Submitted by Prof. George Ma... on Thu, 25/09/2025 - 18:09
“Sadly, the UK is the world leader for mesothelioma because we used too much asbestos and banned it far too late. Incidence is probably peaking now in the UK but we will continue to see cases for another generation” Professor Stefan Marciniak, University of Cambridge
Trials involving intra-pleural (IP) anti-cancer therapy for mesothelioma should be expanded, according to a recent paper published in the The Lancet.
The paper reviews previously published studies that involved treating mesothelioma patients with IP chemotherapy, and describes mesothelioma and the pleural space, the incidence of pleura-only mesothelioma and the role of systemic therapy and surgery in pleura-only mesothelioma. As well as reviewing evidence from historical studies, the paper highlights challenges and opportunities.
In it, the authors – including IRC member Professor Stefan Marciniak of the University of Cambridge – argue for more trials of IP chemotherapy in patients with early stage mesothelioma. Although current evidence supporting treatment at this stage is weak, this is because stage does not influence treatment decisions and so is often not recorded during diagnosis, skewing our picture of the potential value of treating patients earlier, they say.
Another reason for expanding trials in this area is that – thanks to progress made by the IRC in developing chemotherapy-loaded hydrogels to treat mesothelioma locally – is that new drug delivery vehicles are on the horizon.
As well as potentially extending survival times, currently around 18 months, such trials would give patients a much-needed alternative to simply watching and waiting.
There is a clear need to do better for patients with the hard-to-treat cancers that have been the IRC’s focus for the past six years. Despite being hard-to-treat, mesothelioma remains common in the UK. Some 2,500 people die of mesothelioma per year in the UK – more than the number of road traffic deaths – and 1 in 170 men born in the 1940s will die from mesothelioma.
“Sadly, the UK is the world leader for mesothelioma. That’s because we used too much asbestos and banned it far too late. Incidence is probably peaking now in the UK but there will be a very long tail, meaning we will continue to see cases for another generation,” says Professor Marciniak.
“One of the things that keeps me awake at night is that global consumption of asbestos is the same now as it was when the UK used it in the 1960s. Instead of the UK, however, it is being used in countries such as Brazil, Russia, India and China. This means that will be a huge amount of mesothelioma for the rest of the century.”
According to lead author Professor Kevin Blyth, who runs PREDICT-Meso, a group of expert mesothelioma researchers from across Europe: “The motivation for the article is to make the case that mesothelioma confined to the pleural space is more common than previously appreciated, that patients have few proven treatments in this setting and that intra-pleural trials have the potential to improve outcomes.
Reference: Kevin G Blyth et al., The Lancet, 2024
