Pegargiminase (ADI-PEG20) for Mesothelioma

Is Pegargiminase a Breakthrough New Treatment for Mesothelioma?

Yes, some doctors have called pegargiminase a breakthrough treatment for mesothelioma because of its ability to increase overall survival rates and prevent the cancer from progressing.

In a clinical trial of nearly 250 mesothelioma patients, those who received pegargiminase combined with chemotherapy had a median overall survival of 9.3 months compared to 7.7 months for those receiving the placebo combined with chemotherapy.

Some cancer researchers believe pegargiminase could be the first drug of its kind to be effectively combined with chemotherapy in 20 years.

Key Facts on Pegargiminase (ADI-PEG20) for Mesothelioma

• Type of treatment: Enzyme-based cancer drug
• Common side effects: Fatigue, nausea, constipation, and tenderness at injection site
• How it works: By depleting the body of the amino acid arginine, which cancer cells need to grow
• Combined treatments: Chemotherapy drugs, specifically pemetrexed with cisplatin or carboplatin

How Pegargiminase Treats Mesothelioma Cancer

Scientists recently discovered that mesothelioma cells need a lot of arginine (a type of protein) to grow. Pegargiminase is able to break down this food supply, essentially starving the cancer cells.

It does this in two ways:

1. Depleting Arginine

Pegargiminase works by depleting the amino acid arginine, and is very effective in cases of mesothelioma that are deficient in argininosuccinate synthetase (ASS1).

Because people with non-epithelioid mesothelioma are considered to have around three times the amount of tumoral ASS1 deficiency, this treatment method is particularly effective on this subtype.

2. Sensitizing Cancer Cells

Through arginine deprivation, pegargiminase makes cancer cells more sensitive to chemotherapy.

This makes chemotherapy effective in targeting and destroying mesothelioma cells. For this reason, pegargiminase is more beneficial when combined with chemotherapy as opposed to being used on its own.

Get our Free Mesothelioma Guide to learn more about chemotherapy, emerging treatments, and how our team can help you access the best medical care.

Benefits of Pegargiminase for Mesothelioma

One of the main potential benefits of pegargiminase for mesothelioma is its ability to help patients live longer. This is a huge advancement, as some types and stages of mesothelioma cancer have life expectancies as few as 6 months without treatment.

Another benefit of pegargiminase is that it causes few and only typically mild side effects and is considered safe for patients with all stages of mesothelioma.

Clinical Research & Results for Pegargiminase Mesothelioma Treatment

The most recent and significant results for pegargiminase came from the ATOMIC-Meso Clinical Trial, which was led by Professor Peter W. Szlosarek of the Barts Cancer Institute in London.

This ADI-PEG 20 clinical trial began in 2018 and was based on extensive cancer research that took place over 20 years. Phases 2 and 3 of the trial took place from August 2017 to August 2022, with results published in the February 2024 issue of JAMA Oncology.

It involved 249 pleural mesothelioma patients from around the world with all stages of cancer. Over the course of 2 years, half of them were given pegargiminase along with pemetrexed (Alimta®) and cisplatin or carboplatin, while the other half were given a placebo in addition to the same chemotherapy drugs.

The ATOMIC-Meso Clinical Trial found that pegargiminase:

• Helped patients live longer with minimal side effects
• Quadrupled 3-year mesothelioma survival rates
• Stopped cancer progression for over 6 months on average

In an earlier trial called the Arginine Deiminase and Mesothelioma (ADAM) study, 50% of patients with ASS1-deficient pleural mesothelioma who received pegargiminase had stable disease after 4 months, meaning their cancer did not spread. In contrast, only 22% of those who received palliative care experienced the same outcome.

Pegargiminase in Mesothelioma Treatment Plans

Pegargiminase can be used as an initial treatment before chemotherapy or combined with other mesothelioma treatments to help patients live longer.

Pegargiminase and Chemotherapy

Pegargiminase is intended to be combined with chemotherapy when treating mesothelioma, and has shown particular promise when combined with the chemotherapy drug pemetrexed.

In addition to pemetrexed, patients would then be given cisplatin or carboplatin, two types of platinum-based chemotherapy drugs.

Pegargiminase With Other Mesothelioma Treatments

Doctors may also combine pegargiminase and chemotherapy with other mesothelioma treatments like surgery, radiation therapy, and immunotherapy.

Since pegargiminase is intended to be used as a first-line (initial) treatment, these treatments would likely be considered afterward depending on the health of the patient and their cancer stage.

For example, a patient in the later stages of mesothelioma may not be healthy enough to undergo surgery but could qualify for treatment with the immunotherapy drugs Opdivo® and Yervoy®.

Need help finding treatment? Use our Free Doctor Match service to connect with top mesothelioma specialists in your area.

Who Are the Best Candidates for Pegargiminase Mesothelioma Treatment?

Pegargiminase has shown to be especially helpful for mesothelioma patients with the biphasic and sarcomatoid cell types of mesothelioma.

Other groups that may benefit from ADI-PEG20 include:

• Late-stage patients: Pegargiminase was found to be safe and effective for patients with limited treatment options due to the extent of their cancer.
• Newly diagnosed patients: Pegargiminase was tested as a first-line treatment along with chemotherapy, with research showing this was its most effective use.
• Pleural mesothelioma patients: Pegargiminase has shown promise specifically in patients with malignant pleural mesothelioma, which develops in the lung lining.

Since pegargiminase isn’t approved by the FDA yet, further testing is needed to determine who may benefit the most from this new drug.

How Would Pegargiminase Be Used to Treat Mesothelioma?

Right now, patients can only receive pegargiminase treatments through clinical trials since the drug hasn’t been approved by the U.S. Food & Drug Administration (FDA).

Based on clinical trials, however, it’s likely that doctors will continue to use pegargminiase in a similar way if it’s approved.

Your treatment plan may include:

1. Weekly Pegargiminase Injections

Pegargiminase is administered in the arm by intramuscular injection.

You will always be monitored closely during the injection process, and your doctor can address any concerns you have before you start treatment.

2. Chemotherapy Every Three Weeks

In addition to pegargiminase, you would also be given chemotherapy every 3 weeks for up to 6 cycles. This treatment regimen can then continue up to 2 years.

The chemotherapy drug pemetrexed will be administered through intravenous injection along with cisplatin or carboplatin. As with your initial pegargiminase injections, you’ll be carefully monitored after your treatment session to make sure you don’t have any adverse reactions.

3. Monitoring for Side Effects

Possible side effects of pegargiminase include:

• Constipation
• Diarrhea
• Fatigue
• Nausea
• Tenderness around your injection site

The side effects of pegargiminase are usually mild. In very rare instances, pegargiminase can also cause allergic reactions and systemic toxicity (side effects affecting the whole body). You should always tell your doctor about any side effects you experience.

Follow-Up Care After Pegargiminase for Mesothelioma

Mesothelioma patients treated with pegargiminase will require follow-up care that is personalized to their specific cancer stage.

This follow-up may include:

• Additional treatments, depending on how you respond to pegargiminase and what your diagnosis calls for
• Lifestyle changes to manage your mental and physical health while in recovery, such as maintaining a healthy mesothelioma diet, engaging in physical activity and exercise as allowed, and getting enough sleep
• Regular check-ups with you doctor and health care team to see how you’re responding to treatment and address any symptoms or side effects you’re experiencing
• Testing like bloodwork and imaging scans to evaluate the progression of your mesothelioma and how your treatments are working

Close monitoring after treatment will help ensure you have the best possible outcome and maintain a good quality of life.

We Can Help You Find Top Treatments for Mesothelioma

At Mesothelioma Hope, we’re dedicated to providing the latest information on emerging treatments like pegargiminase.

New ways of treating this cancer are continually being studied in clinical trials, offering hope for longer survival and an improved quality of life for mesothelioma patients.

If you have any questions or need support, our team is here to help by:

• Providing detailed information on the latest treatments
• Connecting you with top mesothelioma specialists
• Helping you access clinical trials in your area
• Sharing legal options that can help you pay for treatment

Call us now at (866) 608-8933 or fill out our contact form to get personalized support.