MESOTHELIOMA TREATMENT
While there is currently no known cure for mesothelioma, treatment can help control the disease, relieve symptoms, and in some cases extend survival. Treatment may include surgery, chemotherapy, radiation therapy, immunotherapy, or a combination of these approaches, depending on the type and stage of mesothelioma, whether the cancer can be surgically removed, and the patient’s overall health. Some patients may also be eligible for clinical trials evaluating newer or experimental treatments.
SURGERY
The three main types of surgery for mesothelioma include:
Extrapleural Pneumonectomy (EPP)
A surgical treatment for pleural mesothelioma, a cancer that develops in the lining of the lungs (pleura). This aggressive procedure involves removing the affected lung, the surrounding pleura, part of the diaphragm, and the pericardium (lining around the heart) to eliminate as much of the cancer as possible.
Pleurectomy/Decortication (P/D)
Pleurectomy/decortication (P/D) is a surgical treatment for pleural mesothelioma that removes the diseased pleura and as much visible tumor as possible while preserving the lung. Whether a patient is a candidate depends on factors such as the extent and location of the disease, mesothelioma subtype, overall health, and whether the cancer can be surgically removed.
Cytoreduction with HIPEC
Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) may be considered for selected patients with peritoneal mesothelioma. During cytoreductive surgery, surgeons remove as much visible tumor as possible from the abdominal cavity. HIPEC then delivers heated chemotherapy directly into the abdomen to target remaining cancer cells. Whether this approach is appropriate depends on factors such as the extent of the disease, the patient’s overall health, and whether the tumor can be effectively removed.
CHEMOTHERAPY
Chemotherapy involves the use of powerful anti-cancer drugs that kill fast-growing cells, including cancer cells. It remains a core treatment for mesothelioma, especially for patients who are not candidates for surgery or whose cancer has spread.
The standard first-line chemotherapy for pleural mesothelioma typically includes a combination of:
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Pemetrexed (Alimta®)
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Cisplatin or Carboplatin
Additional drugs may be used in second-line or experimental treatments, depending on the patient’s condition and cancer progression:
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Gemcitabine (Gemzar®)
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Methotrexate
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Vinorelbine
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Mitomycin
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Doxorubicin (Adriamycin®)
RADIATION
Radiation therapy uses high-energy beams to damage cancer cells and slow their growth. In mesothelioma treatment, radiation may be used to relieve symptoms such as pain, reduce tumor size, or help control disease in a specific area. It may also be used before or after surgery in selected cases.
External beam radiation therapy (EBRT) is the most commonly used form of radiation for mesothelioma. More advanced techniques, such as intensity-modulated radiation therapy (IMRT), allow doctors to target tumors more precisely while limiting radiation exposure to nearby healthy tissue. The type of radiation used depends on the location and extent of the cancer, the patient’s overall health, and the goals of
IMMUNOTHERAPY
Immunotherapy helps the immune system recognize and attack cancer cells. For some patients with malignant pleural mesothelioma, immunotherapy may be used as a first-line treatment or as part of treatment for advanced disease, depending on factors such as whether the cancer can be surgically removed, prior treatments, and the patient’s overall health.
Immune Checkpoint Inhibitors
Immune checkpoint inhibitors block proteins that cancer cells can use to avoid detection by the immune system. Several checkpoint inhibitors are now used in the treatment of malignant pleural mesothelioma.
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Nivolumab (Opdivo) and Ipilimumab (Yervoy): This combination was approved by the FDA in 2020 as a first-line treatment for adults with unresectable malignant pleural mesothelioma. In the CheckMate 743 trial, median overall survival was 18.1 months with nivolumab plus ipilimumab compared with 14.1 months with chemotherapy.
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Pembrolizumab (Keytruda): In September 2024, the FDA approved pembrolizumab in combination with pemetrexed and platinum-based chemotherapy as a first-line treatment for unresectable advanced or metastatic malignant pleural mesothelioma. In the KEYNOTE-483 trial, median overall survival was 17.3 months with pembrolizumab plus chemotherapy compared with 16.1 months with chemotherapy alone.
Ongoing Research & Clinical Trials
Researchers are also studying newer immunotherapy approaches, including combinations with other treatments and experimental immune-based therapies. These treatments are still being evaluated in clinical trials and are not appropriate for every patient.
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Combination Therapies: Researchers continue to study immunotherapy in combination with chemotherapy, radiation therapy, and other treatments to determine whether these approaches can improve outcomes for patients with mesothelioma.
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Emerging Immunotherapies: Other immune-based treatments, including cancer vaccines, T-cell therapies, and personalized approaches, are being studied in clinical trials. These treatments remain investigational and are not yet standard treatment for mesothelioma.
Side Effects and Considerations
Immunotherapy can cause side effects because it works by activating the immune system. In some cases, the immune system may also attack healthy tissues, leading to inflammation in organs such as the lungs, intestines, liver, skin, or hormone-producing glands. Side effects can range from mild to serious, so patients should report new or worsening symptoms to their healthcare team promptly. Whether immunotherapy is appropriate depends on factors such as the type and stage of mesothelioma, prior treatments, overall health, and other medical conditions.
Published by: Veterans Asbestos Alliance
Reviewer: T. Scott Hames, Asbestos Litigation Attorney
Last reviewed: October 2026
Sources:
• National Cancer Institute, Treatment for Mesothelioma
• American Cancer Society, Immunotherapy for Mesothelioma
