In Britain it is estimated that the annual number of mesothelioma deaths will rise from approximately 1500 in the year 2000 to a peak of approximately 3000 in 2020. A database on the natural history of mesothelioma has provided a baseline for a new trial at The Royal Marsden looking at early versus delayed chemotherapy in mesothelioma as a new approach to treatment. In the UK chemotherapy is usually in the form of MVP (mitomycin, vinblastine and cisplatin) or vinorelbine, and data have been collected from trials covering both regimens. There is now a national working group for mesothelioma (BMIG) and a proposal for a national trial is being taken forward, comparing chemotherapy with MVP or single agent vinorelbine in addition to active symptom control (ASC) with ASC alone. Novel agents are also being investigated and SRL172 has shown some benefits in combination with chemotherapy in the treatment of malignant mesothelioma.