The pleural team at North Bristol NHS Trust are contributing to several national mesothelioma trials. The trials cover a range of treatments, from surgery to novel treatments, and the team endeavour to offer all patients the option to participate in research if they wish to.

The trials that are currently underway at North Bristol include (those marked with a star reflect trials for which North Bristol is the lead centre):

• ASSESS-meso*
This is a simple study which aims to understand more about mesothelioma and how it progresses by gathering information on patients as they undergo routine care. The research team are collecting information from blood tests, chest x-rays, CT scans and samples of fluid (e.g. age, sex, amount of previous asbestos exposure) to see if they can find out more about mesothelioma, including things like why it is so aggressive in some people and not others, why some patients respond really well to chemotherapy and others don’t, and whether there are any new tests that might help predict life-expectancy. The researchers are also interested in learning about symptoms and how they change or develop over time.

ASSESS-meso is supported by a grant from the Avon Mesothelioma Foundation, and is an example of how donations to the charity are put to good use.

This is a trial of two novel immune-stimulating medicines in patients who are not receiving chemotherapy. Patients are randomly allocated to receive either usual care or one of two types of bacterial agent squirted down their pleural catheter. The two bacterial agents (which are called OK432 and BCG) contain bugs that have been killed or modified to reduce the risk of active infection. Instead, it is hoped that the bugs will stimulate the immune system and attract protective immune cells to the area around the lung, where they will then be able to attack the mesothelioma tumour. The aim of TILT is to find out whether these agents are safe to use in this way, and whether people are willing to receive them.

TILT is supported by a grant from the National Institute of Health research, awarded to Dr Anna Bibby.

We know from previous research that a big operation to remove the whole lung and part of the chest wall (called extra-pleural pneumonectomy or EPP) is not a good treatment for mesothelioma. We also know that a smaller operation that strips away part the affected lung lining (called partial pleurectomy, or PP) also does not extend survival in mesothelioma. The final surgical option is a mid-sized operation that removes the lung lining and the diaphragm if it is involved, or any other areas that are involved (called extended pleurectomy decortication, or EPD). At the moment we don’t know whether EPD may help people live longer with mesothelioma.

MARS2 is aiming to find out whether EPD is an effective treatment for mesothelioma. People with early stage tumours are allocated to either receive surgery or not. As well as looking at overall survival, the trial is looking at the rate of complications and quality of life following surgery.

The team at North Bristol are also able to refer patients to other hospitals for consideration of clinical trials. Patients from Bristol have travelled to London, Leicester and Cardiff in the past to join trials that are not currently running in Bristol. Two current trials that you could be referred for are:
This is a trial of a new immunotherapy drug – a checkpoint inhibitor called Nivolumab, in patients whose tumours have progressed or relapsed following previous chemotherapy. Two thirds of people in the trial will receive Nivolumab, and one third will receive placebo. The closest centre for this trial is Cardiff.

• ATOMIC-meso
This is a trial of a new treatment in patients with a specific type of mesothelioma tumour – either “sarcomatoid” or “biphasic” sub-type. The trial is investigating whether a drug called ADI-PEG20, used alongside standard chemotherapy, can help people live longer. Half of people in the trial receive ADI-PEG20 plus chemotherapy and half receive placebo plus chemotherapy. To participate in theis trial people need to travel to London, but we hope it will soon be running in Bristol.

• Meso-Origins
Benign Asbestos Pleural Effusion (BAPE) is a non-cancerous condition associated with asbestos exposure. Many patients diagnosed with BAPE are subsequently diagnosed with mesothelioma. It is not currently known what triggers the change from benign pleural inflammation to mesothelioma.

The Meso-ORIGINS study aims to explore this by performing 2 years of surveillance of people diagnosed with BAPE, collecting measurements from repeat pleural fluid and biopsy samples, repeat blood tests and scans. The researchers hope that the information from this study will lead onto a much larger study that will definitively clarify the relationship between BAPE and mesothelioma.

Meso-Origins is funded by a grant from the June Hancock Mesothelioma Research Fund.

• MesoTRAP
Some patients with mesothelioma experience fluid building up around the outside of their lungs. Usually when the fluid is removed, the lung that had been squashed by the fluid reinflates, and air can move in and out of it as usual, making the person less breathless. However, in some people, the lung does not reinflate, even after the fluid has been removed. This is usually because the mesothelioma tumour has grown around the outside of the lung and is preventing it from re-expanding. This condition is called “trapped lung”.

Meso-trap is a trial in which people with trapped lung are randomly allocated to receive surgery to release the trapped lung, or an indwelling pleural catheter to drain the fluid as it builds up. Because we don’t currently know how many people with mesothelioma have trapped lung, the aim of MesoTRAP is to collect this information in order to plan a larger trial. MesoTRAP will also investigate whether it is possible to recruit people to a trial that compares a surgical operation with a non-surgical option.

This is an exciting time for mesothelioma research, with lots of different trials on the horizon. The national mesothelioma charity, MesotheliomaUK, keeps an up-to-date list of all current mesothelioma trials, with some information about each trial. This is available here.

Your doctor will be happy to discuss any of these trials with you, and will be able to refer you to the relevant hospital for further discussion if it is appropriate.

Mesothelioma UK offers financial support to help patients and family members travel to other hospitals to discuss research or participate in trials. For more information on this, please contact MesotheliomaUK.