Texas Has 4 NCI Cancer Centers. The Mesothelioma Trials Concentrate at One. The Geographic Gap.

Texas has four National Cancer Institute-designated cancer centers. Three are in the Houston-Dallas-San Antonio triangle. The deepest mesothelioma clinical trial portfolio in the state sits at MD Anderson Cancer Center in Houston, on Holcombe Boulevard in the Texas Medical Center. For a person diagnosed with mesothelioma in El Paso, that’s a 750-mile drive. For Amarillo, 600. For Lubbock, 525. For Beaumont, 90.

Texas is the second-largest US state by land area at 268,597 square miles. Geographic distance to the highest-volume mesothelioma research center is the access story this investigation maps. The framing matters because mesothelioma is a rare cancer, approximately 3,000 new cases nationally per year per the CDC, and the multidisciplinary infrastructure required for deep clinical trial work (thoracic surgery, medical oncology, radiation oncology, pathology, dedicated research operations) tends to concentrate at the largest centers first.

The Four Texas NCI Cancer Centers

The National Cancer Institute designates cancer centers based on rigorous criteria for research, clinical care, and outreach. Texas has four. MD Anderson Cancer Center in Houston was one of the original three NCI Comprehensive Cancer Centers established under the National Cancer Act of 1971, alongside Memorial Sloan Kettering Cancer Center in New York and Roswell Park Memorial Institute in Buffalo. Dan L. Duncan Comprehensive Cancer Center at Baylor College of Medicine in Houston is also a Comprehensive Cancer Center. Harold C. Simmons Comprehensive Cancer Center at UT Southwestern Medical Center in Dallas is the only NCI Comprehensive Cancer Center in North Texas. Mays Cancer Center at UT Health San Antonio holds NCI Clinical Cancer Center designation, the only NCI center in South Texas, with designation since 1991.

The Comprehensive Cancer Center designation requires excellence in basic, clinical, population, and translational research. The Clinical designation requires excellence in clinical research. Both designations are renewed periodically through competitive NCI peer review. The four Texas centers together cover the Houston-Dallas-San Antonio triangle. There is no NCI-designated cancer center in El Paso, Lubbock, Amarillo, the Permian Basin, the Rio Grande Valley, or East Texas outside the Houston metro.

For mesothelioma specifically, the highest-volume clinical research program in Texas operates at MD Anderson under the direction of Dr. Anne Tsao. The program covers pleural mesothelioma, peritoneal mesothelioma, and rare presentations including pericardial mesothelioma. The multidisciplinary team includes thoracic medical oncologists, surgical oncologists, radiation oncologists, pulmonologists, pathologists, and clinical research coordinators. Active studies have included immunotherapy combinations and targeted therapies. The Dan L. Duncan Mesothelioma Treatment Center at Baylor also treats pleural and peritoneal mesothelioma using surgery, immunotherapy, and HIPEC for peritoneal cases. The Simmons Comprehensive Cancer Center at UT Southwestern has a thoracic oncology team that treats mesothelioma. The Mays Cancer Center supports thoracic and pleural mesothelioma cases through its Lung Cancer Program. ClinicalTrials.gov is the canonical source for active trial enrollment status at any US site.

Why Mesothelioma Trials Concentrate

Mesothelioma is rare. The CDC’s United States Cancer Statistics records approximately 3,000 new mesothelioma cases nationally per year. The latency from initial asbestos fiber inhalation runs 20 to 50 years per ATSDR, so the case pipeline reflects exposure that occurred decades ago. Texas accounts for an annual average of approximately 132 mesothelioma deaths based on CDC WONDER data showing 3,034 Texas mesothelioma deaths from 1999 to 2022. The case pipeline is geographically concentrated in the Gulf Coast industrial corridor (the Houston Ship Channel exposure sites and Beaumont-Port Arthur refinery corridor cover the occupational exposure history) but Texans diagnosed with mesothelioma include people who lived in or worked at sites across the state, plus families exposed through take-home dust on work clothing and veterans exposed during military service.

Clinical trial enrollment requires patient volume to power the statistical analysis that drives study completion. For rare cancers, the math is unforgiving. A trial that needs to enroll 100 people with mesothelioma to reach statistical significance can do that in 24 months at a center seeing 200 mesothelioma cases per year, but the same trial would take a decade at a center seeing 20 cases per year. That patient-volume threshold is one reason the deepest mesothelioma trial portfolios concentrate at the highest-volume centers.

The infrastructure investment is the other reason. A mesothelioma program needs thoracic surgeons trained in extrapleural pneumonectomy or pleurectomy and decortication. It needs medical oncologists experienced with platinum-pemetrexed chemotherapy and the immunotherapy combinations that have become first-line for unresectable disease. It needs radiation oncologists with intensity-modulated radiation therapy capability for chest-wall reconstruction cases. It needs pathologists who can distinguish epithelioid, sarcomatoid, and biphasic histology. It needs clinical research coordinators, regulatory specialists, and biospecimen processing. The bench depth that supports a deep trial portfolio is expensive to build and harder to maintain at lower volumes.

The Texas NCI cancer centers all have thoracic oncology programs. MD Anderson has the deepest mesothelioma-specific bench. The clinical pattern (deepest trial portfolio at the highest-volume center) is consistent with mesothelioma research programs nationally, including Memorial Sloan Kettering in New York, Brigham and Women’s in Boston, and the University of Pennsylvania.

The Texas Geography Problem

Texas covers 268,597 square miles per the US Census Bureau, the second-largest US state after Alaska. The geography is the access constraint.

From Beaumont, MD Anderson sits 90 miles away on I-10 West. The drive is 1 hour 30 minutes to 1 hour 45 minutes depending on traffic. A patient in Beaumont can drive in for a clinic appointment, surgical consultation, or trial screening visit and return home the same day. The Beaumont-Port Arthur refinery corridor’s documented occupational exposure history (CDC WONDER recorded approximately 278 asbestos-related deaths in Jefferson and Orange Counties from 1979 to 2002 per the Beaumont-Port Arthur refinery corridor investigation) means a meaningful patient cohort lives within day-trip range of MD Anderson.

From Dallas, MD Anderson is approximately 240 miles via I-45, roughly 4 hours one-way. Patients commonly drive in for appointments and stay overnight, or fly between Dallas Love Field and Houston Hobby. UT Southwestern’s Simmons Comprehensive Cancer Center treats mesothelioma in Dallas, which provides a closer option for North Texas patients who don’t need a trial that exists only at MD Anderson.

From San Antonio, MD Anderson is approximately 200 miles via I-10 East, roughly 3 hours. Mays Cancer Center at UT Health San Antonio is the local NCI Clinical Cancer Center option for South Texas patients.

From Lubbock, the drive to MD Anderson is approximately 525 miles, typically 8 hours. From Amarillo, approximately 600 miles, typically 9 to 10 hours. From El Paso, approximately 750 miles via I-10 East, typically 11 hours. The Permian Basin (Midland-Odessa) is approximately 525 miles. The Rio Grande Valley (McAllen) is approximately 350 miles, roughly 6 hours. The Big Bend region is more than 600 miles. For patients in West Texas, the Panhandle, the Permian Basin, and far South Texas, accessing MD Anderson requires either a multi-day drive or air travel.

What Veterans Should Know

Mesothelioma is a presumptive service-connected condition for qualifying veterans under 38 CFR 3.309 and the PACT Act (38 USC 1112), which Congress passed in 2022. The presumption eliminates the requirement that a veteran prove specific in-service asbestos exposure. Mesothelioma carries a 100% VA disability rating per 38 CFR 4.97, Diagnostic Code 6819. Navy veterans, Army veterans, Air Force veterans, Marines, and Coast Guard veterans with documented mesothelioma may qualify regardless of service branch given the widespread military use of asbestos through the 1980s. Per VA estimates, veterans comprise approximately 30% of US mesothelioma cases.

The VA Beneficiary Travel program reimburses approved travel expenses for service-connected care. A veteran in El Paso traveling to MD Anderson for trial screening would coordinate the referral and travel through their VA primary care team. The VA also has community care options for cancer treatment outside the VA system when the VA cannot provide timely access. The South Texas Veterans Health Care System and the El Paso VA Health Care System both have oncology services, and the VA can refer out to MD Anderson, Dan L. Duncan, Simmons Comprehensive, or Mays Cancer Center as clinically indicated. Veterans should ask their VA primary care provider for the specific referral pathway and travel-benefit eligibility.

What People in West Texas and the Panhandle Should Ask About

The first conversation is with the diagnosing oncologist. Most general oncology practices in non-metro Texas refer mesothelioma cases to a higher-volume thoracic oncology center. The referral can go to MD Anderson, Baylor’s Dan L. Duncan, UT Southwestern’s Simmons, Mays Cancer Center at UT San Antonio, or to high-volume out-of-state centers including Memorial Sloan Kettering, Brigham and Women’s, the University of Pennsylvania, or the National Cancer Institute Center for Cancer Research. The choice depends on the disease subtype (pleural, peritoneal, pericardial), stage at diagnosis, surgical candidacy, comorbidities, and trial eligibility.

ClinicalTrials.gov is the canonical national database for trial enrollment, and the MesoWatch clinical-trials hub tracks the mesothelioma-relevant subset with current Texas-site enrollment status. Searching by condition (mesothelioma) and location returns active trials with site, phase, eligibility criteria, and enrollment status. Many centers offer remote second-opinion consultations through telemedicine. The American Cancer Society’s Hope Lodge program provides free lodging near treatment centers in Houston (the Lloyd K. Whittall Family ACS Hope Lodge) for patients traveling for treatment. Patient navigator programs at each NCI-designated cancer center can help coordinate care, transportation, and lodging.

For people considering a trial that exists only at MD Anderson, the practical question is whether the trial protocol can be coordinated through telemedicine and local infusion centers, with periodic in-person visits at MD Anderson. Some trial protocols allow for that arrangement; others require all study activity at the trial site. The clinical research coordinator at MD Anderson can answer the specific question for any trial under evaluation. The primary oncologist’s role becomes coordination and continuity of care.

The Clinical Trial Landscape at MD Anderson

MD Anderson’s mesothelioma research program has historically run multiple active trials at any given time, spanning Phase I, Phase II, and Phase III enrollment. The studies cover both pleural and peritoneal disease and include immunotherapy combinations (PD-1/PD-L1 plus CTLA-4 inhibitors), antiangiogenic combinations (atezolizumab plus bevacizumab for peritoneal mesothelioma per NCT03762018), surgical neoadjuvant studies, and novel agents in development. The peritoneal program supports cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC). The pleural program supports both extrapleural pneumonectomy and pleurectomy and decortication, depending on disease and patient factors.

The trial portfolio rotates as studies open and close, so the canonical source for current trials at MD Anderson is the MD Anderson website’s clinical trials search and ClinicalTrials.gov. The thoracic oncology research office and patient navigation team can answer trial-specific questions about eligibility and enrollment.

The pattern of trial concentration is not unique to Texas. Mesothelioma trial work nationally tends to cluster at a relatively small number of high-volume centers because the underlying patient pool is small. The geographic question is not whether MD Anderson should hold this much of the Texas trial pipeline (the case math drives that). The question is what the access supports look like for Texans who don’t live in the Houston-Dallas-San Antonio triangle.

A Closing Thesis

Texas has four NCI-designated cancer centers, three in the Houston-Dallas-San Antonio triangle and one in San Antonio, with no center in El Paso, Lubbock, Amarillo, the Permian Basin, the Rio Grande Valley, or East Texas outside Houston. The deepest mesothelioma trial portfolio in the state operates at MD Anderson Cancer Center in Houston. For a Texan diagnosed with mesothelioma, the access question is partly clinical (which trial fits this patient’s disease and stage) and partly geographic (how does the patient get there). Texas covers 268,597 square miles, and the people most affected by the geographic gap are in West Texas, the Panhandle, the Permian Basin, and far South Texas. Veterans have travel benefits through the VA. Civilians can access the Hope Lodge and patient navigation programs. The Dan L. Duncan, Simmons, and Mays Cancer Centers all treat mesothelioma and may run trials at any given time.

What’s missing is a single map of where the mesothelioma research bench actually exists in Texas, who runs which trial, and how a person in El Paso can get a clear answer about whether the right trial for them is in Houston, Dallas, San Antonio, or somewhere else. That map can be built. The four NCI cancer centers, ClinicalTrials.gov, and the patient navigator infrastructure together hold the data. For the Texan reading this with a new mesothelioma diagnosis: the first call is to your oncologist about referral to one of the four NCI centers, and the second call is to the patient navigation desk at whichever center your oncologist recommends. The broader Texas mesothelioma statistical picture shows where the case pipeline is concentrated geographically.