As a result, all patients who are fit enough (ECOG performance status 0-2) should have the opportunity to discuss the merits of chemotherapy in mesothelioma with an oncologist [11] , in the knowledge that there are no published data which compares survival or symptom control in patients treated with chemotherapy or best supportive care only. The first such trial (MSO-1) [92] is complete, and the preliminary results were published in abstract form in 2007 [93] . These results suggest that the addition of chemotherapy to active symptom control with best supportive care did not infer a significant survival benefit in mesothelioma, however this trial was started before the emergence of pemetrexed.