Exploring how immunotherapy affects mesothelioma — without a biopsy
Australian New Zealand Clinical Trials Registry: ACTRN12623000632695
Funding: iCare DDB, Charlies Foundation for Research
Why this study matters
Checkpoint-blocking immunotherapy has extended survival for many people with mesothelioma, yet only a subset responds. Tumour biopsy can measure PD-L1 expression, but results vary within and between tumours and may change once treatment starts. By visualising PD-L1 non-invasively with positron-emission tomography (PET), we aim to:
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map PD-L1 across every tumour deposit before treatment;
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track changes in PD-L1 during therapy; and
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test whether these imaging “signatures” predict—and eventually help direct—clinical response.
If successful, the approach could spare patients ineffective therapy sooner, guide novel combination strategies, and reduce costs to the health-care system.
How the study works
| Stage | Who | What happens | Timing |
|---|---|---|---|
| Stage 1: Safety & biodistribution | First 5 participants | Standard ¹⁸F-FDG PET/CT plus a new tracer, ⁸⁹Zr-durvalumab (⁸⁹Zr-durva), on the same day, followed by repeat ⁸⁹Zr-durva scans on days 3 and 5–7 | One visit pre-treatment, two short follow-up visits |
| Stage 2: Response imaging | Up to 25 additional participants starting immunotherapy (with or without chemotherapy) | Baseline FDG and ⁸⁹Zr-durva PET/CT before treatment, then repeat both scans six weeks after therapy begins | Two imaging visits, six weeks apart |
The science behind the tracer
Durvalumab is a therapeutic antibody that binds PD-L1. By attaching the long-lived radio-isotope zirconium-89 (⁸⁹Zr), we can follow the antibody with PET to show where PD-L1 is expressed throughout the body.
This trial builds on foundational work by NCARD and imaging collaborators to safely develop the radiotracer and imaging approach, now published in The Journal of Nuclear Medicine (PMID: 37224789). We thank the Asbestos Diseases Society of Australia (ADSA) for their philanthropic support of specialist equipment to allow automated radiotracer labelling.
Our team & partners
The PDL1 Meso-PET trial is led by the multidisciplinary NCARD Clinical Trials Group in collaboration with:
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Sir Charles Gairdner Hospital (WA)
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Peter MacCallum Cancer Centre (VIC)
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Olivia Newton John Cancer Research Institute (VIC)
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University of Western Australia & Institute for Respiratory Health
- WA Node of the National Imaging Facility (WA NIF)
Outputs & future directions
Early technical data from this programme have already been shared in peer-reviewed literature, and trial results will be presented at international meetings and published open-access to accelerate translation. Long-term, imaging-derived biomarkers may integrate with genomic and blood-based assays to build comprehensive prediction tools for mesothelioma care.
Interested in participating?
For more information, please visit our Clinical Trials page. To find out if a trial is suitable for you, please discuss with your treating medical team.