GSK’s Zejula (niraparib) has reduced the risk of death or progression by 27% in patients with mesothelioma in an investigator-led Phase II trial.
The NERO study (NCT05455424) investigated the efficacy of Zejula in 88 mesothelioma patients who relapsed after previously receiving platinum-based systemic therapy.
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The study is sponsored by the University Hospital Southampton NHS Foundation Trust and funded by Asthma + Lung UK, with support from Mesothelioma UK and the Mavis Nye Foundation.
Mesothelioma is a highly aggressive cancer that forms in the protective lining surrounding certain internal organs, most commonly the lungs, and is usually linked to asbestos exposure. Treatments are limited, and the standard of care (SOC) includes surgery, chemotherapy, radiation therapy, and immunotherapy.
Those treated with Zejula benefited from an average of 1.5 months progression-free survival (PFS) compared to SOC – marking a 27% reduction in the risk of the cancer progressing or death.
Professor Gareth Griffiths, director of the Southampton Clinical Trials Unit and co-lead of the trial, said: “Although this increase may seem small, for this group of patients who have very few treatment options and a generally poor prognosis, this is a significant step forward.
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By GlobalData“We have shown for the first time that this kind of drug can improve progression-free survival for mesothelioma patients compared with their usual treatment in the NHS. This gives enormous hope to those patients and their families and means we can now carry out further research to find out more about how these treatments could be tailored and enhanced to stimulate an even better response in more people.”
The data was presented at the American Association of Cancer Research (AACR) Annual Meeting 2025 in Chicago, US, on 29 April.
The University Hospital Southampton NHS Foundation Trust is now keen to initiate a new study, SELECTmeso, which will be a Phase II platform trial in patients with confirmed histological diagnosis of mesothelioma with evidence of MTAP loss on immunohistochemistry, and evidence of disease progression following prior standard systemic therapy on CT scan.
Griffiths added: “This trial will see patients tested for certain biomarkers, or genetic signals, in their tumours and then given the drug that is most likely to work for them. We really hope this step into more personalised medicine could further help these patients who desperately need better treatment options.”
Other PARP inhibitors being investigated in mesothelioma
Zejula is an oral poly-ADP ribose polymerase (PARP) inhibitor that was approved on 27 March 2017 by the US Food and Drug Administration (FDA) for the maintenance treatment of adult patients with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer.
Other PARP inhibitors being investigated in patients with mesothelioma include AstraZeneca’s Lynparza (olaparib), which is currently in a Phase II trial (NCT04515836); and Pfizer’s Talzenna (talazoparib), which is also in a Phase II study (NCT04462809).
AstraZeneca is also studying volrustomig, a bispecific antibody immunotherapy that targets and blocks PD-1 and CTLA-4. The drug is currently being evaluated in a Phase III trial for malignant pleural mesothelioma (NCT06097728).
In September 2024, the FDA approved MSD’s Keytruda in combination with chemotherapy as a treatment for unresectable advanced or metastatic malignant pleural mesothelioma, based on data from the KEYNOTE-483 (NCT02784171) study.
