blood samples to monitor treatment response and guide clinical decision-making. Eligible patients are adults diagnosed with unresectable, metastatic colorectal cancer who are starting first-line treatment. The primary goal is to demonstrate a clinically meaningful benefit, particularly in terms of quality of life (QoL) and reduction of treatment-related toxicity, by allowing earlier and more personalized therapeutic adjustments based on liquid biopsy findings.

Study Overview

• Status: Recruiting
• Conditions: Advanced Colorectal Cancer
• Intervention / Treatment: Other: Evaluation therapy through Liquid Biopsy

Detailed Description

FOLICOLOR is a prospective, randomized, open-label, multicentric phase 3 study evaluating the clinical value of ctDNA-based liquid biopsy in the follow-up of patients receiving first-line therapy for metastatic colorectal cancer.

Patients with confirmed NPY methylation-based ctDNA positivity on an initial liquid biopsy sample will be randomized into two study arms:

• Control arm (CT arm): Treatment decisions are guided by radiographic evaluation using conventional CT scans.
• Study arm (LB arm): Treatment decisions are guided by serial liquid biopsy results.

All patients are followed per study protocol for 18 months from the time of inclusion.

Primary Objective:

To determine whether a liquid biopsy-guided follow-up strategy preserves quality of life (QoL) for longer, by enabling earlier detection of disease progression and more timely therapeutic adjustments, thereby reducing exposure to ineffective treatment and associated toxicity.

Secondary Objectives:

• To evaluate whether liquid biopsy allows earlier detection of progressive disease compared to conventional CT imaging (per RECIST 1.1 criteria).
• To assess time to progression and progression-free survival (PFS) in both the LB arm and CT arm, with progression defined as progressive disease (PD) per RECIST 1.1.
• To evaluate the difference in 3-year overall survival (OS) between both study arms.

• Study Type: Interventional
• Enrollment (Estimated): 150
• Phase: Phase 3

Contacts and Locations

• Study Contact: Name: Sanne Wouters; Phone Number: 003238212441; Email: sanne.wouters@uza.be
• Study Contact Backup: Name: Ayla Wyninckx; Phone Number: 003232759745; Email: ayla.wyninckx@uza.be

Study Locations

• Belgium
  • Antwerp
    • Brasschaat, Antwerp, Belgium, 2930
      • Recruiting
      • AZ Klina
    • Edegem, Antwerp, Belgium, 2650
      • Recruiting
      • University Hospital Antwerp
    • Wilrijk, Antwerp, Belgium, 2610
      • Recruiting
      • Sint-Augustinus (ZAS)
  • Antwerpen
    • Mechelen, Antwerpen, Belgium, 2800
      • Recruiting
      • Az Sint Maarten
  • Henegouwen
    • Charleroi, Henegouwen, Belgium, 6020
      • Recruiting
      • Grand Hôpital de Charleroi
  • Oost-Vlaanderen
    • Ghent, Oost-Vlaanderen, Belgium, 9000
      • Recruiting
      • AZ Maria Middelares, Ghent
    • Sint-Niklaas, Oost-Vlaanderen, Belgium, 9100
      • Recruiting
      • Vitaz
  • West-Vlaanderen
    • Bruges, West-Vlaanderen, Belgium, 8000
      • Recruiting
      • AZ Sint Lucas, Brugge
    • Kortrijk, West-Vlaanderen, Belgium, 8500
      • Recruiting
      • AZ Groeninge, Kortrijk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Man or woman ≥ 18 years of age at the time the informed consent is obtained
• ECOG performance status of 0-2
• Histologically or cytologically confirmed adenocarcinoma of the colon or rectum in subjects with unresectable metastatic (M1) disease
• There should be at least 1 uni-dimensionally measurable (min. 10mm) using conventional crosssectional imaging techniques (CT or MRI scan). Lesion must not be chosen from a previously irradiated field, unlessnthere has been documented disease progression in that field after irradiation and prior to randomization. All sites of disease must be evaluated ≤ 28 days prior to randomization
• Adequate hematology, renal, hepatic and coagulation function (at treating physician's discretion)
• Adequate blood results for treatment (at treating physician's discretion)
• Starting a first line treatment

Exclusion Criteria:

• History of prior or concurrent central nervous system metastases
• History of other malignancy, except:

Malignancy treated with curative intent and with no known active disease present for ≥ 3 years prior to randomization and felt to be at low risk for recurrence by the treating physician.

Adequately treated non-melanomatous skin cancer or lentigo maligna without evidence of disease.

Adequately treated cervical carcinoma in situ without evidence of disease. Prostatic intraepithelial neoplasia without evidence of prostate cancer

• Prior chemotherapy or other systemic anticancer therapy for the treatment of metastatic colorectal carcinoma including but not limited to bevacizumab and anti-EGFR therapy (e.g. cetuximab, panitumumab, erlotinib, gefitinib, lapatinib)
• Prior adjuvant chemotherapy (including oxaliplatin therapy) or other adjuvant systemic anticancer therapy including but not limited to bevacizumab and anti-EGFR therapy (e.g. cetuximab, panitumumab, erlotinib, gefitinib, lapatinib) for the treatment of colorectal cancer ≤ 6 months prior to randomization with the following exceptions: Subjects may have received prior fluoropyrimidine therapy if administered solely for the purpose of radiosensitization for the adjuvant or neoadjuvant treatment of rectal cancer.
• Radiotherapy ≤ 14 days prior to randomization. Subjects must have recovered from all radiotherapy-related toxicities.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: CT arm; Treatment decision guided by radiographic evaluation following the standard of care of the treating hospital. (Control arm)
Experimental: Liquid Biopsy arm; Treatment decision guided by liquid biopsies. (intervention arm)	Other: Evaluation therapy through Liquid Biopsy; The LB arm is the intervention group where the evaluation of therapy is guided by Liquid Biopsy results

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time to Deterioration (TTD) in Quality of Life (QoL)	The primary objective of this study is to determine whether the technique of monitoring patients with liquid biopsies can ensure that patients experience a slower decline in their quality of life (and can therefore maintain a good quality of life for longer). This will be evaluated through the difference in time to deterioration (TTD) in Quality of Life (QoL) between patients in which follow-up is done based on the results of LBs (LB-arm) in comparison to the patients in which follow-up is done based on the conventional follow-up techniques (CT-arm). TTD is defined as time from randomization to the first decrease from baseline on the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life questionnaire (QLQ-CR29) summary score by at least 10 percent.	18 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Progression Free Survival (PFS)	To compare progresion free survival between the LB-arm and the CT-arm (progression is defined as PD on CT scan according to RECIST 1.1 criteria).	18 months
3 year overall survival	To evaluate the 3-year overall survival difference between both study arms.	3 year
Earlier detection of progressive disease with liquid biospies	The proportion of patients in which progressive disease can be detected earlier based on the results of liquid biopsies in comparison to conventional CT scans (with RECIST 1.1 measurements).	18 months

Collaborators and Investigators

• Sponsor: University Hospital, Antwerp
• Collaborators: Kom Op Tegen Kanker
• Investigators: Principal Investigator: Timon Vandamme, University Hospital, Antwerp

Study record dates

Study Major Dates

• Study Start (Actual): August 16, 2021
• Primary Completion (Estimated): December 1, 2029
• Study Completion (Estimated): August 1, 2031

Study Registration Dates

• First Submitted: June 16, 2022
• First Submitted That Met QC Criteria: April 22, 2026
• First Posted (Actual): April 30, 2026

Study Record Updates

• Last Update Posted (Actual): April 30, 2026
• Last Update Submitted That Met QC Criteria: April 22, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Liquid Biopsy; NPY Methylation; advanced colorectal cancer patients
• Other Study ID Numbers: 20/04/040

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No