Across 196 colorectal cancer Phase II–III trials authorized in 2024–2026, site activity is concentrated in a small group of high-throughput oncology centers and mature Western European trial networks. Phase II accounts for 128 of 196 trials (65.3%), while Phase III accounts for 68 trials (34.7%), showing that the colorectal development landscape is weighted toward expansion, signal-confirmation, and biomarker-defined programs rather than only large confirmatory studies.
Of 196 included colorectal cancer trials, 128 were Phase II (65.3%) and 68 were Phase III (34.7%). The largest annual cohort was 2024, with 134 of 196 trials (68.4%), followed by 42 trials in 2025 (21.4%) and 20 trials in 2026 (10.2%).
The site landscape is shaped more by Phase II access than by Phase III scale alone. For sponsors, this means the most strategically valuable colorectal sites are not only high-volume enrollment centers, but centers repeatedly selected for early signal expansion, molecular selection, and multi-country oncology execution.
The top 10 recurring sites are dominated by France, Spain, Belgium, Germany, Austria and Italy. Institut Gustave Roussy ranked highest with 12 trial appearances, followed by Centre Léon Bérard with 11 and Institut Bergonié with 9.
| Rank | Site | Country | Appearances |
|---|---|---|---|
| 1 | Institut Gustave Roussy | France | 12 |
| 2 | Centre Léon Bérard | France | 11 |
| 3 | Institut Bergonié | France | 9 |
| 4 | Hospital Universitari Vall d’Hebron | Spain | 8 |
| 5 | Institut Jules Bordet | Belgium | 7 |
| 6 | National Center for Tumor Diseases Heidelberg | Germany | 6 |
| 7 | Charité Universitätsmedizin Berlin | Germany | 5 |
| 8 | Hospital Universitario Ramón y Cajal | Spain | 5 |
| 9 | Medical University of Vienna | Austria | 5 |
| 10 | European Institute of Oncology | Italy | 5 |
The recurring-site pattern identifies a European colorectal cancer network anchored by French comprehensive cancer centers, Spanish academic oncology hospitals, and selected German, Belgian, Austrian and Italian centers. These sites appear repeatedly because they can support complex oncology protocols, biomarker-selected populations, and multi-arm development programs.
The highest country-level activity clustered in France, Spain, Italy and Germany. Together, the four countries represented 438 of 780 site-country placements (56.2%), making them the core operational geography for colorectal cancer Phase II–III execution.
The country pattern shows a two-layer network: large Western European oncology markets provide the backbone, while Belgium, Poland, Romania, Czechia, Sweden and the Netherlands add recruitment diversity and geographic reach.
Among country records with participant targets, the top six countries accounted for 2,872 of 4,780 planned participants (60.1%). France led with 718 participants (15.0%), followed by Spain with 612 (12.8%), Italy with 580 (12.1%), Germany with 420 (8.8%), Poland with 287 (6.0%) and Sweden with 255 (5.3%).
Large country allocations do not always mean the same operational model. France and Spain combine high-volume academic oncology sites with repeated early-phase participation, while Italy and Germany contribute broader multi-site national coverage.
Metastatic colorectal cancer appeared in 132 of 196 trials (67.3%), making it the dominant disease context. Biomarker-defined or molecularly selected colorectal cancer represented 41 of 196 trials (20.9%), while localized, adjuvant, surgical, or post-surgical colorectal settings represented 23 trials (11.7%).
The top colorectal trial sites are mainly being selected for metastatic and molecularly segmented programs. This favors centers with gastrointestinal oncology specialization, access to molecular testing, and the ability to route patients into narrow protocol-defined subgroups.
CRC means colorectal cancer. Phase II refers to trials primarily designed for dose expansion, activity, efficacy signal or regimen optimization. Phase III refers to larger confirmatory comparative trials. Site appearance means a named institution appearing in a trial geography site list. Site-country placement means a country-level site allocation within a trial record.