Multinational phase 2-3 trial of addition of pegargiminase to first-line chemotherapy for nonepithelioid pleural mesothelioma

Nonepithelioid pleural mesothelioma is an arginine-auxotrophic tumor. The multinational phase 2-3 ATOMIC-Meso trial evaluated addition of (arginine deprivating) pegargiminase or placebo to first-line chemotherapy for nonepithelioid pleural mesothelioma. The median overall survival (primary end point) was 9.3 months with pegargiminase-chemotherapy versus 7.7 months with placebo-chemotherapy (HR 0.71; p=0.02), and the median progression-free survival was 6.2 months with pegargiminase-chemotherapy versus 5.6 months with placebo-chemotherapy (HR 0.65; p=0.02). Grade 3 or 4 adverse events were seen in 28.8% of patients with pegargiminase-chemotherapy and 16.9% of patients with placebo-chemotherapy. The authors conclude that addition of pergargiminase to first-line chemotherapy for nonepithelioid pleural mesothelioma was associated with significant improvement of overall and progression-free survival, with a favorable safety profile.