NRG-GI004/SWOG-S1610


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About This Study

NRG-GI004/SWOG-S1610 is a clinical trial that is studying two treatment options for patients with colorectal cancer that has spread to other parts of their body (metastatic). This study is specifically for patients who have a particular type of metastatic colorectal cancer called “MSI-high” or “DNA repair deficient” (these two terms are sometimes used to describe the same thing). This can be learned by doing a specific test on a small piece of the cancer that was used to diagnose the colorectal cancer. For patients with this type of colorectal cancer, doctors know that new medicines may help the patient’s own immune system attack the cancer and this treatment has become a standard. However, these immune system treatments do not work for every “MSI-high” or “DNA repair deficient” metastatic colorectal cancer patient and traditional chemotherapy remains needed for many. This study is trying to answer the question of whether adding traditional chemotherapy and biologic treatment to immunotherapy improves the efficacy compared to immunotherapy alone. Therefore, patients in this study will be randomly assigned to receive one of two treatment options: immunotherapy (using the drug atezolizumab) alone or the same immunotherapy in combination with the chemotherapy and biologic treatment - frequently used for this type of cancer at later lines of therapy - when immunotherapy doesn’t work.

If you agree to take part in this study, you will also have the opportunity to participate in optional sample collections for use of your blood and tumor samples in possible future research studies. An additional sample of tumor tissue from your previous biopsy or surgery and blood samples will be collected if you choose to participate in the sample collection. Researchers use these samples to help them learn more about your cancer, using blood and tissue to find new ways to prevent, detect, treat, or cure cancer. 


Quick Information

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Want more information?

Additional information for the NRG Oncology GI004 trial can be found in the Patient Study Brochure

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Am I eligible for this study?

Men or women may be able to participate if they have colorectal cancer that is known to have a specific alteration that may or may not be hereditary (MSI-high/DNA mismatch repair deficient), has spread to other parts of their body (metastatic), and they have not yet received treatment for their metastatic colorectal cancer. Your healthcare team is the best source for information about your treatment options, including cancer clinical trials. Be sure to take this information to your doctor to discuss your questions and concerns in general and specific to NRG-GI004.

Are there other studies for which I might be eligible?

Please talk to your healthcare team to see if there are other clinical studies for which you may be a good fit. Click here if you would like to view a more detailed chart of other studies available.
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Frequently Asked Questions

Below, you can find FAQs about clinical research and this particular clinical trial.

NRG-GI004/SWOG-S1610 FAQ

Men or women may be able to participate if they have colorectal cancer that is known to have a specific alteration that may or may not be hereditary (MSI-high/DNA mismatch repair deficient), has spread to other parts of their body (metastatic), and they have not yet received treatment for their metastatic colorectal cancer. Your healthcare team is the best source for information about your treatment options, including cancer clinical trials. Be sure to take this information to your doctor to discuss your questions and concerns in general and specific to this trial.
Immunotherapy is a standard first-line treatment for MSI-high/DNA mismatch repair deficient metastatic colorectal cancer.This study is trying to answer the question of whether adding chemotherapy FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) and bevacizumab (biologic therapy routinely added to FOLFOX) to immunotherapy (atezolizumab) treatment improves efficacy compared to atezolizumab alone.

Patients in this study will be randomly assigned to receive one of these two treatment options.
All patients will be randomly assigned to one of two groups in the study. Group 2 will receive immunotherapy alone with atezolizumab. Group 3 will receive the same immunotherapy with FOLFOX and bevacizumab. The type of chemotherapy you will receive is a combination called FOLFOX which includes 5-fluorouracil (5-FU), leucovorin, and oxaliplatin. Bevacizumab, a biologic therapy, is routinely added to FOLFOX. NOTE: there was previously a Group 1 in this study who did receive FOLFOX and bevacizumab chemotherapy and no atezolizumab. This treatment group is no longer an option.
Patients with metastatic colorectal cancer which is MSI-high/DNA repair deficient who are not in a research study are usually treated with immunotherapy. The Food and Drug Administration (FDA)-approved immunotherapy with pembrolizumab for the first-line treatment of patients with unresectable or metastatic MSI-high/DNA mismatch repair deficient colorectal cancer
If you choose to take part in this study, there is a risk that:

  • You may lose time at work or home and spend more time in the hospital or doctor’s office than usual.
  • You may be asked sensitive or private questions which you normally do not discuss.
  • There is a risk someone could get access to the personal information in your medical records or other information researchers have kept about you.  Someone might be able to trace this information back to you.  The researchers believe the chance that someone will identify you is very small, but the risk may change in the future as people come up with new ways of tracing information. In some cases, this information could be used to make it harder for you to get or keep a job.  
  • Adding FOLFOX and bevacizumab to atezolizumab for this type of cancer may not be better than atezolizumab alone, and could possibly be worse, than the standard immunotherapy alone for your cancer.  
FOLFOX, bevacizumab, and atezolizumab may cause side effects. Your doctor will review all of the potential side effects with you. It is important to tell your doctor about any side effects during the study so that they may be treated and so that potential adjustments to the study drugs may be made.
It is not possible to know if adding chemotherapy and biologic treatment to the standard immunotherapy treatment is better than immunotherapy alone, so this study may or may not help you.  However, all of these treatments are commonly used for patients with this disease.  This study will help researchers learn things that may help future patients with this type of cancer.
You will receive atezolizumab (Group 2) or atezolizumab with 5-FU, leucovorin, oxaliplatin and bevacizumab (Group 3). If you are in Group 3, for as long as you continue to benefit or as long as your doctors think it is safe to keep you on therapy, you will continue on treatment with 5-FU, leucovorin, and bevacizumab. Oxaliplatin will continue up to a total of 10 cycles in this group. 

In either group, you will receive atezolizumab for up to 2 years. 

If you stop study treatment for any reason, your study doctor will see you about 1 month after you stop to check for any side effects that you may be having. If your cancer has not progressed (grown) at the time you stop study treatment, you will continue to have scans until your cancer grows or until you begin another treatment for your cancer.  After that, the researchers who are conducting this study would like to know how you are doing about every 6 months from the time you stop study therapy through about 5 years from when you joined the study.  This can be done at a visit to your study doctor or by a phone call from your study team.
No. Taking part in this study is voluntary. You are free to choose to participate or not to participate. If you choose to participate in this study, you are able to leave the study at any time. If you decide not to take part in this study, your doctor will discuss other treatment options with you.
Atezolizumab will be supplied at no charge while you take part in this study.  It is possible that atezolizumab may not continue to be supplied while you are on the study. Although not likely, if this occurs, your study doctor will talk to you about your options.

Neither you nor your health care plan/insurance carrier will be billed for the collection and shipping of blood or tumor samples associated with this study. 


You and/or your health plan/insurance company will need to pay for all of the other costs of treating your cancer while in this study, including the cost of the other standard treatment drugs, 5-fluorouracil, leucovorin, oxaliplatin, and bevacizumab and the cost of getting the IV drugs ready and giving them to you, the cost of tests and procedures, and the cost of managing any side effects. Before you decide to be in the study, you should check with your health plan or insurance company to find out exactly what they will pay for. 

You will not be paid for taking part in this study.
Your privacy is very important to us and the researchers will make every effort to protect it. Your information may be given out if required by law. For example, certain states require doctors to report to health boards if they find a disease like tuberculosis. However, the researchers will do their best to make sure that any information that is released will not identify you. Some of your health information and/or information about your specimens from this study will be kept in a central database for research. Your name or contact information will not be put in the database.

There are organizations that may inspect your records. These organizations are required to make sure your information is kept private, unless required by law to provide information. Some of these organizations are:

  • The study sponsors, NRG Oncology and SWOG, and Genentech or any other drug company supporting the study
  • Alliance for Clinical Trials in Oncology and ECOG-ACRIN Cancer Research Group
  • The Institutional Review Board, IRB, is a group of people who review the research with the goal of protecting the people who take part in the study.
  • The Food and Drug Administration and the National Cancer Institute (and its agents) in the U.S.

Clinical Studies FAQ

Doctors and researchers conduct a clinical study, also called a “clinical trial”, to find better ways to prevent, diagnose, or treat an illness. NRG Oncology is supported by the National Cancer Institute and runs clinical studies specifically for patients with cancer or to prevent cancer. Most clinical studies test something we know against something we don’t know. In all situations, these studies are strictly evaluated before they are allowed to be offered to any patient. The study is designed to answer the question that we do not know the answer to, so that current and future patients may have better treatments or information than what we currently have. There are different types of clinical studies that might be available for patients. For more information see “Types of Clinical Trials” and “Phases of Clinical Trials”. 


Patients who volunteer to take part in a clinical study are followed closely by their health care professionals and members of the research team. For more information see “Research Team Members”.
Yes. They are exactly the same thing.
The care cancer doctors provide to cancer patients today is the direct result of clinical studies (also known as clinical trials) that were done in the past. Clinical studies give doctors and the treatment team information about what types of treatments work and what treatments do not work, in a number of different situations. Some studies focus on treating the cancer, others on preventing the cancer, and others on helping patients feel better or healthier during or after treatments. When you take part in a clinical study, you add to our knowledge about cancer and it may help improve cancer care for future patients. Clinical studies are available to patients with many types of cancer and at all stages of treatment. In some situations, the only way to get these new treatments is by joining a clinical study.
A clinical study may take place in many locations, such as:

  • physician offices
  • hospitals
  • clinics


  • A study is typically led by a principal investigator who is a doctor or other advanced health care professional. A clinical study is carried out by following a very specific plan known as the “protocol”. The protocol is designed so all patients in the study are treated as well as possible and in the same way. The protocol also provides rules for the doctors and clinical study staff to follow to keep patients safe and make sure the study is run in an ethical manner.
    No, not at all. Participation in a clinical study is completely voluntary. For more information see “Deciding to Take Part in a Clinical Trial”. You are free to choose to participate or not to participate. If you choose to participate in a study, you may still decide to leave the study at any time. If you decide not to participate in a study, your doctor will discuss other treatment options with you. For more information see “Questions to Ask Your Doctor about Treatment Clinical Trials".

    If you decide not to take part in a clinical study, you still have other choices. Talk to your doctor about your other choices.For example:

    • You may choose to have the usual treatment approach (known as “standard of care”)
    • You may choose to take part or learn more about a different study, if one is available
    • You may choose not to be treated for cancer

    About NRG Oncology

    At NRG Oncology, we focus on conducting clinical studies aimed to improve current cancer care practices and the lives of cancer patients. NRG Oncology partners with more than 1,300 member sites world-wide to research ways to improve treatment standards in the cancer community. Our organization is supported primarily through grants from the National Cancer Institute (NCI) and is one of five research groups in the NCI's National Clinical Trial's Network.

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