Atezolizumab, Pemetrexed Disodium, Cisplatin, and Surgery With or Without Radiation Therapy in Treating Patients With Stage I-III Pleural Malignant Mesothelioma

1. Is the biology right?

• Somatic driver evidence: no · None of CD274, TYMS, DHFR, GART has somatic-mutation evidence in malignant biphasic mesothelioma

  Rule: Open Targets has somatic-mutation evidence for the target in this cancer. Source: Open Targets: CD274 in malignant biphasic mesothelioma, 2026-11-11
• Human genetic evidence: no · No germline or somatic evidence for CD274, TYMS, DHFR, GART in malignant biphasic mesothelioma

  Rule: Any germline or somatic human genetic evidence for the target in this cancer, counted apart from animal-model and literature evidence. Source: Open Targets: CD274 in malignant biphasic mesothelioma, 2026-11-11
• Pediatric target: yes · CD274, TYMS on the FDA list

  Rule: Target is on FDA's Pediatric Molecular Target List (relevant targets); membership alone neither requires nor waives a study. Source: FDA Pediatric Molecular Target List (Listed as February 2026 on the FDA Pediatric Oncology page; the file served is 9.7.22_the_relevant_molecular_target_list.xlsx, whose Summary of Changes sheet is headed 'SEPTEMBER 2022 UPDATE' (footnote date 2022-09-01)), 2026-11-11
• Haematologic cancer: no · Solid tumour

  Rule: From the indication, or the registry conditions when no indication matches. Source: ClinicalTrials.gov NCT03228537, 2026-11-11

  Published context: Likelihood of approval from phase 1: 7.5% haematologic vs 4.6% solid (BIO / Informa / QLS 2021, 2011–2020). Population-level, not a prediction.

• CD274 (via Atezolizumab): Open Targets has no association between CD274 and malignant biphasic mesothelioma. · Open Targets: CD274 in malignant biphasic mesothelioma
• TYMS (via Pemetrexed Disodium): Open Targets has no association between TYMS and malignant biphasic mesothelioma. · Open Targets: TYMS in malignant biphasic mesothelioma
• DHFR (via Pemetrexed Disodium): Open Targets has no association between DHFR and malignant biphasic mesothelioma. · Open Targets: DHFR in malignant biphasic mesothelioma
• GART (via Pemetrexed Disodium): Open Targets has no association between GART and malignant biphasic mesothelioma. · Open Targets: GART in malignant biphasic mesothelioma

• Not loaded on this app yet: Normal-tissue expression in vital organs. Source: Human Protein Atlas (ticket 36).
• Not loaded on this app yet: Pan-essential in cell lines. Source: DepMap (ticket 36).
• Not loaded on this app yet: Approved drug on this target. Source: Drugs@FDA (ticket 30).

2. Can the result be trusted?

• Randomised: no · Single group

  Rule: Registry allocation field. Source: ClinicalTrials.gov NCT03228537, 2026-11-11
• Small denominator: yes · 28 enrolled; each patient moves a rate by 100 ÷ 28 = 3.6 points

  Rule: Enrolment under 30; the arithmetic is shown, not a benchmark. Source: ClinicalTrials.gov NCT03228537, 2026-11-11
• Primary endpoint is overall survival: no · Feasibility of Neoadjuvant Cisplatin-Pemetrexed-Atezolizumab, Surgery +/- Radiation, and Maintenance Therapy.; Safety of Neoadjuvant Cisplatin-Pemetrexed-Atezolizumab, Surgery +/- Radiation, and Maintenance Therapy.

  Rule: A registered primary outcome measure names overall survival. Source: ClinicalTrials.gov NCT03228537, 2026-11-11

  Published context: Non-OS primary endpoint: odds ratio 2.79 for a positive phase 3 (Otsuka 2021, 400 phase 3 oncology trials, to 2020). Shown with the next figure: a surrogate is easier to hit, and often a weak guide to survival.

  Published context: 52% of surrogate-to-OS correlations are low (Prasad 2015, published to 2014). Shown with the figure above.
• Results overdue: no · Results posted 2024-03-05

  Rule: Primary completion (actual) more than 12 months ago and no results posted to the registry. Source: ClinicalTrials.gov NCT03228537, 2026-11-11

• Not loaded on this app yet: Treated and evaluable counts, assessor, confirmed response, follow-up and data cutoff. Source: Readout extraction (ticket 32).
• Not loaded on this app yet: Primary endpoint changed between registry versions. Source: Registry versions in the store (ticket 32).

3. What must it beat?

• Not loaded on this app yet: Control-arm result and approved therapies for the same segment, with label links. Source: Drugs@FDA, FDA labels and readouts (tickets 30, 32).

4. Too crowded, or too late?

• Stopped on this target: 415 terminated, withdrawn or suspended trials of drugs against CD274; 1 of the 200 most recent give no reason. Reasons are quoted as the registry gives them on the target page. · CD274: what already stopped

• Not loaded on this app yet: Programs on the target by phase and months behind the leader. Source: Programs and Drugs@FDA (ticket 33).

5. Can it be approved, and stay approved?

• Single-country: yes · All 174 sites in United States

  Rule: All listed sites are in one country; the share of US sites is shown. Source: ClinicalTrials.gov NCT03228537, 2026-11-11
• EU paediatric investigation plan: yes · EMEA-003418-PIP01-23 (tiragolumab;atezolizumab, Treatment of lung carcinoma): W: decision granting a waiver in all age groups for all conditions or indications, 8 Aug 2023; EMEA-001638-PIP02-21 (atezolizumab, Treatment of all conditions included in the category of malignant neoplasms (except central nervous system tumours, hematopoietic and lymphoid tissue neoplasms and melanoma)): W: decision granting a waiver in all age groups for all conditions or indications, 8 Sept 2021; EMEA-001638-PIP01-14-M02 (atezolizumab, Treatment of all conditions included in the category of malignant neoplasms (except central nervous system tumours, haematopoietic and lymphoid tissue neoplasms)): PM: decision on the application for modification of an agreed PIP, 12 Jun 2019; compliance positive 20 Sept 2019; EMEA-000126-PIP01-07 (pemetrexed disodium, Carcinoma of the head and neck (Covered by class waiver: oropharyngeal epithelial carcinoma, excluding nasopharyngeal carcinoma);Malignant pleural mesothelioma): W: decision granting a waiver in all age groups for all conditions or indications, 24 Feb 2009

  Rule: An EMA PIP decision (agreement, modification or waiver) lists the drug as its active substance, exact name. Source: EMA data download (dated snapshot), 2026-11-11
• EU orphan designation: yes · EU/3/01/060 withdrawn 17 Sept 2001: Treatment of malignant mesothelioma

  Rule: An EU orphan designation lists the drug as its active substance (exact name) or belongs to a medicine that does; withdrawn and expired designations are listed with their status. Source: EMA EU/3/01/060, 2026-11-11
• Authorised in the EU: yes · Tecentriq: authorised since 20 Sept 2017; Pemetrexed Pfizer (previously Pemetrexed Hospira): authorised since 19 Nov 2015; Pemetrexed Krka: withdrawn since 22 May 2018

  Rule: An EMA medicine record lists the drug as its active substance or INN, exact name; national-only authorisations are not in this file. Source: EMA data download (dated snapshot), 2026-11-11
• FDA orphan designation: not published · FDA's orphan designation database turns away automated requests, so this app does not read it; search it by hand at the link

  Rule: Would be: an FDA orphan designation names the drug. Source: FDA orphan designations search
• FDA pediatric oncology approval: yes · Atezolizumab and hyaluronidase-tqjs [Tecentriq Hybreza], 24 Nov 2025: Treatment of adult and pediatric patients 12 years of age or older with unresectable or metastatic alveolar soft part sarcoma (ASPS); Atezolizumab [Tecentriq], 9 Dec 2022: As a single agent, for the treatment of adult and pediatric patients 2 years of age and older with unresectable or metastatic alveolar soft part sarcoma (ASPS)

  Rule: FDA's Pediatric Oncology Drug Approvals table names the drug. Source: FDA Pediatric Oncology Drug Approvals (content current as of 2026-03-03), 2026-11-11
• Registered studies open to children: yes · 97 interventional studies of Atezolizumab, Pemetrexed Disodium include patients under 18; 32 are recruiting, not yet recruiting or active

  Rule: The registry's age group includes Child (birth to 17 years), which also counts studies that set no minimum age. Source: ClinicalTrials.gov search, 2026-11-11

• Caveat: Site counts are not patients per country, and trials registered only outside ClinicalTrials.gov are not covered. Where the sites are is a fact about the record, not a judgement of its quality.
• Rare pediatric disease voucher: FDA, content current as of 29 Apr 2026: “As of February 3, 2026, enactment of the Consolidated Appropriations Act, 2026, the rare pediatric disease PRV program will sunset after September 30, 2029. FDA may not award any PRVs under this program after September 30, 2029.” Voucher sale prices are not shown here; they appear only as company-reported news. · FDA: Rare Pediatric Disease Designation and Priority Review Voucher Programs

• Not loaded on this app yet: Precedent approvals for target, modality and endpoint; accelerated-approval status. Source: Drugs@FDA and FDA accelerated-approval tables (ticket 30).

6. Can the sponsor finish?

• Sponsor: National Cancer Institute (NCI) (academic or other) · ClinicalTrials.gov NCT03228537
• principal investigator: Anne S Tsao, SWOG Cancer Research Network · Person page

• Not loaded on this app yet: Filed cash, quarterly spend and the runway arithmetic. Source: SEC XBRL company facts (ticket 37).
• Not loaded on this app yet: Sponsor's completed vs stopped oncology trials and results-reporting record. Source: Registry, by company (ticket 37).

What public data cannot tell you

Public records cannot show: sales forecasts; a probability of success for this asset; full deal terms and net prices; FDA designations and action dates before approval (shown only as company-reported); clinical holds unless the company disclosed them; manufacturing; patents on unapproved drugs; whether preclinical findings have been replicated.