For years, Nigerians diagnosed with a particularly stubborn form of colorectal cancer had few good options. A landmark clinical trial — the first of its kind in the country — is now trying to change that.
When doctors at the Lagos University Teaching Hospital, LUTH, began seeing a troubling pattern — younger patients, advanced tumours, and a subtype of colorectal cancer that barely flinched at conventional chemotherapy — they knew something had to give.
That reckoning has now produced a milestone. LUTH, in partnership with the MedServe Cancer Centre, has launched Nigeria’s first immunotherapy clinical trial for colorectal cancer, a development that researchers say signals not just a new treatment pathway for patients, but a fundamental shift in the country’s capacity to conduct world-class cancer research on home soil.
Colorectal Cancer is the third most diagnosed cancer globally and the second leading cause of cancer death worldwide, according to the World Health Organization. dMMR subtypes account for approximately 15% of all colorectal cancers.
It has long been regarded in global health circles as a disease of the affluent West — one associated with diet, aging, and sedentary lifestyles in high-income countries. Nigeria, and much of sub-Saharan Africa, were rarely part of that conversation.
That perception is now outdated.
“Colorectal cancer is increasingly affecting Nigerians, including younger patients,” said Prof. Abdul Kareem Fatimah, the trial’s Principal Investigator and a specialist in LUTH’s Department of Molecular and Anatomic Pathology. “A significant proportion of our patients have the mismatch repair–deficient subtype, which responds poorly to conventional chemotherapy but has shown promising results with immunotherapy in international studies.”
Also Read: WHO seeks global prevention of cancer scourge
Mismatch repair–deficient colorectal cancer — or dMMR CRC — is a genetically distinct subtype in which the cellular machinery that corrects errors in DNA replication is faulty. The result is a tumour that accumulates mutations rapidly, making it largely invisible to standard chemotherapy. But that same genetic instability, paradoxically, makes it highly recognisable to a primed immune system. That is precisely where immunotherapy steps in.
The science of immunotherapy is, in many ways, elegant in its logic. Cancer cells survive, in part, by exploiting a natural “off switch” in the immune system — a protein pathway known as PD-1 — to disguise themselves and evade destruction. Anti-PD-1 therapy essentially removes that disguise.
“Immunotherapy works by enabling the body’s immune system to recognize and attack cancer cells,” Prof. Fatimah explained. “The anti-PD-1 therapy removes the brake that prevents immune cells from destroying tumour cells.”
The trial, formally titled PD-1 Blockade in Mismatch Repair–Deficient Colorectal Cancer, will enrol 40 adult patients across two categories: those with metastatic colorectal cancer who have not yet received treatment, and those with localised stage II or III rectal cancer. It is designed as a pilot, open-label study — a first step toward generating Nigerian-specific evidence in a field that has, for too long, relied on data generated elsewhere.
Participants will be monitored through imaging, laboratory tests, and standardised clinical assessments throughout the course of the trial.
A Coalition Built for Impact
The trial does not stand alone. It is the product of an unusual convergence of institutional will, international partnership, and what its organisers describe as years of quiet, deliberate groundwork.
LUTH is conducting the study alongside the Obafemi Awolowo University Teaching Hospital, broadening the geographic and institutional reach of the research. On the international side, the Memorial Sloan Kettering Cancer Centre — one of the world’s leading cancer institutions — serves as both sponsor and data coordinating centre, lending the trial a rigorous scientific architecture. The African Research Group for Oncology and the Thompson Family Foundation in the United States provide additional support.
Prof. Wasiu Adeyemo, LUTH’s Chief Medical Director, said the significance of that coalition cannot be overstated.
“This launch represents the culmination of years of investment in infrastructure, training, and international collaboration,” he said. “LUTH now has the expertise and systems required to conduct cutting-edge clinical research that meets global standards.”
Safety, Access, and the Ethics of Inclusion
One of the persistent anxieties surrounding clinical trials in low- and middle-income countries concerns the protection of participants — whether safety standards are maintained, and whether patients, often desperate and financially constrained, are adequately protected from exploitation.
The LUTH-MedServe trial has sought to address those concerns directly. Dr. Eben Aje, Co-Principal Investigator and Director at MedServe Cancer Centre, was emphatic on the point.
“While immunotherapy can cause side effects, they are generally manageable and often less severe than those associated with traditional chemotherapy,” he said. “We have comprehensive safety protocols in place, and patient welfare remains our top priority.”
Critically, the medication will be provided at no cost to participants, and all enrolled patients will be insured for the entire duration of the trial — a provision that, in a country where out-of-pocket health expenditure remains among the highest in the world, is far from trivial.
The study has received dual ethical clearance — from the National Health Research Ethics Committee of Nigeria and from LUTH’s own Health Research Ethics Committee — underscoring the institutional seriousness with which patient protection has been approached.
More Than a Trial
Beyond the immediate question of whether the therapy works in Nigerian patients, those behind the trial are candid about what they hope it seeds.
Nigeria has the largest population in Africa, a growing cancer burden, and a research ecosystem that has historically been better at consuming foreign evidence than producing its own. A successful immunotherapy trial — one that meets international standards, generates publishable data, and demonstrates replicability — could shift that dynamic.
For the patients who will walk through LUTH’s doors to enrol in the coming months, the stakes are, of course, far more personal. They come carrying diagnoses that, until now, offered them truly little. What they are being offered instead is a chance — monitored, insured, and supported by some of the best cancer research infrastructure in the world — to be at the frontier.
In Nigeria, that frontier has just moved.
