Mesothelioma Treatment Options Overview

Treatment Overview

Mesothelioma treatment has advanced significantly in recent years.

Treatment options depend on:

• Stage at diagnosis (early vs. advanced)
• Mesothelioma type (pleural, peritoneal, etc.)
• Cell type (epithelioid, sarcomatoid, biphasic)
• Overall health and performance status
• Patient preferences

Surgery

Surgery offers the best chance for long-term survival but is only an option for approximately 20% of patients — those diagnosed early with good overall health.

Pleural Mesothelioma Surgery

Procedure	What It Does	Recovery Time	Best For
Extrapleural Pneumonectomy (EPP)	Removes affected lung, pleural lining, part of diaphragm, and pericardium	2-3 months	Patients in excellent health
Pleurectomy/Decortication (P/D)	Removes pleural lining while preserving the lung	1-2 months	Most surgical candidates

Peritoneal Mesothelioma Surgery

Cytoreductive Surgery (CRS) with HIPEC

Palliative Surgery

When curative surgery isn’t possible, palliative procedures can relieve symptoms:

• Pleurodesis: Seals pleural space to prevent fluid buildup
• Thoracentesis: Drains pleural fluid
• Paracentesis: Drains abdominal fluid
• Shunt placement: Allows continuous fluid drainage

Chemotherapy

Standard First-Line Regimen

Pemetrexed (Alimta) + Cisplatin or Carboplatin

This combination has been the standard of care for over 15 years:

• Given as IV infusion every 3 weeks
• Duration: 4-6 cycles typically
• Folic acid and vitamin B12 supplements reduce side effects

When Chemotherapy Is Used

Timing	Purpose
Neoadjuvant	Before surgery to shrink tumors
Adjuvant	After surgery to kill remaining cells
Primary	Main treatment when surgery isn't possible
Palliative	To slow progression and relieve symptoms

Cell Type Response

Chemotherapy effectiveness varies by cell type:

Cell Type	Median Survival with Chemo	Treatment Response
Epithelioid	26.7 months	Best response
Non-epithelioid	15 months	More resistant

Side Effects

Common chemotherapy side effects:

• Fatigue
• Nausea and vomiting
• Low blood counts
• Increased infection risk
• Hair thinning (not complete loss)
• Kidney effects (with cisplatin)

Immunotherapy

FDA-Approved: Opdivo + Yervoy

In October 2020, the FDA approved nivolumab (Opdivo) combined with ipilimumab (Yervoy) for first-line treatment of unresectable pleural mesothelioma.

Chemotherapy + Immunotherapy

Combining chemotherapy with durvalumab (another immunotherapy) has shown:

• Median survival: 20.4 months
• Better than either treatment alone

Who Responds Best

Not everyone responds equally to immunotherapy. Factors associated with better response:

• Higher PD-L1 expression
• Non-epithelioid cell types (surprisingly, these respond better to immunotherapy)
• Good overall health

Side Effects

Immunotherapy side effects differ from chemotherapy:

• Fatigue
• Skin rash
• Diarrhea
• Autoimmune reactions (thyroid, liver, lungs)
• Usually manageable with steroids

Radiation Therapy

Radiation is typically used in combination with other treatments, not alone.

Uses for Radiation

• Adjuvant: After surgery to kill remaining cells
• Palliative: To shrink tumors and relieve pain
• Prophylactic: To prevent tumor growth at surgical incision sites

Types of Radiation

• External beam radiation (EBRT): Standard approach
• Intensity-modulated radiation (IMRT): More precise targeting
• Proton therapy: Emerging option with less damage to healthy tissue

Multimodal Treatment

This is why seeking care at specialized mesothelioma centers matters — they offer comprehensive multimodal approaches.

Emerging Treatments & Clinical Trials

ADI-PEG20

Phase III ATOMIC-Meso trial results (February 2024):

Tumor Treating Fields (TTFields)

• Uses electric fields to disrupt cancer cell division
• Non-invasive device worn on the body
• Being studied in combination with chemotherapy

CAR T-Cell Therapy

• Genetically modifies patient’s immune cells to target cancer
• Early trials showing promise for mesothelioma
• Available through clinical trials

Gene Therapy

• Targets genetic mutations driving cancer growth
• Research ongoing for mesothelioma-specific approaches

Finding Clinical Trials

Treatment by Stage

Stage	Treatment Goal	Typical Treatment	Median Survival
Stage 1-2 (Early)	Cure or long-term control	Surgery (EPP or P/D) + chemotherapy, consider immunotherapy, clinical trials	19-22 months (longer with multimodal)
Stage 3 (Locally Advanced)	Control and extend life	Chemotherapy + immunotherapy (first-line), surgery for select patients, radiation	18 months
Stage 4 (Metastatic)	Quality of life & symptom control	Immunotherapy + chemotherapy, palliative care, clinical trials	13-15 months

Choosing a Treatment Center

Mesothelioma requires specialized expertise. Look for:

Questions to Ask Your Doctor