Mesothelioma Survival Rates by Treatment Type
Survival rates for mesothelioma by treatment: surgery, chemotherapy, immunotherapy, multimodal, and HIPEC. Data from SEER, NCI, and clinical trials.
The 12% five-year survival rate cited for pleural mesothelioma is a population average. It includes people diagnosed at every stage, with every cell type, receiving every level of treatment, including none at all.
The number that matters is the one that reflects a specific person’s situation: their type of mesothelioma, their cell type, and the treatment they receive. The data below breaks survival down by each of these variables, drawing from SEER, NCI, and the results of major clinical trials.
Survival by Treatment Approach
| Treatment | Median Survival | 1-Year | 2-Year | 5-Year |
|---|---|---|---|---|
| No treatment | 6-8 months | ~25% | ~10% | <5% |
| Chemotherapy alone (EMPHACIS / CheckMate 743 control) | 12-14 months | ~50% | 27% | 6% |
| Immunotherapy (nivo + ipi, CheckMate 743) | 18.1 months | 68% | 41% | 14% |
| Pembro + chemo (KEYNOTE-483) | 17.3 months | - | - | - |
| Extended P/D + chemo (MARS 2) | 19.3 months | - | - | - |
| SMART protocol (epithelioid-dominant) | 42.8 months | - | - | - |
| Peritoneal CRS/HIPEC | 39-80 months | - | - | 37-69% |
These figures represent medians across published studies and clinical trials. Individual outcomes vary based on stage, cell type, overall health, and treatment center.
Chemotherapy
Standard first-line chemotherapy for pleural mesothelioma is pemetrexed combined with cisplatin or carboplatin. The EMPHACIS trial that established this regimen reported a response rate of approximately 41% and a median overall survival of about 12 months. CheckMate 743’s chemotherapy control arm reached 14.1 months.
Before immunotherapy became available in 2020, this was the only approved systemic treatment. It remains part of the standard of care, either alone or combined with immunotherapy.
For people who cannot receive immunotherapy due to autoimmune conditions or other factors, chemotherapy alone still offers a meaningful extension of life compared to best supportive care.
Immunotherapy
Immunotherapy has produced the most significant survival improvements in mesothelioma over the past five years.
Nivolumab Plus Ipilimumab (CheckMate 743)
The CheckMate 743 trial demonstrated an 18.1-month median survival with nivolumab plus ipilimumab, compared to 14.1 months for chemotherapy. The five-year data showed the benefit grew over time: 14% of people on immunotherapy were alive at five years versus 6% on chemotherapy. One-year overall survival was 68% on immunotherapy, and two-year survival was 41% versus 27% on chemotherapy.
The benefit was most pronounced for non-epithelioid cell types, where the hazard ratio favored immunotherapy more strongly than in the epithelioid subgroup.
Pembrolizumab Plus Chemotherapy (KEYNOTE-483)
KEYNOTE-483 showed that adding pembrolizumab to chemotherapy produced a 52% response rate and a median survival of 17.3 months, versus 16.1 months for chemotherapy alone. The FDA approved this combination in September 2024.
Surgery
The role of surgery in mesothelioma depends heavily on the specific procedure, the surgeon’s experience, and the disease type.
Pleural Mesothelioma
Two main surgical approaches exist for pleural mesothelioma: pleurectomy/decortication (P/D) and extrapleural pneumonectomy (EPP).
| Procedure | Median Survival | Notes |
|---|---|---|
| P/D (lung-sparing) | ~58 months | High-volume cohorts, epithelioid, macroscopic complete resection |
| EPP (lung removed) | 15-20 months | Higher morbidity, declining use |
| Extended P/D + chemo (MARS 2) | 19.3 months | Chemo alone reached 24.8 months in the same trial |
The MARS 2 trial tested extended pleurectomy/decortication plus chemotherapy against chemotherapy alone. Adding surgery did not improve survival in that broad population; the chemotherapy-only arm actually reached a higher median. Lung-sparing P/D at specialized centers continues to produce different outcomes in highly selected people, particularly those with epithelioid cell type and early-stage disease.
Peritoneal Mesothelioma: CRS/HIPEC
Cytoreductive surgery with heated intraperitoneal chemotherapy (HIPEC) for peritoneal mesothelioma produces meaningfully better outcomes than systemic treatment alone.
| Measure | CRS/HIPEC Results |
|---|---|
| Median survival, complete cytoreduction (Sugarbaker 2006) | 37.8 months |
| Median survival range across large series | 39-80 months |
| Median survival, CC-2 residual disease | 6.5 months |
| 5-year survival range | 37-69% |
The key variable is cytoreduction completeness. When surgeons remove all visible disease (CC-0 or CC-1), Sugarbaker’s 2006 cohort reported a median survival of 37.8 months, and repeat CRS/HIPEC series have reported medians up to 80 months. When residual disease exceeds 2.5 cm (CC-2), median survival falls to 6.5 months in the same primary source.
Multimodal Treatment
Multimodal therapy combines two or more treatment types, typically surgery with chemotherapy and sometimes radiation.
| Combination | Median Survival | Best For |
|---|---|---|
| SMART protocol (radiation first, then EPP) | 42.8 months | Epithelioid-dominant cohorts; 72% 3-year OS |
| SMART protocol, epithelioid N0 subgroup (n=19) | 65.9 months | Select early-stage epithelioid |
| Perioperative nivo + ipi + surgery (Hopkins Arm B) | 28.6 months | Phase 2 data, n=14 |
The Hopkins perioperative immunotherapy trial reported a 28.6-month median survival in its combination arm (Arm B) in Nature Medicine in 2025. The SMART protocol, developed at the University of Toronto, delivers hemithoracic intensity-modulated radiation before EPP; de Perrot’s primary publication reports a 72% three-year survival in epithelioid-dominant cohorts and a 65.9-month median in N0 epithelioid patients.
Survival by Cell Type
Cell type is one of the strongest predictors of how well treatment works.
| Cell Type | Frequency | Treatment Response |
|---|---|---|
| Epithelioid | 50-70% | Responds to all treatments; longest survival across regimens |
| Biphasic | 20-35% | Variable, depends on epithelioid ratio |
| Sarcomatoid | 10-20% | Historically poor response; non-epithelioid subgroup benefited most from immunotherapy in CheckMate 743 |
The most important shift in recent years is for non-epithelioid disease. Historically, sarcomatoid and biphasic subtypes responded poorly to every treatment. CheckMate 743 showed the non-epithelioid subgroup derived a larger benefit from nivolumab plus ipilimumab than the epithelioid subgroup. ATOMIC-Meso, which enrolled non-epithelioid disease (sarcomatoid and biphasic), reported a three-year overall survival of 11.9% with pegargiminase plus chemotherapy versus 3.3% with placebo plus chemotherapy, a roughly 3.6-fold difference.
Survival by Stage
Stage at diagnosis has an outsized impact on treatment eligibility. Most people with pleural mesothelioma present with advanced disease.
SEER reports survival using Localized, Regional, and Distant summary stage rather than TNM Stage 1 through 4. Pleural mesothelioma five-year survival by SEER summary stage:
| SEER Summary Stage | 5-Year Survival |
|---|---|
| Localized | 20% |
| Regional | 16% |
| Distant | 8% |
Cohort studies that use TNM staging report median survivals of roughly 19-21 months at Stage 1, 13-16 months at Stage 3, and 9-12 months at Stage 4. The gap between earlier and later stages reflects the limited five-year survival of pleural mesothelioma with standard treatment across all stages, as well as selection bias in who reaches aggressive multimodal treatment.
Survival statistics represent population averages from published data. Individual outcomes depend on treatment center experience, cell type, overall health, and treatment response. People considering treatment options should discuss their specific situation with their medical team. The 2026 clinical trials landscape report lists 92 trials currently open.
References
NCI SEER Cancer Stat Facts: Mesothelioma. National Cancer Institute, Surveillance, Epidemiology, and End Results Program..
https://seer.cancer.gov/statfacts/html/meso.html
National Cancer Institute. Malignant Mesothelioma Treatment..
https://www.cancer.gov/types/mesothelioma
Baas et al. First-line nivolumab plus ipilimumab in unresectable malignant pleural mesothelioma (CheckMate 743). NEJM, 2021. PMID 33485464..
https://www.nejm.org/doi/full/10.1056/NEJMoa2003798
Scherpereel et al. CheckMate 743 five-year overall survival update. Journal of Clinical Oncology, 2026..
https://ascopost.com/news/march-2026/five-year-outcomes-with-first-line-nivolumab-plus-ipilimumab-in-unresectable-pleural-mesothelioma/
Lim et al. MARS 2: Extended pleurectomy decortication versus chemotherapy alone. Lancet Respiratory Medicine, 2024. PMID 38740044..
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(24)00029-0/fulltext
Szlosarek et al. ATOMIC-Meso: Pegargiminase plus chemotherapy in non-epithelioid mesothelioma. JAMA Oncology, 2024..
https://jamanetwork.com/journals/jamaoncology/fullarticle/2815000
de Perrot et al. SMART protocol (accelerated hemithoracic IMRT followed by EPP) for pleural mesothelioma. Journal of Thoracic Oncology, 2021..
https://pubmed.ncbi.nlm.nih.gov/33450184/
Forde et al. Perioperative nivolumab with or without ipilimumab for resectable diffuse pleural mesothelioma. Nature Medicine, 2025;31(12):4097-4108..
https://pubmed.ncbi.nlm.nih.gov/40921804/
Sugarbaker et al. Cytoreductive surgery and HIPEC for peritoneal mesothelioma. 2006. PMID 16485159..
https://pubmed.ncbi.nlm.nih.gov/16485159/
FDA. KEYNOTE-483 approval of pembrolizumab plus chemotherapy for unresectable advanced pleural mesothelioma..
https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-pembrolizumab-chemotherapy-unresectable-advanced-or-metastatic-malignant-pleural
Reader Q&A
Frequently Asked Questions
What is the average life expectancy for mesothelioma?
Median survival for untreated pleural mesothelioma is roughly six to eight months. Chemotherapy alone extends the median to 12-14 months. Nivolumab plus ipilimumab extended median survival to 18.1 months in CheckMate 743, and the SMART protocol has reported a 42.8-month median in epithelioid-dominant cohorts at specialized centers.
Which mesothelioma treatment has the highest reported median survival?
For pleural mesothelioma, the SMART protocol has reported the highest published median at 42.8 months in epithelioid-dominant cohorts. For peritoneal mesothelioma, CRS/HIPEC series report five-year survival of 37-69% with medians of 39-80 months.
Has immunotherapy improved mesothelioma survival?
Yes. CheckMate 743 showed that nivolumab plus ipilimumab extended median survival to 18.1 months from 14.1 months with chemotherapy. At five years, 14% of people on immunotherapy were still alive versus 6% on chemotherapy.
What is the survival rate for peritoneal mesothelioma?
SEER reports a five-year survival of approximately 65% for peritoneal mesothelioma overall. CRS/HIPEC series report five-year survival in the 37-69% range, with median survival of 39-80 months across large cohorts. Sugarbaker’s 2006 complete-cytoreduction cohort reported a 37.8-month median.
Does cell type affect mesothelioma survival?
Significantly. People with epithelioid mesothelioma have the longest median survival across every treatment regimen. Non-epithelioid disease (sarcomatoid and biphasic) has historically responded poorly to chemotherapy but showed larger relative benefit from immunotherapy in CheckMate 743 and from pegargiminase plus chemotherapy in ATOMIC-Meso.
Does surgery help mesothelioma survival?
It depends on the procedure and the center. The MARS 2 trial found that adding extended pleurectomy/decortication to chemotherapy did not improve survival versus chemotherapy alone (19.3 vs. 24.8 months). High-volume centers report longer medians with lung-sparing P/D in selected epithelioid patients. CRS/HIPEC for peritoneal mesothelioma shows five-year survival of 37-69%.
What percentage of people with mesothelioma survive five years?
SEER reports an overall five-year survival of 12% for pleural mesothelioma, with 20% for Localized, 16% for Regional, and 8% for Distant disease. Treatment changes this: 6% for chemotherapy alone in CheckMate 743, 14% for nivolumab plus ipilimumab, and 37-69% for peritoneal CRS/HIPEC cohorts.
What is a treatment in statistics?
In statistics, a treatment refers to the specific conditions, interventions, or levels of a factor applied to experimental units to assess their impact on outcomes. Examples include different medication dosages, teaching methods, or fertilizers administered to groups for comparison. Treatments enable evaluation of cause-and-effect relationships through methods like ANOVA or randomized experiments, often contrasting with control groups.