# MiST: HCP commentary report

> 227 verified statements (11 from clinicians verified by NPI or staff page) from 35 commentary sources · 9 findings · updated Nov 1, 2026

## Report

- Trial: Mesothelioma Stratified Therapy (MiST): A Stratified Multi-arm Phase IIa Clinical Trial to Enable Accelerated Evaluation of Targeted Therapies for Relapsed Malignant Mesothelioma
- NCT ID: NCT03654833
- Registry: https://clinicaltrials.gov/study/NCT03654833
- Sponsor: University of Leicester
- Phase: Phase 2
- Status: Completed
- Drugs tested: rucaparib; abemaciclib; pembrolizumab plus bemcentinib
- Indication: relapsed malignant mesothelioma
- Version: v1.0.0, edition 1
- Accepted: 2026-11-01
- Last checked: 2026-11-01
- Release hash: 8eff8817e524d873c5251bdbc11e47726ddf10f6d114c91510ba8e354448453d

## Counts

- HCP commentary sources screened: 193
- Sources cited by verified statements: 46
- Verified statements: 227
- From speakers with a confirmed clinical role (verified by the NPI registry or their own institution's staff page): 11
- Findings: 9
- Named people in screened sources (unnamed speakers and accounts not counted): 14
- Voices cited: 13
- Cited voices identity-verified: 10
- Organisational or shared accounts (not counted as people): 10

Counts describe the retained sources. They do not estimate how many HCPs hold a view.

## Abstract

MiST evaluates targeted therapies for disease control in relapsed malignant mesothelioma; debate centers on niraparib’s added benefit and treatment after prior immunotherapy. The report cites three medical oncologists and speakers described in the sources reviewed for this edition as presenting MiST and authoring its results, or as involved in MiST. Further questions concern PARP sensitivity markers and the clinical use of microbiome findings. What evidence would establish added benefit and reliable patient selection, and distinguish research opportunities from treatment ready for broader use?

## Open Medical Affairs question

What evidence will separate added drug benefit, reliable patient selection and a research opportunity from a treatment strategy ready for broader use?

Raised by the leading finding. The report shows what clinicians said and the sources behind it; it does not settle the question.

## Findings (titles)

- F1. MiST5 enthusiasm does not resolve niraparib’s contribution or treatment after prior immunotherapy
- F2. The MiST1 PARP signal is considered promising, but a clinically useful sensitivity marker remains unsettled
- F3. Relapsed immunotherapy is supported despite negative comparative endpoints, with response and treatment sequence central to the reasoning
- F4. MiST3 leaves the added value of bemcentinib unresolved
- F5. MiST2 supports biological plausibility and further testing, not proven clinical superiority
- F6. Microbiome and immune-context findings are an explanatory opportunity, not yet a clinical selection or dietary rule
- F7. Focused diagnostic information is favored over universal sequencing in the NHS discussion
- F8. MiST’s platform contribution is framed as feasible stratification and a route to stronger evidence
- F9. A speaker participation and access attract support, but institutional optimism is not clinical consensus

## What sits behind each finding

Counts describe what the report retained, not how many clinicians hold a view. A statement can support more than one finding.

| Finding | Statements | Passages | Sources | Named voices | Counterview | Limitations |
| --- | ---: | ---: | ---: | ---: | --- | ---: |
| F1 | 17 | 7 | 5 | 4 | recorded | 3 |
| F2 | 19 | 12 | 6 | 2 | recorded | 3 |
| F3 | 13 | 11 | 3 | 3 | recorded | 3 |
| F4 | 9 | 6 | 4 | 2 | recorded | 2 |
| F5 | 7 | 5 | 4 | 2 | none recorded | 3 |
| F6 | 34 | 30 | 9 | 5 | recorded | 5 |
| F7 | 11 | 12 | 1 | 2 | recorded | 2 |
| F8 | 25 | 16 | 4 | 3 | none recorded | 3 |
| F9 | 9 | 8 | 7 | 7 | none recorded | 3 |

### What the statements are

| Finding | Views | Questions and uncertainty | Clinical experience | Comparisons | Restated results and context | Passages supporting | Passages giving context | Sources by kind | Feeds the Medical Affairs question |
| --- | ---: | ---: | ---: | ---: | ---: | ---: | ---: | --- | --- |
| F1 | 9 | 2 | 0 | 2 | 4 | 18 | 4 | 2 posts and articles, 3 podcasts and video | yes |
| F2 | 8 | 4 | 1 | 0 | 6 | 20 | 1 | 1 post or article, 4 podcasts and video, 1 publication | yes |
| F3 | 6 | 3 | 1 | 2 | 1 | 13 | 6 | 3 podcasts and video | yes |
| F4 | 3 | 1 | 0 | 1 | 4 | 11 | 1 | 1 post or article, 2 podcasts and video, 1 registry | yes |
| F5 | 4 | 0 | 0 | 1 | 2 | 9 | 0 | 1 post or article, 2 podcasts and video, 1 publication | yes |
| F6 | 16 | 7 | 0 | 4 | 7 | 39 | 3 | 2 posts and articles, 5 podcasts and video, 1 publication, 1 registry | yes |
| F7 | 7 | 0 | 2 | 2 | 0 | 15 | 4 | 1 podcast or video | yes |
| F8 | 19 | 1 | 1 | 0 | 4 | 27 | 2 | 1 post or article, 2 podcasts and video, 1 registry | yes |
| F9 | 7 | 0 | 1 | 0 | 1 | 9 | 0 | 7 posts and articles | yes |

### Trial dimensions

- Primary endpoint: Disease Control Rate (DCR) at 12 Weeks Assessed by Modified RECIST 1.1, in Patients With Relapsed Mesothelioma.: F1 (3 shared claims), F2 (1 shared claims)
- Secondary endpoint: Disease Control Rate (DCR) at 24 Weeks Assessed by Modified RECIST 1.1, in Patients With Relapsed Mesothelioma.: F1 (1 shared claims), F2 (1 shared claims)
- Secondary endpoint: Objective Response Rate (ORR) at 24 Weeks Assessed by Modified RECIST 1.1, in Patients With Relapsed Mesothelioma.: F1 (3 shared claims), F2 (1 shared claims), F4 (1 shared claims), F5 (1 shared claims), F6 (1 shared claims)
- Population and setting: F1 (3 shared claims), F3 (6 shared claims), F8 (4 shared claims)
- The comparison: F1 (8 shared claims), F2 (2 shared claims), F4 (3 shared claims), F5 (6 shared claims), F6 (2 shared claims), F8 (8 shared claims)
- Safety and tolerability: F1 (1 shared claims)
- Design and conduct: F1 (2 shared claims), F2 (1 shared claims), F8 (7 shared claims), F9 (1 shared claims)

## Sample findings

Paraphrased; the full report links each statement to its source.

### F8. MiST’s platform contribution is framed as feasible stratification and a route to stronger evidence

In a podcast discussion of MiST’s platform, a speaker asked whether successful genotype-directed proof-of-concept work would require phase II or randomized evaluation.

Source: podcast, 2024-04-01.

### F2. The MiST1 PARP signal is considered promising, but a clinically useful sensitivity marker remains unsettled

An X post asked whether rucaparib response in BAP1- or BRCA1-deficient mesothelioma differs between germline and somatic alterations.

Source: X thread, 2021-08-06.

## What's inside

| Section | Items | Access |
| --- | ---: | --- |
| Findings with interpretation, counterviews and limits | 9 | Titles free |
| Detailed analysis | 10 sections | Paid |
| Verified statements with short source quotes and links | 227 | Paid |
| Trial aspects mapped | 13 | Free |
| Sources with links | 46 | Counts free |
| Speaker attribution for cited voices | 13 | Paid |

## Trial aspects

13 discussed · 0 no commentary found · 0 assessment incomplete.

| Aspect | Coverage | Statements | Sources |
| --- | --- | ---: | ---: |
| Primary endpoint: Disease Control Rate (DCR) at 12 Weeks Assessed by Modified RECIST 1.1, in Patients With Relapsed Mesothelioma. | discussed | 7 | 5 |
| Secondary endpoint: Disease Control Rate (DCR) at 24 Weeks Assessed by Modified RECIST 1.1, in Patients With Relapsed Mesothelioma. | discussed | 3 | 2 |
| Secondary endpoint: Objective Response Rate (ORR) at 24 Weeks Assessed by Modified RECIST 1.1, in Patients With Relapsed Mesothelioma. | discussed | 10 | 7 |
| Population and setting | discussed | 19 | 4 |
| The comparison | discussed | 36 | 13 |
| Safety and tolerability | discussed | 3 | 3 |
| Design and conduct | discussed | 13 | 7 |
| PARP sensitivity, biomarker uncertainty and the NERO follow-up | discussed | 35 | 12 |
| Host biomarkers, tumor immune context and microbiome hypotheses | discussed | 24 | 10 |
| Relapsed immunotherapy alternatives, symptom benefit, sequence and cost | discussed | 16 | 5 |
| Diagnostic molecular information, selective sequencing and trial referral | discussed | 11 | 1 |
| Master protocols, genotype-directed development and SELECT | discussed | 28 | 8 |
| Participation, funding, treatment continuity and institutional support | discussed | 15 | 12 |

An aspect marked incomplete is a question the public commentary did not let us answer. We show it rather than hide it.

## Sources

| Channel | Screened | Cited |
| --- | ---: | ---: |
| X threads | 136 | 24 |
| Bluesky threads | 25 | 0 |
| Podcasts | 17 | 5 |
| YouTube | 15 | 6 |
| Registry (primary source, cited for context) | not screened | 7 |
| Publications (primary source, cited for context) | not screened | 4 |

- Screened window: 2018-03-01 to 2026-10-24
- Cited window: 2018-06-29 to 2026-09-14
- Retrieved: 2026-10-31

Screened sources were retrieved for this trial. Cited sources back at least one verified statement and include primary sources used for context.

## The trial

From ClinicalTrials.gov.

- Title: Mesothelioma Stratified Therapy (MiST): A Stratified Multi-arm Phase IIa Clinical Trial to Enable Accelerated Evaluation of Targeted Therapies for Relapsed Malignant Mesothelioma
- Also known as: MiST3
- Registry: NCT03654833 (https://clinicaltrials.gov/study/NCT03654833)
- Study IDs: 0627
- Sponsor: University of Leicester
- Collaborators: British Lung Foundation, Clovis Oncology, Inc., Eli Lilly and Company, Merck Sharp & Dohme LLC, BerGenBio ASA, Roche Pharma AG, University Hospitals, Leicester, The Christie NHS Foundation Trust, GlaxoSmithKline
- Design: Phase 2 · interventional, non randomized, parallel, phase2
- Status: Completed
- Enrollment: 186 (actual)
- Start: 2019-01-28 (actual)
- Primary completion: 2023-02-21 (actual)
- Primary endpoint: Disease Control Rate (DCR) at 12 Weeks Assessed by Modified RECIST 1.1, in Patients With Relapsed Mesothelioma. (12 weeks)
- Intervention: Rucaparib (drug)
- Intervention: Abemaciclib (drug)
- Intervention: pembrolizumab & bemcentinib (drug)
- Intervention: Atezolizumab & Bevacizumab (drug)
- Intervention: Dostarlimab and Niraparib (drug)

## Scope and limits

This report does not judge efficacy, estimate HCP prevalence or consensus or give treatment advice.

- Discussion that does not name the trial may be missing from this edition.
- For 1 recording, a transcript separated by speaker was not available, so quotes come from the original automatic transcript and may lack speaker labels.
- 1 cited commentary passage leaves a source question open, such as who was speaking. The report attributes no further than the source shows.
- Some clinician views in the sources used in this report are not yet captured as evidence in this edition.
- Some passages in the sources used in this report were not fully assessed for clinician views, so a view there may be missing from this edition.
- 141 statements in the sources reviewed for this edition are about other patients or topics, or only mention the trial, and are not counted.
- Further source limits: discussion that describes the trial without naming it may be incomplete; some discussion that describes the trial without naming it may be missing; sources about other trials are not included.
- The sources reviewed for this edition are not a representative sample of all HCP opinion, and source totals cannot be interpreted as numbers of independent clinicians.
- Some relevant discussion of access-dependent sequencing, biomarker-guided treatment choice and interpretations of CONFIRM is not fully represented. Other potentially relevant passages were not examined in detail.
- The October 2023 comparison of genomic and immune-context findings, sampling timing and explanation of T-cell recruitment is incompletely represented. The April 2024 account of treatment choices after first-line immunotherapy is also incomplete. These gaps limit interpretation of the host-biomarker rationale and the relapsed-treatment sequence.
- Discussion that used unfamiliar spellings or did not name the trial may be absent. One recording had limited transcript confirmation.
- Several passages cannot be assigned to a named speaker. Conflicting names in some recordings leave identities unresolved; programme participation alone does not resolve ownership of the words.
- Many views come from people described in the sources as presenting, authoring or participating in MiST. Those descriptions do not make their opinions independent validation or establish consensus.
- Some speakers' identities or clinical roles are not established in the sources used in this report; each statement is attributed only as far as its source shows.
- Early single-arm activity, historical or cross-trial comparisons and exploratory biological associations do not establish incremental benefit, treatment equivalence or a validated selection rule.
- A speaker’s MiST5 conclusion conflates 12-week and best-response disease control. Informal descriptions of MiST4’s partner drug or checkpoint class also differ from its protocol; each has been preserved as an attributed statement rather than silently corrected.
- Statements about treatment standards, access, future trial starts and anticipated presentations belong to their original time and jurisdiction. Dates do not establish a change of mind, and intervention-specific regulatory labeling is not comprehensively established here.
- Not yet captured in this edition: a view on precision-medicine development and synthetic-lethal treatment approaches for relapsed mesothelioma.
- Not yet captured in this edition: a question about biomarkers guiding treatment selection in relapsed mesothelioma.
- Not yet captured in this edition: a view on access-dependent sequencing of chemotherapy and immunotherapy in mesothelioma.
- Not yet captured in this edition: a view on genomic versus immune response biomarkers, pretreatment sensitivity and uncertainty about T-cell recruitment.
- Not yet captured in this edition: a view on second-line treatment options for previously treated mesothelioma.

How reports are built and checked: https://www.erudio.com/methods

## Editions and corrections

- v1.0.0, accepted 2026-11-01: current edition, corrected 2026-11-01
  - Correction 2026-11-01: Corrected to match the delivered report: the limitations; the sample findings; the report description. The trial's name is spelled as its investigators write it, “MiST” (NCT03654833), outside quotations (was “MIST”, “Mist”).

Last checked for new commentary 2026-11-01. Versions follow semver: a new or changed finding is a minor version, more evidence without a material change is a patch.

## Offer

- Size: Standard (227 verified statements)
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## Cite

Erudio Health. MiST (NCT03654833): HCP commentary report. Edition 1, v1.0.0. Accepted Nov 1, 2026. https://www.erudio.com/reports/mist-nct03654833

## Machine access

- JSON: https://www.erudio.com/reports/mist-nct03654833.json
- Markdown: https://www.erudio.com/reports/mist-nct03654833.md
- MCP, no sign-in: https://mcp.erudio.com/free, tool `get_report_card` with `{"slug": "mist-03654833"}`