Mesothelioma

Pegargiminase

Pegargiminase (pegylated recombinant arginine deiminase), an investigational arginine deprivation therapy, has been studied in one phase 3 randomised placebo-controlled trial. Patients with non-epithelioid pleural mesothelioma were assigned to standard platinum-based chemotherapy plus pegargiminase, or to standard chemotherapy plus placebo. Pegargiminase plus chemotherapy increased overall survival with a favourable safety profile.[111]Szlosarek PW, Creelan BC, Sarkodie T, et al. Pegargiminase plus first-line chemotherapy in patients with nonepithelioid pleural mesothelioma: the ATOMIC-Meso randomized clinical trial. JAMA Oncol. 2024 Apr 1;10(4):475-83. https://jamanetwork.com/journals/jamaoncology/fullarticle/2815000 http://www.ncbi.nlm.nih.gov/pubmed/38358753?tool=bestpractice.com ​ The American Society of Clinical Oncology guidelines recommend pegargiminase in selected mesothelioma patients with non-epithelioid histology.[47]Kindler HL, Ismaila N, Bazhenova L, et al. Treatment of pleural mesothelioma: ASCO guideline update. J Clin Oncol. 2025 Mar 10;43(8):1006-38. https://ascopubs.org/doi/10.1200/JCO-24-02425 http://www.ncbi.nlm.nih.gov/pubmed/39778125?tool=bestpractice.com ​ Pegargiminase is not commercially available in the US; it has orphan drug designation in the US and Europe and is only available within the context of a clinical trial.