Mesothelioma Treatment Options

Treatment Overview

Mesothelioma treatment depends on the type (pleural vs. peritoneal), stage at diagnosis, cell type, and the patient’s overall health. Most patients receive a combination of therapies — known as multimodal treatment — which has been shown to produce the best outcomes. The five main treatment modalities are:

Chemotherapy for Mesothelioma

Chemotherapy is part of the standard treatment for all stages of mesothelioma. The first-line regimen is pemetrexed (Alimta) combined with either cisplatin or carboplatin, which produces response rates of 30–45%.

Standard Chemotherapy Regimens

• Pemetrexed + Cisplatin — The gold standard first-line regimen. FDA approved in 2004. Median overall survival of 12–16 months.
• Pemetrexed + Carboplatin — Similar efficacy with a more tolerable side-effect profile. Preferred for patients who cannot tolerate cisplatin.
• Gemcitabine + Cisplatin — Alternative first-line option, especially in some clinical settings. Read more about gemcitabine.

Second-Line & Salvage Chemotherapy

When first-line chemotherapy stops working, several agents may be used:

• Vinorelbine (Navelbine) — Oral or IV, well-tolerated, response rates of 16–24% in second-line
• Doxorubicin (Adriamycin) — Anthracycline used in salvage settings, including via HIPEC
• Raltitrexed (Tomudex) — Antifolate alternative to pemetrexed, used primarily in Europe and Australia
• Gemcitabine — May be used as a single agent or combined with other drugs

Radiation Therapy for Mesothelioma

Radiation therapy uses high-energy beams to target and kill mesothelioma cells. While radiation alone is rarely curative for mesothelioma, it plays important roles in multimodal treatment and symptom management.

Types of Radiation for Mesothelioma

• Intensity-Modulated Radiation Therapy (IMRT) — Advanced technique that precisely shapes radiation beams to conform to the tumor while sparing surrounding organs. This is the standard radiation approach for mesothelioma.
• Adjuvant Radiation — Given after surgery (EPP or P/D) to kill remaining microscopic cancer cells and reduce recurrence. Particularly important after EPP, where the empty hemithorax can receive higher doses.
• Palliative Radiation — Used to relieve pain, reduce tumor bulk, and control symptoms like chest wall pain and shortness of breath. Can significantly improve quality of life.
• Prophylactic Radiation — Targeted to surgical port sites and biopsy tracts to prevent tumor seeding (tract metastasis). Effectiveness is debated, but some centers routinely offer it.

Radiation in Multimodal Treatment

The most promising use of radiation for mesothelioma is as part of a trimodal approach: surgery + chemotherapy + radiation. The SMART (Surgery for Mesothelioma After Radiation Therapy) protocol delivers accelerated hemithoracic radiation before surgery, and has shown encouraging results in select patients. For more on multimodal treatment strategies, see our comprehensive diagnosis and treatment guide.

Mesothelioma Drug & Therapy Comparison

The following table lists all 16 drugs and therapies currently profiled in our drug encyclopedia, organized by treatment modality. Click any drug name for a detailed guide including mechanism of action, clinical trial data, side effects, and patient resources.

Our drug encyclopedia is continuously updated as new clinical trial data emerges. Browse all drug & therapy entries for detailed guides on each treatment.

Frequently Asked Questions About Mesothelioma Treatment

• What is the most effective treatment for mesothelioma? +

  The most effective treatment for mesothelioma is multimodal therapy — a combination of surgery, chemotherapy, and/or radiation. For resectable pleural mesothelioma, surgery (P/D or EPP) combined with chemotherapy (pemetrexed + cisplatin) offers median survival of 16–31 months. For unresectable disease, the FDA-approved immunotherapy combination of nivolumab + ipilimumab (Opdivo + Yervoy) has shown median survival of 18.1 months. For peritoneal mesothelioma, CRS + HIPEC offers the best outcomes with 5-year survival rates reaching 41–59%.

• Is immunotherapy better than chemotherapy for mesothelioma? +

  It depends on the cell type. The CheckMate 743 trial showed that nivolumab + ipilimumab was superior to chemotherapy for non-epithelioid subtypes (sarcomatoid and biphasic), with dramatically better survival. For epithelioid mesothelioma, chemotherapy (pemetrexed + cisplatin) and immunotherapy showed similar overall survival, so the choice often depends on individual factors. Many clinical trials are now studying combinations of immunotherapy with chemotherapy, which may prove superior to either alone.

• Can mesothelioma be cured? +

  While there is currently no cure for mesothelioma, long-term survival is possible, especially with early detection and aggressive multimodal treatment. Some peritoneal mesothelioma patients treated with CRS + HIPEC have survived 10+ years. Pleural mesothelioma patients who undergo surgery with chemotherapy and radiation at specialized centers have achieved survival well beyond median estimates. Research into immunotherapy and novel therapies continues to improve outcomes, and clinical trials offer access to the most promising new treatments.

• What is TTFields and is it available for mesothelioma? +

  TTFields (Tumor Treating Fields) is an FDA-approved device-based therapy that uses alternating electric fields applied to the chest to disrupt cancer cell division. The device, marketed as Optune Lua (NovoTTF-100L), was approved in May 2019 for use with pemetrexed + cisplatin/carboplatin in unresectable pleural mesothelioma. The STELLAR trial showed median overall survival of 18.2 months. TTFields is non-invasive and can be used alongside chemotherapy. Talk to your oncologist about whether TTFields is appropriate for your treatment plan.

• How do I choose between surgery and non-surgical treatment? +

  The decision depends on several factors: stage at diagnosis (surgery is most beneficial for stages I–II), cell type (epithelioid responds better to surgery), overall health and lung function, and treatment center expertise. A multidisciplinary tumor board at a specialized mesothelioma center will evaluate all these factors and recommend the optimal approach. Getting a second opinion from a mesothelioma specialist is always advisable before making treatment decisions.

• How much does mesothelioma treatment cost? +

  Mesothelioma treatment costs can range from $50,000 to $500,000+ depending on the type and duration of treatment. Surgery can cost $50,000–$150,000+, chemotherapy $10,000–$30,000+ per cycle, and immunotherapy $100,000–$250,000+ per year. However, most patients have options to offset these costs: health insurance, Medicare/Medicaid, VA benefits (for veterans), asbestos trust fund claims, and lawsuit settlements. Many mesothelioma patients recover significant compensation that covers treatment costs and provides financial security for their families. See our financial assistance guide for help.