The Excalibur-project is studying new treatment modalities, and strategies,
for patients with colorectal livermetastases and heavy tumour burden.

The Excalibur-project

The Excalibur-project explores new treatment options for patients with colorectal-livermetastases and heavy tumour burden in need for next line chemotherapy. Designed to encompass the heterogenicity of this patient population our three RCT`s range from the unresectable, liver only disease to the resectable patients with extensive extrahepatic disease.

Standard of care for these patients today is next line chemotherapy. In the Excalibur-project we are studying three more treatment-options being Liver-Tx, HAI-Floxuridine, aggressive liver resection, compared to the standard of care alone.

The Excalibur-project consists of three RCT`s, EXCALIBUR 1-3, where 1 and 2 are for the unresectable patients and 3 is for the resectable.

Already established as a valuable treatment-option, Liver-Tx has been reserved for the few, highly selected patients with advantageous tumor-biology. Our RCT EXCALIBUR1 is studying the role of Liver-TX in patients with aggressive tumor-biology. Also allowing for slight extrahepatic disease and RAS-mutations we are studying Liver-TX as a treatment option in patients with much worse prognosis than previously studied.

HAI-Floxuridine is well-established in both the adjuvant and neoadjuvant setting in the US through the pioneering work of Memorial Sloan Kettering Cancer Center, New York. Although it has yet to gain foothold outside of the US. Logically based on the idea that liver-metastases have predominantly arterial blood-supply and Floxuridine a 100% firstpass metabolism in liver. Hepatic Artery Infusion therapy with Floxuridine should increase effectiveness of chemotherapy measured by RECIST, overall survival and possibly convert more patients to resection compared to systemic chemotherapy alone. At the same time being safe and well tolerated.

The role of liver-resections for patients with extensive extra-hepatic disease is unclear although benefits in OS with an aggressive resection-strategy have been published. The grey zone between when we should, and when we shouldn`t, operate is unchartered and remains a conundrum in everyday medical practice.

Aiming to establish better treatment options for these patients with a current dismal prognosis the study-group, lead by Dr Kristoffer Lassen and Dr Svein Dueland, designed the EXCALIBUR-studies and started inclusion summer 2021 sponsored by Oslo University Hospital and South-Eastern Norway Regional Health Authority.

Based at Oslo University Hospital Rikshospitalet the EXCALIBUR-studies allow nationwide participance and possibility for international multicentre collaboration. With great support and mentoring from Erasmus Medical Centre Rotterdam the studies have been launched safely.

We sincerely hope our research will support the development of better treatment-options for patients with colorectal-livermetastases and heavy tumour burden.

On behalf of the study-group.

Dr. John Christian Fischer Glent MD.