AstraZeneca's eVOLVE-Meso Phase 3 Trial: Will Volrustomig Be the Next Mesothelioma Breakthrough?

AstraZeneca's eVOLVE-Meso is one of the most closely watched Phase 3 clinical trials in mesothelioma today. The study is testing volrustomig — a bispecific antibody designed to block two immune checkpoints with a single molecule — against the current first-line standard of care in approximately 825 patients with previously untreated unresectable pleural mesothelioma. The trial began enrolling in November 2023 and remains active, with primary completion estimated for November 2027 and primary results most likely reported in 2028. If volrustomig outperforms the established nivolumab plus ipilimumab regimen, it could reshape first-line mesothelioma treatment for the first time since 2020. For patients and families navigating a diagnosis, this is one of the most consequential pipeline trials in the field. Learn more about active mesothelioma clinical trials or speak with specialized mesothelioma attorneys about pursuing compensation in parallel with treatment.

What Is the eVOLVE-Meso Clinical Trial?

eVOLVE-Meso is a Phase 3, randomized, open-label, multicenter global study sponsored by AstraZeneca, listed under the study code D7988C00001 and the ClinicalTrials.gov identifier NCT06097728.^[4] The trial is designed to answer one question: does volrustomig plus standard platinum-based chemotherapy extend survival in patients with previously untreated unresectable pleural mesothelioma compared with the current first-line standard of care?

Patients enrolled in eVOLVE-Meso were randomized to receive either volrustomig (also called MEDI5752) combined with carboplatin and pemetrexed, or investigator's choice of two established regimens: nivolumab plus ipilimumab (the current standard since FDA approval in October 2020) or platinum chemotherapy plus pemetrexed (the regimen used before immunotherapy became first-line). This comparator structure allows the trial to test volrustomig against both the modern immunotherapy benchmark and the traditional chemotherapy backbone in a single study.^[5]

The study has a planned enrollment of approximately 825 patients across more than a dozen countries, with enrollment beginning November 9, 2023. As of the most recent ClinicalTrials.gov update on April 27, 2026, the trial remains in actively recruiting status, with sites participating across North America, Europe, Asia-Pacific, and Latin America. Primary completion is estimated for November 19, 2027, and full study completion for November 16, 2028 — a long follow-up window typical for mesothelioma overall survival endpoints.^[6]

What Is Volrustomig and How Does It Work?

Volrustomig — pharmaceutical code MEDI5752 — is a bispecific monoclonal antibody developed in AstraZeneca's immuno-oncology pipeline. Where conventional monoclonal antibodies bind a single target, a bispecific antibody is engineered with two binding sites that recognize two different proteins. Volrustomig's two binding sites target the immune checkpoint proteins PD-1 and CTLA-4 on T cells.

The biological rationale is that both PD-1 and CTLA-4 sit on the same T cell. When a T cell encounters a tumor antigen, blocking both checkpoints simultaneously can unlock a stronger anti-tumor response than blocking either alone. Two separate antibody drugs can do this — that is exactly how the currently approved nivolumab plus ipilimumab combination works — but the two drugs circulate independently, binding their targets throughout the body, including in healthy tissue. This independent distribution is a major driver of the severe immune-related side effects seen with separate dual-checkpoint therapy.

AstraZeneca's preclinical rationale for volrustomig is that a bispecific molecule preferentially co-engages PD-1 and CTLA-4 on the same T cell — particularly on tumor-infiltrating T cells, which express both targets at high density. The intended effect is stronger checkpoint blockade where it matters most (inside the tumor) while reducing systemic immune activation that produces side effects.^[4] Whether that hypothesis translates into a real-world survival advantage is exactly what eVOLVE-Meso is designed to test.

How Does eVOLVE-Meso Compare to the Current Standard of Care?

The current first-line standard for unresectable pleural mesothelioma is nivolumab plus ipilimumab, established by the CheckMate 743 trial. Five-year follow-up data from CheckMate 743 were published in the Journal of Clinical Oncology in February 2026 and reported that 14% of patients on nivolumab plus ipilimumab were alive at five years compared with 6% on chemotherapy — a hazard ratio of 0.74 favoring immunotherapy. In the non-epithelioid subgroup (sarcomatoid and biphasic), the advantage was even more pronounced: 12% versus 1% at five years, with a hazard ratio of 0.48.^[8]

That benchmark — durable five-year survival in roughly one out of seven patients — is what eVOLVE-Meso needs to beat. Because the comparator arm in eVOLVE-Meso includes nivolumab plus ipilimumab as one of the investigator's choice options, the trial allows a direct head-to-head signal between the bispecific antibody approach and the established two-drug combination.

One of the more interesting design choices in eVOLVE-Meso is the combination of an immunotherapy with chemotherapy in the experimental arm. CheckMate 743 used immunotherapy alone in its experimental arm. The Canadian Cancer Trials Group IND.227 trial (NCT02784171) — a Phase 3, open-label, randomised study published in The Lancet in December 2023 — demonstrated that adding pembrolizumab to platinum-based chemotherapy improved overall survival versus chemotherapy alone in untreated advanced pleural mesothelioma, establishing the rationale for combining checkpoint inhibition with chemotherapy in this disease.^[11] eVOLVE-Meso is the first Phase 3 trial to test a bispecific antibody plus chemotherapy in mesothelioma.

"For more than two decades, our clients faced a treatment landscape that barely changed. CheckMate 743 was the first real shift in 2020. Now we are watching a Phase 3 trial that could shift the standard again — and the speed of the pipeline matters because every additional month of effective treatment is a month families spend together. Newly diagnosed clients should be talking with mesothelioma specialists about trial options while we pursue their legal claims in parallel."

— Paul Danziger, Founding Partner, Danziger & De Llano

When Will eVOLVE-Meso Results Be Available?

eVOLVE-Meso is still actively recruiting as of the most recent ClinicalTrials.gov update on April 27, 2026. Because mesothelioma is a disease where overall survival is measured in years rather than months, the trial requires extended follow-up after the last patient is randomized before primary results can be analyzed. ClinicalTrials.gov lists primary completion as estimated for November 19, 2027 and full study completion for November 16, 2028; primary results — including overall survival and progression-free survival — are therefore most likely to be reported in 2028.^[9]

Interim safety data and preliminary efficacy signals may be presented earlier at major oncology conferences such as the American Society of Clinical Oncology (ASCO) Annual Meeting or the European Society for Medical Oncology (ESMO) Congress. Full peer-reviewed publication typically follows the conference presentation by several months.

Patients and families tracking the trial can monitor ClinicalTrials.gov (NCT06097728) for updates, where study completion milestones and primary results posting dates are updated as they are reached.

Can Patients Still Enroll in eVOLVE-Meso?

Yes. As of the most recent ClinicalTrials.gov update on April 27, 2026, eVOLVE-Meso remains in actively recruiting status, enrolling adults with previously untreated unresectable pleural mesothelioma at sites in North America, Europe, Asia-Pacific, and Latin America.

For patients newly diagnosed with previously untreated unresectable pleural mesothelioma who are interested in clinical trial participation, the National Cancer Institute maintains a list of more than 38 active treatment trials, spanning investigational immunotherapies, antibody-drug conjugates, CAR-T cell therapies, targeted agents, and combination regimens.^[7] The full pipeline is summarized in our overview of the 2026 mesothelioma clinical trial pipeline.

Specialist input matters. A 2022 mixed-methods study of mesothelioma multidisciplinary teams in the United Kingdom found that only 10% of mesothelioma patients across participating trusts were enrolled in clinical trials, with significant variation across healthcare settings.^[12] Patients seen at high-volume NCI-designated cancer centers with dedicated thoracic oncology programs are substantially more likely to be matched to active trials than those treated in community settings without specialist input.

Does Joining a Clinical Trial Affect a Mesothelioma Lawsuit?

No. Participating in a clinical trial does not waive a patient's right to pursue legal compensation for asbestos exposure, and it does not reduce the value of a mesothelioma claim.^[10] The underlying liability of asbestos manufacturers, employers, and trust funds is established by the patient's exposure history and diagnosis — not by which treatment the patient chooses to pursue.

Practical points families should know:

• Treatment costs covered by the trial sponsor do not offset damages. Damages in a mesothelioma case include pain and suffering, lost income, lost consortium, and other categories that are independent of medical bills.
• Asbestos trust fund claims are not affected by trial participation. Trust fund eligibility is based on diagnosis, exposure history, and product identification — not treatment choice.
• Settlement timelines and trial timelines run in parallel, not in conflict. Mesothelioma cases are typically expedited in court because of the disease's prognosis. Your legal team handles the litigation while you focus on treatment.
• Some trial sites require travel. Patients should ask whether the trial sponsor covers travel and lodging, and whether ancillary costs are reimbursed.

The legal team at Danziger & De Llano regularly works with clients enrolled in clinical trials at major academic centers. Pursuing the most aggressive treatment available and pursuing legal compensation are not in tension — they are the two halves of a complete response to a mesothelioma diagnosis.

What Should Patients and Families Do Now?

While the field waits for eVOLVE-Meso's primary readout — most likely in 2028 — patients newly diagnosed with mesothelioma have several immediate priorities:

1. Get evaluated at an NCI-designated cancer center. A mesothelioma specialist can confirm diagnosis, determine subtype (epithelioid, sarcomatoid, or biphasic), and identify whether the patient is a candidate for surgery, immunotherapy, chemotherapy, or trial participation.
2. Ask explicitly about clinical trial eligibility. Trials are often the route to access drugs that will not be commercially available for years. The NCI trial database is the starting point.
3. Document the exposure history. Specific employers, job sites, dates, and asbestos-containing products — even decades-old details — are what mesothelioma attorneys use to identify which trust funds and defendants apply to the case.
4. Consult a mesothelioma attorney early. Statutes of limitations for asbestos claims vary by state and by trust fund. Early consultation preserves the full range of legal options. Call (855) 699-5441 for a free case review.

For broader context on what is in the mesothelioma development pipeline beyond eVOLVE-Meso, see our coverage of global mesothelioma trials and the eight major active studies of 2026.