Decades after inhaling asbestos fibers in a factory boiler room, a man named Mick was told he had four months to live — a prognosis that has long defined mesothelioma, one of medicine's most unforgiving cancers. In London, researchers found a way not to attack the disease directly, but to starve it: an experimental drug called ADI-PEG20 cuts off the amino acid that mesothelioma cells cannot produce on their own, leaving them without the means to survive. A clinical trial of 249 patients showed that combining this approach with chemotherapy quadrupled three-year survival rates, transforming wha
Experimental drug ADI-PEG20 quadruples three-year survival in mesothelioma patients
Mesothelioma patients face one of the lowest survival rates among solid cancers; workplace asbestos exposure continues to cause this fatal disease decades after initial exposure.
I wouldn't want to miss all that.
Mark
Why does mesothelioma take so long to appear after asbestos exposure?
Mimi
The fibers settle deep in lung tissue and cause chronic irritation over decades. The cancer doesn't develop overnight—it's a slow accumulation of cellular damage that can take twenty, thirty, even forty years to become a tumor.
Mark
And most people don't know they were exposed until they get sick?
Mimi
Exactly. Mick worked in a boiler room in the seventies. He didn't think about it. Then one day in 2018 he's losing weight and feeling ill, and suddenly his past catches up with him.
Mark
What makes ADI-PEG20 different from other cancer treatments?
Mimi
Most drugs try to poison the cancer cell directly. This one takes a different approach—it removes something the cancer cell needs to survive. It's like cutting off the food supply instead of attacking the enemy.
Mark
But the survival extension is only 1.6 months on average. That sounds small.
Mimi
It is small as an average. But when you quadruple the three-year survival rate, you're talking about people who would have died in months now living for years. Mick was supposed to have four months. He's now past eighty.
Mark
What happens to the people in the trial who didn't survive?
Mimi
That's the weight of it. Mick says some of the other participants "disappeared over time." The drug works for some. For others, it doesn't. But it gave more people more time than they would have had otherwise.
Mark
Is this a cure?
Mimi
No. Mick's cancer came back. But he got another treatment, and now it's controlled. It's not a cure. It's a reprieve. And for mesothelioma, a reprieve is revolutionary.
Il Polso
- Mesothelioma kills most of its patients within months, and decades of asbestos exposure continue to generate new diagnoses long after the original harm was done.
- Mick was given four months to live in 2018 — a timeline that reflects the brutal arithmetic of a disease with a five-year survival rate between five and ten percent.
- ADI-PEG20 exploits a specific vulnerability: mesothelioma cells cannot manufacture their own arginine, so blocking their external supply effectively starves them into collapse.
- A 249-patient clinical trial showed the drug extended average survival by 1.6 months and quadrupled three-year survival rates with minimal side effects when paired with chemotherapy.
- Mick survived long enough to turn eighty, meet two great-grandchildren, and reflect on a future he was told he would never have.
- Researchers are now applying the same arginine-deprivation logic to sarcomas and brain tumors, opening a broader front in the strategy of starving cancer rather than simply striking it.
Decades after inhaling asbestos fibers in a factory boiler room, a man named Mick was told he had four months to live — a prognosis that has long defined mesothelioma, one of medicine's most unforgiving cancers. In London, researchers found a way not to attack the disease directly, but to starve it: an experimental drug called ADI-PEG20 cuts off the amino acid that mesothelioma cells cannot produce on their own, leaving them without the means to survive. A clinical trial of 249 patients showed that combining this approach with chemotherapy quadrupled three-year survival rates, transforming what was once a sentence into something closer to a negotiation. The discovery carries weight beyond one cancer — it suggests that for diseases built on dependency, deprivation may be as powerful as destruction.
Mick was working in a factory boiler room in the 1970s when he inhaled asbestos fibers without much thought. Forty years later, the consequences arrived — rapid weight loss, worsening health, and a diagnosis of malignant mesothelioma. His doctors gave him four months to live.
Mesothelioma is among medicine's cruelest diseases. It attacks the lining of the lungs, traces back to workplace asbestos exposure in about four out of five cases, and carries a five-year survival rate of just five to ten percent. For most patients, the prognosis leaves little room for hope.
But Mick enrolled in a clinical trial at Queen Mary University of London testing a drug called ADI-PEG20. The principle behind it is almost elegant: starve the cancer. Mesothelioma cells lack the protein needed to manufacture their own arginine, an amino acid essential for growth. ADI-PEG20 blocks their ability to absorb it externally, cutting off their supply entirely. For two years, Mick traveled weekly for injections, experiencing no serious side effects, while other participants around him came and went.
The results, published in JAMA Oncology in February 2024, were significant. Among 249 patients, the drug combined with chemotherapy extended average survival by 1.6 months and quadrupled the three-year survival rate compared to chemotherapy alone. When Mick's cancer returned after two and a half years, a second course of immunotherapy brought it under control. He celebrated his eightieth birthday. He now has five grandchildren and two great-grandchildren.
"I wouldn't want to miss all that," he said. The research, led by Dr. Peter Szlosarek at Barts Cancer Institute, is now being extended to other arginine-dependent cancers, including sarcomas and brain tumors — suggesting that the strategy of deprivation, rather than direct assault, may open a new chapter in how medicine confronts the disease.
Mick was working in a factory boiler room during the 1970s when he inhaled asbestos fibers without much concern. Forty years later, in 2018, the consequences arrived. He lost more than forty pounds and felt increasingly unwell. The diagnosis came as a shock: malignant mesothelioma, a rare and aggressive cancer that typically kills its victims within months. His doctors gave him four months to live.
Mesothelioma is one of medicine's cruelest diseases. It attacks the lining of the lungs, and about four in five cases trace back to workplace asbestos exposure—fibers inhaled decades earlier that settle in lung tissue and trigger cellular damage that can take years or even decades to manifest as cancer. The disease carries one of the lowest survival rates of any solid tumor: between five and ten percent of patients survive five years. For most people diagnosed, the prognosis is grim.
But Mick became part of something that changed the trajectory of his illness. Researchers at Queen Mary University of London were testing an experimental drug called ADI-PEG20, which works on a principle that sounds almost elegant in its simplicity: starve the cancer cells. The drug blocks cancer cells from absorbing arginine, an amino acid they need to grow and multiply. Most cells can manufacture their own arginine using a protein called ASS1, but mesothelioma cells lack this protein. Cut off their external supply, and their ability to thrive collapses.
The clinical trial enrolled 249 patients with malignant mesothelioma. Mick was among them. For two years, he traveled to the hospital every week for injections—one in each arm. He experienced no serious side effects. Around him, other trial participants came and went. Some disappeared. Mick kept going. The drug, combined with traditional chemotherapy, extended his average survival by 1.6 months and, more dramatically, quadrupled the three-year survival rate compared to chemotherapy alone. These numbers matter because they represent the difference between months and years, between missing milestones and witnessing them.
Two and a half years into the trial, Mick's cancer returned. He received a second course of treatment using immunotherapy. His disease came under control. He celebrated his eightieth birthday. He now has five grandchildren and two great-grandchildren—a future he was told he would not have.
"This trial has changed the lives of people with mesothelioma, allowing us to live longer," Mick reflected. "I wouldn't want to miss all that." The research, led by Dr. Peter Szlosarek at Queen Mary's Barts Cancer Institute, represents years of work translating laboratory discoveries into clinical reality. The findings were published in JAMA Oncology in February 2024.
The implications extend beyond mesothelioma. Researchers are now testing ADI-PEG20 in patients with sarcomas, brain tumors, and other cancers that depend on arginine to survive. For a disease that has historically offered little hope, the drug represents a fundamental shift in how doctors might approach treatment—not by attacking cancer cells directly, but by removing the nutrients they need to exist.
Citazioni salienti
It was a bit of a shock: I was given four months to live.— Mick, mesothelioma patient in the trial
This trial has changed the lives of people with mesothelioma, allowing us to live longer.— Mick
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