Mesothelioma is an aggressive and rare form of cancer which develops in the lining of the heart, lungs, or abdomen. Exposure to asbestos is the primary cause of the disease. The inhalation or swallowing of asbestos leads to an accumulation in the lining of the lungs or the abdomen, causing damage to the tissue. This, in turn, leads to damage to the cells’ DNA, and uncontrolled cell growth.

Key Takeaways

• Datamonitor Healthcare estimates that in 2019, there were 30,000 incident cases of mesothelioma in adults aged 40 years and older worldwide, and forecasts that number to increase to 33,900 incident cases by 2028.
• Oceania is estimated to have the highest disease incidence rate (9.90 per 100,000 males and 1.90 per 100,000 females), while Africa has the lowest incidence rate (0.47 per 100,000 males and 0.30 per 100,000 females).
• The approved drugs in the mesothelioma space target thymidylate synthase, the immune system, programmed death-1 receptor/programmed death ligands, and dihydrofolate reductase. All of the approved drugs are administered via the intravenous route.
• The majority of industry-sponsored drugs in active clinical development for mesothelioma are in Phase II. Therapies in the mesothelioma space focus on a wide variety of targets. The majority of drugs in development for mesothelioma are administered via the intravenous route, with the remainder being intramuscular, oral, intratumoral, percutaneous catheter/injection, and subcutaneous formulations.
• The only high-impact upcoming event for drugs in the mesothelioma space is topline Phase III trial results for Opdivo. The overall likelihood of approval of a Phase I mesothelioma asset is 5.9%, and the average probability a drug advances from Phase III is 33.3%. Drugs, on average, take 14.9 years from Phase I to approval, compared to 9.2 years in the overall oncology space.
• There have been six licensing and asset acquisition deals involving mesothelioma drugs during 2015–20. The $475m licensing agreement signed in 2017 between Calithera Biosciences and Incyte to research, develop, and commercialize Calithera’s CB1158 was the largest deal.
• The distribution of clinical trials across Phase I–IV indicates that the vast majority of trials for mesothelioma have been in the early and mid-phases of development, with 95% of trials in Phase I–II, and only 5% in Phase III–IV.
• The US has a substantial lead in the number of mesothelioma clinical trials globally. The UK leads the major European markets, while Japan has the top spot in Asia.
• Clinical trial activity in the mesothelioma space is dominated by completed trials. Eli Lilly has the highest number of completed clinical trials for mesothelioma, with 44 trials. Eli Lilly also leads industry sponsors with the highest overall number of clinical trials for mesothelioma.