By Edmund Young, Principal Lawyer at Slater and Gordon Lawyers (UK)

The ATOMIC-meso trial

The ATOMIC-meso trial marks the culmination of two decades of research conducted at Queen Mary’s Barts Cancer Institute. This journey commenced with Professor Szlosarek’s and Professor Fennell’s discovery that mesothelioma cells lack a protein called ASS1, which enables cells to manufacture their own arginine.

Subsequently, Professor Szlosarek and his team devoted their efforts, and utilised this identification, to develop an effective, breakthrough treatment for patients with mesothelioma.

The ATOMIC-meso trial – an international and randomised trial involving 249 patients with pleural mesothelioma from the UK, US, Australia, Italy and Taiwan – found that a treatment, which combines a new drug, ADI-PEG20 (pegargiminase), with traditional chemotherapy, increased the median overall survival of participants by 1.6 months, and quadrupled the survival at 36 months, compared to placebo-chemotherapy. Pegargiminase-based chemotherapy was well tolerated with no new safety signals. The results were published in the journal, JAMA Oncology, on 15 February 2024. The findings are significant and offer hope to patients with mesothelioma and their families.

ADI-PEG20 is the first of its kind to be effectively combined with chemotherapy in two decades. ADI-PEG20 works by reducing arginine levels in the bloodstream. For tumour cells that cannot manufacture their arginine because of a missing enzyme, this means their growth is thwarted.

Professor Szlosarek said: “It’s truly wonderful to see the research into the arginine starvation of cancer cells come to fruition. This discovery is something I have been driving from its earliest stages in the lab, with a new treatment, ADI-PEG20, now improving patient lives affected by mesothelioma. I thank all the patients and families, investigators and their teams, and Polaris Pharmaceuticals for their commitment to defining a new cancer therapy.”

Mick, a patient who benefitted from the drug, said: “This trial has changed the lives of people with mesothelioma, allowing us to live longer”. Mick, who recently celebrated his 80th birthday, was awarded compensation from his former employer after being exposed to asbestos in a factory in the 1970s. He was given four months to live, but due to the trial is still alive five years later. He further said: “I have five grandchildren and two great-grandchildren now – I wouldn’t want to miss all that”.

Liz Darlison, chief executive of Mesothelioma UK, said: “The UK mesothelioma community, including doctors, nurses, patients and families living with mesothelioma, are extremely proud of ATOMIC. It offers another much-needed treatment option and, above all, hope to those living with mesothelioma. We look forward to seeing this treatment become available as a standard option to all patients in the future.”

The benefit of obtaining an indemnity or court order for private treatment as part of a legal claim

When negotiating settlements in mesothelioma legal claims, it is often vital to agree that as part of a settlement of a claim, the Defendant(s) provide an indemnity for privately funded treatment. This is particularly important as patients with mesothelioma (a form of cancer of the lining of the lung or abdomen usually caused by previous asbestos exposure) are often candidates for treatment not available on the NHS, which can be very expensive to fund privately.

Securing an indemnity for privately funded treatment means that patients will not need to use their compensation for any future treatments they may need, and if successfully negotiated or ordered by the court, the Defendant(s) will pay for it separately for as long as is required, and provided it is recommended by a patient’s treating oncologist.

As a specialist asbestos solicitor, this is an important aspect of the legal claim which provides claimants and their families comfort and security of knowing where there is such an indemnity or court order in place, they can access appropriate treatment for their mesothelioma on a private basis, which may not be available to them on the NHS. Although the NHS does provide immunotherapy for suitable patients, as of 14th July 2022, it is only available for a maximum of two years and can be quite inflexible. Hence the importance of keeping private treatment options available.

The results of ATOMIC provide a much-needed and long-awaited extra treatment option, which is currently not available on the NHS but could become available to suitable patients with mesothelioma on a private basis in the near future. 

Having the option of seeking an indemnity for the cost of future private medical treatment or applying for a court order for interim payments to cover such treatment as part of a personal injury claim, provides patients with cutting–edge treatment options not otherwise available on the NHS, often improving prognosis and quality of life.