What Are the Treatment Options for Mesothelioma?

Overview of Mesothelioma Treatments

Mesothelioma treatment has advanced significantly in recent years. While there is no guaranteed cure, several treatment approaches can extend survival and improve quality of life. The most effective strategy for many patients is multimodal therapy — combining two or more treatments such as surgery, chemotherapy, and radiation or immunotherapy.

Your treatment plan will depend on several factors: the type of mesothelioma (pleural or peritoneal), the stage at diagnosis, the cell type (epithelioid, sarcomatoid, or biphasic), your age, and your overall health. Treatment decisions should be made in consultation with a multidisciplinary team at a center experienced in mesothelioma care.

Surgical Options

Surgery offers the best chance for long-term survival in patients whose cancer has not spread extensively and who are in good enough health to tolerate the procedure. The specific surgery depends on the type of mesothelioma.

For pleural mesothelioma:

Extrapleural pneumonectomy (EPP) is the most aggressive surgical option. It involves removing the affected lung, the surrounding pleura, portions of the diaphragm, and the pericardium (heart lining). EPP is typically reserved for earlier-stage patients who are physically fit enough for this extensive procedure.

Pleurectomy/decortication (P/D) removes the diseased pleural lining while preserving the lung. P/D has become increasingly preferred by many surgeons because it maintains lung function and carries a lower risk of complications, while achieving comparable survival outcomes for many patients.

For peritoneal mesothelioma:

Cytoreductive surgery (CRS) with HIPEC is the standard of care. The surgeon removes all visible tumors from the abdominal lining, then circulates heated chemotherapy solution directly through the abdomen to kill microscopic cancer cells. This combined approach has achieved 5-year survival rates of approximately 50% in eligible patients — a dramatic improvement over systemic chemotherapy alone.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells throughout the body. For mesothelioma, the standard first-line chemotherapy regimen is pemetrexed (Alimta) combined with cisplatin or carboplatin. This combination was established as the standard of care based on clinical trial data showing it extends survival and improves quality of life compared to cisplatin alone.

Chemotherapy may be used in several ways. Neoadjuvant chemotherapy is administered before surgery to shrink tumors and make surgical removal more effective. Adjuvant chemotherapy is given after surgery to destroy remaining cancer cells. Palliative chemotherapy is used when surgery is not an option, aiming to slow disease progression and manage symptoms.

According to the National Cancer Institute, systemic chemotherapy remains an important part of multimodal treatment and is often combined with other approaches for the best results.

Immunotherapy

Immunotherapy has emerged as a significant treatment advance for mesothelioma. On October 2, 2020, the U.S. Food and Drug Administration approved the combination of nivolumab (Opdivo) and ipilimumab (Yervoy) for the treatment of unresectable malignant pleural mesothelioma.

This approval was based on the CheckMate 743 clinical trial, which demonstrated that the Opdivo plus Yervoy combination improved overall survival compared to standard chemotherapy, with a median overall survival of 18.1 months versus 14.1 months. The benefit was particularly pronounced in patients with non-epithelioid (sarcomatoid and biphasic) cell types, which historically have responded poorly to chemotherapy.

Immunotherapy works by helping the body's own immune system recognize and attack cancer cells. It represents a fundamentally different approach from chemotherapy and has opened new possibilities for patients who are not surgical candidates or whose cancer has progressed after initial treatment.

Radiation Therapy

Radiation therapy uses high-energy beams to damage the DNA of cancer cells, preventing them from growing and dividing. For mesothelioma, radiation is most commonly used as part of a multimodal approach rather than as a standalone treatment.

Intensity-modulated radiation therapy (IMRT) is the most commonly used technique. It shapes radiation beams to conform closely to the tumor, delivering higher doses to cancer tissue while minimizing exposure to healthy organs.

Proton therapy is a newer form of radiation that uses proton beams instead of X-rays. Protons deposit most of their energy at a specific depth, potentially reducing damage to surrounding tissue. While promising, proton therapy for mesothelioma is still being studied and is available at a limited number of centers.

Radiation may be used after surgery to reduce the risk of cancer recurrence at the surgical site, or as a palliative treatment to relieve pain, reduce tumor size, and manage symptoms like chest wall pain or difficulty breathing.

Clinical Trials and Emerging Treatments

Clinical trials are essential for advancing mesothelioma treatment. Current research is investigating several promising areas including new immunotherapy combinations, targeted therapies that attack specific molecular features of mesothelioma cells, gene therapy approaches, and photodynamic therapy.

For patients whose cancer has progressed after standard treatments, or for those seeking access to the newest therapies, clinical trials may offer additional options. Many trials are available at no cost to the patient and provide access to treatments that would otherwise be unavailable.

Choosing a Treatment Center

Mesothelioma is a rare cancer, and outcomes are generally better at centers that treat a high volume of cases. When evaluating treatment centers, consider the number of mesothelioma cases the center treats annually, the experience of the surgical team with specific procedures (EPP, P/D, or CRS with HIPEC), availability of multimodal treatment programs, access to clinical trials, and the availability of a multidisciplinary tumor board.

Major mesothelioma treatment centers are located throughout the United States. Your oncologist, or an attorney experienced with mesothelioma cases, can help connect you with appropriate specialists. Compensation from legal claims can help cover the cost of travel and treatment at specialized centers.