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What is mesothelioma?
Mesothelioma grows in the mesothelium, the lining around the lungs, abdomen, and heart. About 80 percent of cases are pleural, around the lungs, causing shortness of breath, chest pain, and fluid buildup. Most of the rest are peritoneal, in the abdomen, causing swelling and digestive problems. Asbestos is the cause. Fibers lodge in these linings and do damage over decades, so most people are diagnosed in their 60s and 70s from work in construction, shipbuilding, manufacturing, or the military. Veterans are about 30 percent of US cases, and men are diagnosed four times as often as women. The EPA banned the last asbestos still in use in March 2024, but new cases will keep coming for decades.
The disease is aggressive and usually found late. Five year survival is about 12 percent for pleural disease, though peritoneal does better when surgery with heated chemotherapy in the abdomen is possible. Treatment has moved faster lately than in the previous half century. In 2020 an immunotherapy combination became the first new approval in 16 years, and in 2024 immunotherapy with chemotherapy was approved too. Trials now add surgery to immunotherapy, target mesothelin with engineered cells, and test PARP inhibitors in people with inherited BAP1 mutations. Our cancer treatment guide explains how immunotherapy works.
Is mesothelioma curable?
Rarely, and mainly in early stage or peritoneal disease treated with surgery. For most people it is treated to extend life and control symptoms. It is not always fatal in the short term: immunotherapy has produced long lasting responses in some people, and survival has improved since 2020 after decades without progress.
Types of mesothelioma clinical trials
Immunotherapy trials. New combinations of checkpoint inhibitors, immunotherapy given before surgery, and studies for people whose disease progressed after the approved immune treatments.
Mesothelin targeted trials. CAR T cells, antibody drug conjugates, and immunotoxins aimed at mesothelin, a protein on most mesothelioma cells, many in early phase and open only at a few centers.
Surgery and multimodality trials. Studies combining surgery with chemotherapy, radiation, or immunotherapy for pleural disease, and refinements of heated intraperitoneal chemotherapy for peritoneal disease.
Targeted therapy trials. PARP inhibitors for people with BAP1 and other DNA repair mutations, and drugs aimed at pathways such as MTAP loss or YAP/TEAD that are common in mesothelioma.
Supportive and monitoring studies. Managing fluid buildup, protecting the kidneys during heated chemotherapy, and breath analysis tools to track response.
Genetics and exposure studies. Research on inherited BAP1 mutations, which raise mesothelioma risk and can affect whole families, and on why some exposed people develop the disease and others do not.
Mesothelioma is often confused with lung cancer, which asbestos also causes but which starts inside the lung rather than its lining. New to research? Read how clinical trials for cancer work.
Who can participate in mesothelioma clinical trials?
Most trials enroll adults with a confirmed diagnosis of pleural or peritoneal mesothelioma, usually specifying the site and often the cell type: epithelioid, the most common and most treatable, or sarcomatoid and biphasic, which behave more aggressively and are sometimes studied separately. First line trials want people who have not yet started treatment; others require progression after chemotherapy or immunotherapy. Mesothelin targeted studies require a tumor test showing the protein, and some CAR T trials require a specific HLA type. Surgical trials require a tumor judged resectable. Because the disease is rare, many studies accept people from across the country and help with travel. Family members of people with inherited BAP1 mutations may qualify for genetic studies. Eligibility always varies by study.
The stages of mesothelioma, and why they matter for trials
Pleural mesothelioma is staged I to IV by how far it has spread within the chest and beyond; peritoneal mesothelioma is more often described by how much of the abdominal lining is involved and whether it can be surgically removed.
Stage I and II. Confined to the lining and nearby tissue on one side. Surgery may be an option, and trials test immunotherapy before or after it.
Stage III. Spread into the chest wall, diaphragm, or lymph nodes. Some people are still surgical candidates; trials test multimodality treatment.
Stage IV. Spread to distant organs or the other side of the chest. Treated with systemic therapy, and where most drug trials, including immunotherapy combinations and mesothelin targeted studies, recruit.
Study titles say "pleural" or "peritoneal," "resectable" or "unresectable," and often "epithelioid" or "after platinum chemotherapy." Your site, cell type, and prior treatment tell you at a glance which studies fit.
How to enroll in a mesothelioma clinical trial
Identify your trial. Use the filters. Titles specify pleural or peritoneal, resectable or not, and the line of treatment. With a rare cancer, apply to every study that fits and consider sites beyond your city.
Select your preferred location. Enter your city or state, then widen the radius; mesothelioma programs are concentrated at a limited number of cancer centers, and many sponsors cover travel.
Explore study details. Click "Learn More" for eligibility, including cell type, prior treatments, whether a mesothelin or HLA test is needed, and the visit schedule.
Complete the health profile. Click "Get started" to begin the 5-step application. Have three things ready: whether your mesothelioma is pleural or peritoneal and its cell type, the treatments you have had and how the disease responded, and any genetic test results including BAP1.
Submit the application. A clinical trial coordinator reviews it and contacts you. Nothing is decided until informed consent, and participation is voluntary at every step.