MESOTHELIOMA TREATMENT
While no known cure for mesothelioma exists, there are treatment options available which can prolong the lifespan of mesothelioma patients. Mesothelioma treatment options include surgery, chemotherapy, radiation therapy, and immunotherapy or a combination of any of the four, which has proven to be more effective than any one individual treatment alone. The type of treatment depends on the stage of the patient's cancer, their overall health, and the type of mesothelioma. In addition, mesothelioma patients may also try experimental treatments through clinical trials.
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)
This is another surgical treatment for pleural mesothelioma. This procedure removes the cancerous pleura along the chest wall and any visible tumors inside the chest, but unlike extrapleural pneumonectomy (EPP), it does not involve removing the lung. Patients diagnosed in the earlier stages and in relatively good health are typically good candidates for this surgery.
Cytoredcution with HIPEC
This is the primary surgical option for patients with peritoneal mesothelioma, a cancer that develops in the lining of the abdomen (peritoneum). The procedure removes visible tumors from the abdominal cavity and is often paired with hyperthermic intraperitoneal chemotherapy (HIPEC) to target remaining cancer cells. When combined, this treatment approach can significantly improve life expectancy. Patients diagnosed with peritoneal mesothelioma in the earlier stages and in good overall health are generally considered strong candidates for this surgery.
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 may be used in all stages of cancer. It may be used following surgery to remove any remaining areas of cancer that were not seen or removed during surgery, this is referred to as adjuvant radiation therapy. Radiation therapy may be used as a palliative procedure to ease mesothelioma symptoms such as pain, shortness of breath, etc. There are only two types of radiation therapy that are used to treat mesothelioma:
External beam radiation therapy (EBRT): This is the most common and effective. This radiation therapy uses x-rays from a machine outside the body to kill cancer cells.
Brachytherapy: For this kind of radiation therapy, which is rarely used for mesothelioma, a radiation source is put inside the body, in or near the cancer. Because the radiation travels only a very short distance, it minimizes any potential damage to nearby healthy tissues.
IMMUNOTHERAPY
Immunotherapy is a groundbreaking approach that enhances the body’s natural defenses to identify and fight cancer more effectively. In mesothelioma treatment, immunotherapy has emerged as a promising option—especially for patients who do not respond well to traditional methods like surgery, chemotherapy, or radiation.
Immune Checkpoint Inhibitors
One of the most significant advances in mesothelioma treatment involves immune checkpoint inhibitors. These drugs help restore the immune system’s ability to detect and destroy cancer cells by targeting specific proteins that normally keep immune cells from attacking healthy tissue.
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Nivolumab (Opdivo) and Ipilimumab (Yervoy):
This combination was approved by the FDA in October 2020 for adults with unresectable malignant pleural mesothelioma. Clinical studies showed that patients receiving these drugs experienced a median overall survival of 18.1 months—compared to 14.1 months with standard chemotherapy.
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Pembrolizumab (Keytruda):
Approved by the FDA in September 2024, Keytruda is used with pemetrexed and platinum-based chemotherapy as a first-line treatment for unresectable or advanced mesothelioma. Based on Phase 3 trials, this combination therapy significantly improved survival and reduced the risk of death by 21% compared to chemotherapy alone.
Ongoing Research and Clinical Trials
The field of mesothelioma immunotherapy is rapidly evolving. Current clinical trials are exploring new ways to boost treatment outcomes:
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Combination Therapies: Researchers are studying how immunotherapy works in combination with chemotherapy and radiation, aiming to enhance effectiveness and extend survival.
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Emerging Immunotherapies: Innovative strategies—such as cancer vaccines, T-cell therapies, and personalized immunotherapy—are under investigation and offer hope for the future of mesothelioma care.
For patients considering participation in clinical trials, it's essential to consult with healthcare providers to understand eligibility criteria and potential benefits. Clinical trials offer access to cutting-edge treatments that may not yet be widely available.
Side Effects and Considerations
Immune-Related Adverse Events: Since immunotherapy enhances immune activity, there's a risk of the immune system attacking healthy organs, leading to conditions like pneumonitis, colitis, hepatitis, and endocrinopathies. Prompt reporting of new or worsening symptoms to healthcare providers is vital for timely management.
