Mesothelioma Clinical Trials

About Mesothelioma trials

Trial selection in mesothelioma depends first on anatomic site (pleural, peritoneal, pericardial), histologic subtype (epithelioid, biphasic, or sarcomatoid), and BAP1 status. BAP1 mutations are present in 50-60% of pleural mesothelioma (both germline and somatic) and define a clinically meaningful subset; germline BAP1 mutations also identify the BAP1 tumor predisposition syndrome, which gates additional trial considerations and hereditary cancer screening. NF2 alterations occur in 30-40% of mesothelioma and drive Hippo pathway dysregulation, which gates trials of Hippo / YAP-targeted agents. CDKN2A loss is the most common alteration (60-70%) and contributes to molecular classification rather than direct trial gating. TP53 mutations are less common in mesothelioma than in many solid tumors but provide context for combination and resistance trials.

Recruiting trials in mesothelioma organize along site, histology, and treatment line. Front-line metastatic pleural mesothelioma trials test additions to or alternatives to nivolumab + ipilimumab (the CheckMate 743 standard for non-epithelioid disease) and cisplatin / carboplatin + pemetrexed combinations (with or without IO) for epithelioid disease. Locally advanced and resectable trials test multimodality strategies combining surgery (pleurectomy / decortication or extrapleural pneumonectomy), chemotherapy, and radiation, with neoadjuvant IO an emerging area. Tumor-treating fields (TTFields) trials test combinations of TTFields with chemotherapy or IO. BAP1-deficient trials are an active space testing PARP inhibitors and EZH2 inhibitors based on synthetic lethality with BAP1 loss; tazemetostat trials specifically enroll BAP1-mutant patients. Peritoneal mesothelioma trials are typically separate from pleural, often involving cytoreductive surgery + hyperthermic intraperitoneal chemotherapy (HIPEC). Asbestos-exposure-based prevention and early-detection trials enroll high-risk individuals separate from established disease.

Beyond biomarkers, mesothelioma trial eligibility depends on anatomic site, histology, and prior platinum and IO exposure. Anatomic site (pleural vs peritoneal vs pericardial vs tunica vaginalis) gates most trials. Histologic subtype (epithelioid, biphasic, sarcomatoid, or desmoplastic) determines which trial set applies and significantly affects prognosis. Stage and resectability gate trials by treatment intent. Prior platinum + pemetrexed exposure is the standard front-line for epithelioid mesothelioma, and most R/R trials are line-defined relative to it. Prior IO exposure for IO-pretreated trials. Prior surgical resection (pleurectomy / decortication or extrapleural pneumonectomy) and time since surgery for trials testing post-operative therapies. BAP1 status (germline or somatic) for BAP1-targeted trials. Performance status, with most trials accepting ECOG 0-1. Pulmonary function tests are screened on most pleural mesothelioma trials because pleural disease and prior surgery often impact lung function; some trials require minimum FEV1 or DLCO.

Biomarkers tested in Mesothelioma trials

These are the molecular markers most commonly required or evaluated in Mesothelioma eligibility criteria. OncoMatch extracts them from each trial's protocol and matches them against your test results.