Mesothelioma Treatment Options

Understanding your treatment options is crucial for making informed decisions about your mesothelioma care. Treatment plans are typically personalized based on mesothelioma type, stage, location, overall health, and individual preferences.

Overview of Treatment Approaches

Mesothelioma treatment typically involves one or a combination of the following approaches:

  • Surgery: Removal of tumors and affected tissue
  • Chemotherapy: Medication to kill cancer cells
  • Radiation Therapy: High-energy rays to destroy cancer cells
  • Immunotherapy: Treatments that help your immune system fight cancer
  • Multimodal Therapy: Combination of two or more treatment types
  • Clinical Trials: Access to experimental and emerging treatments

Surgical Options

Curative Surgery

For patients with early-stage mesothelioma, aggressive surgery may aim to remove all visible cancer:

Extrapleural Pneumonectomy (EPP)

  • Removal of the affected lung, pleura, diaphragm, and pericardium
  • Reserved for select patients with pleural mesothelioma
  • Major surgery with significant recovery time

Pleurectomy/Decortication (P/D)

  • Removal of the pleura and visible tumors while preserving the lung
  • Less invasive than EPP with potentially lower risk
  • Increasingly preferred for eligible candidates

Peritonectomy with HIPEC

  • For peritoneal mesothelioma
  • Removal of peritoneal lining combined with heated intraperitoneal chemotherapy
  • Can significantly extend survival in select patients

Palliative Surgery

To relieve symptoms and improve quality of life:

Pleurodesis

  • Procedure to prevent fluid buildup between lung and chest wall
  • Reduces breathlessness and discomfort

Thoracentesis and Paracentesis

  • Drainage of excess fluid from chest or abdomen
  • Provides temporary symptom relief

Chemotherapy

Chemotherapy uses drugs to kill cancer cells or slow their growth:

Standard Chemotherapy

Pemetrexed (Alimta) + Cisplatin

  • The gold standard first-line treatment for pleural mesothelioma
  • Approved by FDA specifically for mesothelioma
  • Typically administered intravenously every 3 weeks

Alternative Regimens

  • Pemetrexed + Carboplatin (for patients who cannot tolerate cisplatin)
  • Gemcitabine-based combinations
  • Second-line chemotherapy options for disease progression

Targeted Delivery

HIPEC (Hyperthermic Intraperitoneal Chemotherapy)

  • Heated chemotherapy delivered directly into the abdomen
  • Used during surgery for peritoneal mesothelioma
  • Increases drug effectiveness while reducing systemic side effects

Radiation Therapy

Radiation uses high-energy beams to kill cancer cells:

Types of Radiation Therapy

External Beam Radiation

  • Most common type for mesothelioma
  • Precise targeting of tumor areas
  • Often used after surgery or for symptom control

Intensity-Modulated Radiation Therapy (IMRT)

  • Advanced technique for precise dose delivery
  • Minimizes damage to surrounding healthy tissue
  • May improve outcomes and reduce side effects

Applications

  • Post-surgical radiation to prevent recurrence
  • Palliative radiation for pain relief
  • Treatment of metastatic lesions
  • Part of multimodal treatment plans

Immunotherapy

Immunotherapy helps your immune system recognize and attack cancer cells:

FDA-Approved Options

Nivolumab (Opdivo) + Ipilimumab (Yervoy)

  • Approved in 2020 for first-line treatment of unresectable pleural mesothelioma
  • Immune checkpoint inhibitors
  • Alternative to chemotherapy for eligible patients

How It Works

  • Blocks proteins that prevent immune system from attacking cancer
  • Can produce durable responses in some patients
  • Different side effect profile than chemotherapy

Emerging and Experimental Treatments

Clinical Trials

Access to innovative treatments through research studies:

  • Novel immunotherapy combinations
  • Targeted therapies based on genetic mutations
  • CAR T-cell therapy
  • Tumor treating fields (TTFields)
  • Photodynamic therapy
  • Gene therapy approaches

Why Consider Clinical Trials

  • Access to cutting-edge treatments
  • Close monitoring by specialist teams
  • Contribution to medical research
  • May offer hope when standard treatments are ineffective

Multimodal Treatment

Combining treatment approaches often provides the best outcomes:

Common Combinations

Surgery + Chemotherapy

  • Neoadjuvant chemotherapy before surgery to shrink tumors
  • Adjuvant chemotherapy after surgery to eliminate remaining cancer cells

Surgery + Chemotherapy + Radiation

  • Aggressive trimodal approach for select patients
  • May offer best chance for long-term survival
  • Requires careful patient selection and experienced medical team

Supportive and Palliative Care

Managing symptoms and maintaining quality of life:

Symptom Management

  • Pain control strategies
  • Breathlessness management
  • Nutrition support
  • Fatigue management
  • Emotional and psychological support

Palliative Care Services

  • Specialized medical care focused on relief from symptoms
  • Can be provided alongside curative treatment
  • Improves quality of life for patients and families
  • Access to social work, counseling, and spiritual support

Choosing Your Treatment

Factors to Consider

  • Disease Stage: Early-stage vs. advanced disease
  • Mesothelioma Type: Pleural, peritoneal, or other
  • Cell Type: Epithelioid, sarcomatoid, or biphasic
  • Overall Health: Ability to tolerate aggressive treatments
  • Personal Goals: Quality vs. quantity of life preferences
  • Treatment Center: Access to experienced mesothelioma specialists

Questions to Ask Your Doctor

  1. What is my specific mesothelioma type and stage?
  2. What are all my treatment options?
  3. What are the goals of each treatment option?
  4. What are the potential benefits and risks?
  5. How will treatment affect my quality of life?
  6. Should I consider a second opinion or specialist center?
  7. Am I eligible for clinical trials?
  8. What supportive care services are available?

Finding Specialized Care

Mesothelioma is a rare cancer, and treatment at a specialized center can significantly impact outcomes:

Benefits of Specialized Centers

  • Experienced surgical teams
  • Access to advanced treatments and clinical trials
  • Multimodal treatment coordination
  • Support services for patients and families

National Cancer Institute-Designated Centers

Consider seeking treatment at NCI-designated comprehensive cancer centers with mesothelioma expertise.

Additional Resources

For more detailed information about specific treatments, explore our articles:

Medical Disclaimer: This information is for educational purposes only and should not replace consultation with qualified healthcare professionals. Treatment decisions should be made in partnership with your medical team based on your individual circumstances.

Last Updated: December 21, 2025

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