Mesothelioma Treatment

Q: What is the best way to treat mesothelioma?

The best way to treat mesothelioma is with surgery and other therapies, such as chemotherapy or immunotherapy, before or after the operation. This approach is called multimodal mesothelioma treatment and offers patients the best chance for a long life expectancy.

The top options for mesothelioma treatment are surgery, immunotherapy, chemotherapy and radiation. Follow this mesothelioma treatment guide to give yourself the best chance of beating the cancer. Treatment for mesothelioma cancer from an experienced doctor and medical team gives patients the best chances for long survival with good quality of life.

AI Summary of Mesothelioma Treatment

Mesothelioma is a rare and aggressive cancer that affects the lining of the lungs, abdomen, heart, or testicles. Due to its complexity and the specialized nature of treatment options, it is very important for patients to seek care from experienced mesothelioma specialists. Treatment aims to control the cancer, relieve symptoms, and improve quality of life.

Important Facts About Mesothelioma Treatment

Mesothelioma treatment is the best way to stop this aggressive cancer from spreading.
Approximately 74% of patients receive at least one type of mesothelioma therapy.
The most common mesothelioma treatment option is chemotherapy, followed by surgery.
The United States Food and Drug Administration (FDA) approved chemotherapy, immunotherapy and tumor treating fields for mesothelioma. Doctors recommend these options to patients who cannot or do not want to have surgery.

What Are the Top Options for Mesothelioma Treatment?

The top mesothelioma treatment options are surgery, chemotherapy, immunotherapy and radiation. This guide to mesothelioma treatment explains each.

Surgery is the first option considered for mesothelioma. The FDA approved chemotherapy, immunotherapy, and a tumor treating fields device for patients who cannot have surgery.

Clinical trials for mesothelioma test new surgical methods, treatment combinations and therapies. Two examples of emerging mesothelioma treatments available today in clinical trials include the use of oncolytic viruses and CAR T cells.

Mesothelioma specialists prefer to combine the top treatment options. This approach is called multimodal mesothelioma treatment. The most common combination is surgery and chemotherapy.

FDA-Approved Treatment for Malignant Mesothelioma

There are three FDA-approved treatment options for malignant mesothelioma:

Chemotherapy
(pemetrexed and cisplatin)

Immunotherapy
(Opdivo and Yervoy, or
Keytruda)

Tumor treating fields
(Optune Lua)

The FDA approved pemetrexed and cisplatin as a combination chemotherapy regimen. Some patients may react poorly to cisplatin. In those instances, patients can receive carboplatin as a substitute.

The FDA approved Opdivo and Yervoy as a combination immunotherapy regimen for people with pleural mesothelioma who cannot have surgery. Pleural mesothelioma is a type of mesothelioma that forms in the lining of the lungs. Keytruda, another immunotherapy, is also approved for people with pleural mesothelioma who cannot have surgery.

How to Receive the Best Mesothelioma Treatment

Here are four steps to receive the best mesothelioma treatment:

See a mesothelioma specialist. Seeing a general oncologist for treatment is not recommended for people with mesothelioma. Reach out to an experienced mesothelioma doctor or surgeon. This cancer is rare, and specialists have necessary training to treat mesothelioma.

Do your research. Look into the different treatment options and what they require of patients. Read about recovery times from surgery and potential side effects from treatment medications. See what other mesothelioma patients – such as mesothelioma survivor Gary Maxwell – suggest.

Consider financial assistance to pay for treatment. Mesothelioma treatment is often expensive. Patients and their families should not need to handle the cost burden alone. Financial assistance, such as travel grants or other compensation, is available to help pay for mesothelioma treatment.

Speak with a mesothelioma treatment guide. People with mesothelioma do not need to go through the treatment process alone. Patient advocates are the best mesothelioma treatment guides and allies. They provide information on which U.S. cancer centers have mesothelioma treatment programs, mesothelioma specialists, and mesothelioma clinical trials. Patient advocates also can help connect patients with specialists, answer questions and provide other resources. Rely on these experts – such as Mesothelioma Guide’s registered nurse Karen Ritter – for help navigating treatment of this complex cancer.

Treatment by Type of Mesothelioma

There are four types of mesothelioma, and treatment options are different for each:

Pleural Mesothelioma

Pleural mesothelioma forms in the tissue lining of the lungs.

Peritoneal Mesothelioma

Peritoneal mesothelioma forms in the lining around the abdominal cavity.

Pericardial Mesothelioma

Pericardial mesothelioma forms in the lining around the heart.

Testicular Mesothelioma

Testicular mesothelioma forms in the lining around the testes.

Pleural mesothelioma and peritoneal mesothelioma are the most common types. They account for approximately 99% of diagnosed mesothelioma cases. These two types have the most treatment options.

There are two surgeries for pleural mesothelioma and one surgery for peritoneal mesothelioma. Radiation is a common option for pleural mesothelioma only. Immunotherapy is FDA-approved for pleural mesothelioma, and it’s in clinical trial testing for peritoneal mesothelioma.

Mesothelioma Surgery

There are three main options for mesothelioma surgery:

Pleurectomy with decortication
Extrapleural pneumonectomy
Cytoreduction surgery with HIPEC.

doctors with scrubs and mask on performing surgery

The two surgery options for pleural mesothelioma are:

Pleurectomy with decortication
Extrapleural pneumonectomy

There is only one main surgery for peritoneal mesothelioma: cytoreduction with hyperthermic intraperitoneal chemotherapy (HIPEC). This mesothelioma treatment option combines surgery and a type of heated chemotherapy treatment.

QUICK FACT

Approximately 27% of diagnosed mesothelioma patients receive surgery. In a study published in 2023, the average survival for patients receiving mesothelioma surgery was a little more than 2 years.

Surgery for Pleural Mesothelioma

Pleurectomy With Decortication (P/D)

Pleurectomy with decortication (P/D) is an aggressive surgery for pleural mesothelioma with the potential to eliminate the cancer and help patients live long past the average survival.

P/D surgery removes the pleura, which is a thin lining between your chest wall and lung. Pleural mesothelioma forms in this location.

Some doctors may need to remove part of the patient’s diaphragm and pericardium (lining around the heart) during P/D surgery, depending on the extent of the cancer. P/D surgery does not involve removing the patient’s lung, which is why doctors call it the “lung-sparing” mesothelioma surgery. Tumors often spread from the pleura toward the lungs.

Patients who received P/D had a median survival of 22 months following surgery, in a study at world-renowned MD Anderson Cancer Center in Houston, Texas.

Extrapleural Pneumonectomy (EPP)

Extrapleural pneumonectomy (EPP) is an aggressive surgery for pleural mesothelioma with the potential of eliminating tumors by taking out the patient’s lung.

During EPP, surgeons remove the pleura, the affected lung, part of the diaphragm, and the pericardium. EPP is more aggressive than P/D since the lung is taken out. Doctors may prefer this surgery since it is more aggressive, but it can cause complications after surgery since patients only have one lung remaining.

In the same study at MD Anderson, patients receiving EPP had a median survival of 15 months following surgery. Other studies report average survival of 2-3 years thanks to EPP.

Surgery for Peritoneal Mesothelioma

Cytoreduction With HIPEC

Cytoreduction with HIPEC is an aggressive surgery for peritoneal mesothelioma that utilizes chemotherapy during the procedure.

Cytoreduction is a debulking surgery. Doctors remove all visible tumors and diseased tissue in and near the abdominal cavity. Doctors remove the omentum (a large, flatty tissue layer in the abdomen) during cytoreduction. They may remove the peritoneum (thin lining around the abdominal cavity), which is where peritoneal mesothelioma forms. Doctors may also remove the spleen, gallbladder, or part of the small and large intestines.

HIPEC is a heated chemotherapy treatment. It stands for hyperthermic intraperitoneal chemotherapy.

During the HIPEC part, doctors insert a hot liquid chemotherapy solution into the abdominal cavity. This bathes the inside of the abdominal cavity with chemotherapy. The intent is to kill any remaining cancer cells.

Patients receiving cytoreduction with HIPEC in one particular study had a median survival time of a little more than 3 years following surgery. The study included more than 700 cases of patients receiving this mesothelioma treatment.

Mesothelioma Pain-Relief Surgery

Mesothelioma pain-relief surgery is not an aggressive type of surgery. This type of surgery can drain excess fluid and reduce symptoms. Fluid often builds up in the thin linings where mesothelioma forms, and doctors can drain the fluid to relieve pressure. Doctors recommend these procedures to help patients improve their quality of life.

Thoracentesis (for pleural mesothelioma) removes excess fluid from inside the pleural cavity around the lungs. Paracentesis (for peritoneal mesothelioma) removes fluid from inside the peritoneal lining in the abdominal cavity.

Mesothelioma Chemotherapy

Mesothelioma chemotherapy is the most common treatment for this cancer. Approximately 74% of diagnosed mesothelioma patients received chemotherapy.

The mesothelioma chemotherapy drugs are:

Pemetrexed (FDA-approved)
Gemcitabine
Cisplatin (FDA-approved)
Vinorelbine
Carboplatin (FDA-approved as a substitute for cisplatin)
Doxorubicin

Types of Mesothelioma Chemotherapy

There are three main types of mesothelioma chemotherapy:

Systemic chemotherapy

Given through an IV into the bloodstream, where the medications travel through the body killing tumor cells. This type of chemotherapy can cause nausea, fatigue and decreased appetite.

Intraoperative chemotherapy

Given directly into the chest or abdominal cavity during surgery. The chemotherapy is in liquid form, usually heated. Doctors drain the chemotherapy from the body after a short time (usually less than two hours). HIPEC is an example of intraoperative chemotherapy.

Dwell chemotherapy

Given directly into the disease location (near the lungs or in the abdominal cavity) through catheters. The chemotherapy remains in the patient’s body for multiple days.

Mesothelioma Immunotherapy

Mesothelioma immunotherapy uses drugs to help the patient’s immune system attack and kill cancer cells.

There are three FDA-approved immunotherapy treatments for pleural mesothelioma:

Opdivo (nivolumab) and Yervoy (ipilimumab) image

Opdivo (nivolumab) and Yervoy (ipilimumab) – Approved together as an immunotherapy combination for unresectable malignant pleural mesothelioma.

Keytruda (pembrolizumab) – Approved for people with unresectable malignant pleural mesothelioma.

Immunotherapy often causes fewer side effects and less severe side effects than chemotherapy. Nearly 6% of people diagnosed with mesothelioma receive immunotherapy, and the number is growing each year as more doctors recommend this treatment option.

Some patients also have longer survival. In the Checkmate 743 study, Opdivo and Yervoy led to a median survival of 18 months, while chemotherapy led to a median survival of 14 months.

Median Survival Rate

18 Months with Opdivo and Yervoy

14 Months with chemotherapy

Mesothelioma Radiation Therapy

Mesothelioma radiation therapy, also called radiotherapy, delivers high-energy radiation particles at tumors. These particles disrupt the cancer cells’ ability to multiply and grow the tumor.

There are three types of radiation therapy for pleural mesothelioma:

Photon Radiation Therapy

Traditional type that causes the most damage to healthy tissue.

Intensity-Modulated Radiation Therapy (IMRT)

Run by computer programs that sends more targeted beams from different angles.

Proton Radiation Therapy

The most advanced type of radiation for mesothelioma as it limits the beam to the intended target and reduces the amount of radiation spray to nearby healthy tissue and organs.

*In one study, photon radiation therapy caused 25% of mesothelioma patients receiving radiation to experience severe lung tissue inflammation (pneumonitis). IMRT caused severe pneumonitis for less than 10% of patients, and proton radiation caused severe pneumonitis for only 5% of patients.

Approximately 8% of people with mesothelioma receive radiation therapy. Doctors may recommend it for people diagnosed with pleural mesothelioma. Radiation is not a main option for people with peritoneal mesothelioma.

Tumor Treating Fields for Mesothelioma

Tumor treating fields for mesothelioma are electric waves sent by a wearable device through the cancer site. These waves disrupt cell division and prevent tumor growth.

The FDA approved tumor treating fields for unresectable malignant pleural mesothelioma. The approved device is called Optune Lua. This therapy is used along with the patient’s mesothelioma chemotherapy treatment.

Patients wear the device for approximately 18 hours a day. It does not affect people’s sleep or ability to perform daily tasks.

Emerging Treatment Options for Mesothelioma

Emerging treatment options for mesothelioma include:

Gene therapy

Virotherapy
(oncolytic viruses)

Cell therapy

Patients can receive these treatments in clinical trials. Scientists continue to research and test new therapies for mesothelioma.

Importance of Exercise and Nutrition During Mesothelioma Treatment

Exercise and nutrition play an important role in the mesothelioma treatment journey. Treatment options such as surgery and chemotherapy require good physical health and a healthy lifestyle.

People with mesothelioma need a high-protein diet. This helps patients maintain their muscle strength and receive their daily calorie intake. Suggested foods include chicken, turkey, eggs, cottage cheese and fish. Vegetarians should eat and drink plenty of soy milk, tofu, almonds, walnuts and peanut butter.

HELPFUL TIP

Experts recommend people undergoing mesothelioma chemotherapy treatment or recovering from mesothelioma surgery have 5-6 smaller meals a day rather than three large meals. Smaller meals help avoid getting tired or sick from a larger intake of nutrients.

Regular exercise helps the body prepare for treatment and recover after treatment. Walking, light jogging, and mild resistance training are recommended activities.

Top Doctors and Cancer Centers for Mesothelioma Treatment

There are many extraordinary mesothelioma doctors who have treated patients and helped people beat mesothelioma. These doctors are called mesothelioma specialists since they specialize in understanding the cancer and knowing the best options for treatment.

Some of the top mesothelioma specialists are:

Dr. Hassan Khalil

Thoracic surgeon in
Boston, MA, specializing in
pleural mesothelioma

Contact Dr. Hassan Khalil

Dr. Eugene Choi

Surgical oncologist in
Houston, TX, specializing in
peritoneal mesothelioma

Contact Dr. Eugene Choi

Dr. Joseph Friedberg

Thoracic surgeon in
Philadelphia, PA, specializing in
pleural mesothelioma

Contact Dr. Joseph Friedberg

Dr. James Pingpank

Surgical oncologist in
Pittsburgh, PA, specializing in
peritoneal mesothelioma

Contact Dr. James Pingpank

People with mesothelioma have the greatest chance of receiving the best treatment options when they seek medical care from experienced mesothelioma specialists. Many of the esteemed cancer hospitals in the United States have these doctors on staff.

Below are several of the high-ranking mesothelioma cancer centers of excellence:

Brigham and
Women’s Hospital

Boston, MA

Specialty: Pleural
Mesothelioma

Baylor St. Luke's
Medical Center

Houston, TX

Specialty: Peritoneal
Mesothelioma

Wake Forest
Baptist Health

Winston-Salem, NC

Specialty: Pleural and
Peritoneal Mesothelioma

University of Pittsburgh Medical Center

Pittsburgh, PA

Specialty: Peritoneal
Mesothelioma

Mesothelioma Treatment Survival Stories

Treatment regularly extends the lives of people with mesothelioma. There are many inspiring mesothelioma survival stories thanks to specialized mesothelioma treatment. Three of these stories are below.

GARY MAXWELL

Gary Maxwell was diagnosed with pleural mesothelioma in 2014. His survival of a decade is thanks largely to receiving P/D surgery soon after his diagnosis.

Read About Gary

ALEXIS KIDD

Alexis Kidd was diagnosed with peritoneal mesothelioma in 2007. She has survived for more than 15 years. Alexis underwent cytoreduction with HIPEC a few months after her diagnosis.

Read About Alexis

JODI PAGE

Jodi Page was diagnosed with pleural mesothelioma in December 1999, more than 20 years ago. She underwent EPP surgery.

Read About Jodi

Mesothelioma Treatment Costs

Mesothelioma treatment is expensive. Doctor’s visits and appointments, surgery, inpatient hospital care, chemotherapy, immunotherapy and physical therapy for recovery can add up to hundreds of thousands of dollars in medical costs.

In 2014, the average cost for in-patient care was $24,000 per patient. This amount likely has increased in the 10 years since the data.

Below are a few examples of estimated mesothelioma treatment costs on average at hospitals:

EPP surgery
$62,000

Immunotherapy
More than $200,000/year

P/D surgery
$54,000

Chemotherapy
$35,000

Cytoreduction with HIPEC
$20,000

Radiation
$9,000

Note: These amounts are not how much patients must pay as they do not factor insurance coverage. They are estimated cost amounts from the hospital.

Paying for Mesothelioma Treatment

There are several options to help with paying for mesothelioma treatment. These include health insurance, assistance from VA benefits programs or nonprofits, and legal compensation.

Health Insurance for Mesothelioma Treatment

Many health insurance providers pay for most cancer treatment options such as surgery and chemotherapy. Patients and their families may have to pay deductibles and copays for treatments and medications depending on the specifics of their health coverage.

For example, the website VeryWellHealth reports that lung cancer patients with Medicare health insurance paid on average $1,738 out of pocket for surgery. Their insurance plans covered chemotherapy treatment with no out-of-pocket costs. Lung cancer is a similar disease to mesothelioma and the treatment costs are comparable.

Some insurance plans do not cover unexpected costs such as:

Daily living expenses
Hiring a caregiver
Travel costs to a top cancer center for treatment
Lodging when receiving treatment in a different city or state
Other transportation costs such as gas, mileage and parking fees

Financial Assistance Programs

There are nonprofit organizations providing financial assistance to people with mesothelioma and their families. Two examples of assistance are: travel grants and free or discounted flights. Mesothelioma support resources help people receive the best treatment possible from top doctors and cancer centers even if they are across the country.

Veterans with mesothelioma can receive VA benefits to help pay for treatment. Benefits that provide compensation include VA Disability Compensation or VA Pension.

Legal Compensation to Pay for Mesothelioma Treatment

Another recommended option to help pay for mesothelioma treatment is legal compensation. People affected by mesothelioma are victims of corporate negligence and greed. Asbestos was a prized mineral during the 20th century. It’s also the only known cause of mesothelioma cancer, and companies used asbestos in manufacturing despite knowing the harm they were causing.

Legal compensation from asbestos trust funds is available to people diagnosed with mesothelioma. This form of compensation does not require a lawsuit or going to court. Companies set aside money in asbestos trust funds to pay the victims of asbestos exposure.

Contact our patient advocate team to learn how to access this money owed to you.

Frequently Asked Questions About Mesothelioma Treatment

Can mesothelioma be treated?

Yes, mesothelioma can be treated with surgery, chemotherapy, immunotherapy and radiation therapy. It is recommended to receive treatment from a mesothelioma specialist at a top cancer hospital. Mesothelioma specialists are doctors trained to treat this specific type of cancer.

How is pleural mesothelioma treated?

Pleural mesothelioma is treated with surgery, chemotherapy, immunotherapy and radiation therapy. The two main surgeries for pleural mesothelioma are extrapleural pneumonectomy (EPP) and pleurectomy with decortication (P/D). The FDA has approved chemotherapy and immunotherapy for pleural mesothelioma when patients cannot have surgery.

How is peritoneal mesothelioma treated?

Peritoneal mesothelioma is treated with surgery and chemotherapy. The main surgery is cytoreduction with hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal mesothelioma. Chemotherapy is available for patients who cannot have surgery. Immunotherapy is an option through clinical trials.

What is the best way to treat mesothelioma?

The best way to treat mesothelioma is with surgery and using other therapies, such as chemotherapy or immunotherapy, before or after the operation. This approach is called multimodal mesothelioma treatment and offers patients the best chance for a long life expectancy.

How do patients pay for mesothelioma treatment?

The top methods for patients to pay for mesothelioma treatment are with health insurance, from financial assistance programs, and from legal compensation such as asbestos trust funds. Treatment for mesothelioma unfortunately can be expensive. Surgery is on average approximately $50,000 and chemotherapy is on average nearly $40,000.

Does health insurance mesothelioma treatment?

Many health insurance plans cover mesothelioma treatment to help patients significantly. However, health insurance may not pay for travel costs to a top cancer center or the cost of hiring a professional caregiver. Financial assistance from nonprofits or through VA benefits programs can help cover these costs.

Can mesothelioma compensation help pay for treatment?

Yes, mesothelioma compensation can help pay for treatment. Many people with mesothelioma are owed restitution from the companies responsible for asbestos exposure to help pay these costs. Most people file asbestos trust fund claims, which means they do not need to file a lawsuit or go to court to receive this financial assistance.

Sources & Author

Epidemiological, therapeutic, and survival trends in malignant pleural mesothelioma: A review of the National Cancer Database. Cancer Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10278474/. Accessed: 05/11/2024.
Impact of guideline therapy on survival of patients with stage I-III epithelioid mesothelioma. Journal of Thoracic Disease. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/38249900/. Accessed: 05/11/2024.
First-line nivolumab plus ipilimumab versus chemotherapy in patients with unresectable malignant pleural mesothelioma: 3-year outcomes from CheckMate 743. Annals of Oncology. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/35124183/. Accessed: 05/13/2024.
Variation in the Cost of Radiation Therapy. Journal of Oncology Practice. Retrieved from: https://ascopubs.org/doi/10.1200/JOP.2015.005694. Accessed: 04/20/2021.
Cost of Medical Care for Mesothelioma. Rare Tumors. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6637828/. Accessed: 04/20/2021.
The cost of cancer: new drugs show success at a steep price. Reuters. Retrieved from: https://www.reuters.com/article/idUSKBN1750FT/. Accessed: 05/23/2024.
What Drives High Costs of Cytoreductive Surgery and HIPEC: Patient, Provider or Tumor? Annals of Surgical Oncology. Retrieved from: https://link.springer.com/article/10.1245/s10434-020-08583-7. Accessed: 04/20/2021.
How Much Does Lung Cancer Treatment Cost? VeryWellHealth. Retrieved from: https://www.verywellhealth.com/lung-cancer-treatment-cost-5217734. Accessed: 05/23/2024.
Hot Chemotherapy Bath: Patients See Hope, Critics Hold Doubts. The New York Times. Retrieved from: https://www.nytimes.com/2011/08/12/business/heated-chemotherapy-bath-may-be-only-hope-for-some-cancer-patients.html. Accessed: 04/20/2021.
Extrapleural Pneumonectomy versus Pleurectomy/Decortication for Malignant Pleural Mesothelioma. Annals of Surgical Oncology. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/33971174/. Accessed: 05/11/2024.
Predictors and Outcomes of Surgery in Peritoneal Mesothelioma: An Analysis of 2000 Patients From the National Cancer Database. Annals of Surgical Oncology. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/32006127/. Accessed: 07/08/2020.
Chemotherapy for Malignant Mesothelioma. American Cancer Society. Retrieved from: https://www.cancer.org/cancer/types/malignant-mesothelioma/treating/chemotherapy.html. Accessed: 02/09/2021.
Malignant pleural mesothelioma: adjuvant therapy with radiation therapy. Annals of Translational Medicine. Retrieved from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497112/. Accessed: 02/28/2020.
Consensus Statement on Proton Therapy in Mesothelioma. Practical Radiation Oncology. Retrieved from:
https://www.practicalradonc.org/article/S1879-8500(20)30117-X/abstract. Accessed: 06/10/2020.
FDA approves pembrolizumab with chemotherapy for unresectable advanced or metastatic malignant pleural mesothelioma. U.S. Food and Drug Administration. Retrieved from: https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-pembrolizumab-chemotherapy-unresectable-advanced-or-metastatic-malignant-pleural. Accessed: 09/18/2024.

About the Writer, Karen Ritter, RN BSN

Karen Ritter, a registered nurse, is the lead patient advocate for Mesothelioma Guide. She has a deep passion for patient care, which includes helping patients and their families search for treatment options at the top mesothelioma cancer centers. She finds the balance between encouraging patients to receive the best treatment possible while enjoying their time with loved ones and friends. Karen is a valuable asset for patients due to her knowledge of mesothelioma, compassion for the victims of this disease and dedication to guiding patients through their treatment journey.