Malignant pleural mesothelioma is a poorly responsive tumor known to overexpress the phase II detoxification enzyme glutathione-S-transferase, which catalyzes the conjugation between glutathione and platinum(II)-containing drugs. Therefore, we evaluated the effect of the strong glutathione S-transferase inhibitor NBDHEX on human mesothelioma cell lines (MSTO-211H, MPP89, MM-B1 and Mero 48a) featuring the most common mesothelioma phenotypes: epithelioid and biphasic. Even though a different response to NBDHEX was observed, the molecule was very effective on all cell lines tested, triggering a sustained activation of both JNK and p38, followed by caspase activation and apoptosis. NBDHEX also caused severe oxidative stress in the MPP89 cells and, to a lesser extent, in the MMB1 cells, while it did not cause a significant redox imbalance in the other cell lines. The efficacy of the drug was found to be comparable or even higher than that of cisplatin. Moreover, it showed synergistic or additive effects when used in combination with cisplatin. In conclusion, NBDHEX was effective on mesothelioma cell lines, with IC 50 values in the low micromolar range (IC 50 between 1 and 4 lM). These findings indicate that NBDHEX, alone or in combination with cisplatin, is a promising new strategy for treating this rare and aggressive malignancy. (Cancer Sci 2013; 104: 223-230) M esothelioma is a malignant tumor that arises from pluripotent mesothelial cells of pleura or peritoneum. (1,2) Mesothelioma cells show different phenotypes, including the epithelioid, sarcomatoid and the mixed type. Epithelioid is the most common form (60-70% of cases). The sarcomatoid form represents 10-20% of mesotheliomas, and the mixed (or biphasic) form, with epithelioid and sarcomatoid areas, represents 30-40% of all mesotheliomas.(3) There is strong evidence for a causal relation between the development of mesotelioma and asbestos exposure.(4) Although its use has been widely abandoned in the developed world, the mortality rate will continue to increase over the forthcoming years because of the long latency period between the exposure to asbestos and the onset of tumor.(5) Malignant pleural mesothelioma (MPM) responds poorly to chemotherapy. (6,7) Several clinical studies have been performed using the platinum (II)-containing compound CDDP in combination with antifolates (pemetrexed and raltitrexed), nucleoside analogues (gemcitabine), topoisomerase inhibitors (irinotecan) or mitotic inhibitors (vinorelbine) to improve the response rate of MPM to treatment.(8-12) The combination of pemetrexed plus CDDP is the approved "standard of care" for patients with unresectable MPM; (13)(14)(15)(16) however, only a partial benefit has been shown in terms of survival. (15,17) Among the mechanisms of CDDP resistance, the most studied are those dependent on the elevated expression of glutathione S-transferases (GST) (18,19) and of the export pumps MRP1 and MRP2 (multidrug resistance-associated protein). A coordinated action between these pumps and GST enables e...