fbpx

1.888.385.2024
Call Us Now Icon

home » Mesothelioma Treatment

Written By: Karen Ritter, RN BSN

Mesothelioma Treatment

The top options for mesothelioma treatment are surgery, immunotherapy, chemotherapy and radiation. Clinical trials offer patients with mesothelioma cancer a chance to combine treatments, test new therapies, and receive emerging treatment options. Prioritize receiving treatment from an experienced doctor and medical team for the best possible outcome for survival and quality of life.

medical shield icon

Medically reviewed for accuracy by

Dr. Hassan Khalil

Mesothelioma Thoracic Surgeon

JUMP TO A TOPIC

jump to icon

SCROLL TO TOP

Have a medical question?

  • Learn about your treatment options
  • Ask questions about your diagnosis
  • Get doctor recommendations

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. 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 or new 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 Mesothelioma Treatments

chemotherapy icon

Chemotherapy
(pemetrexed and cisplatin)

immunotherapy icon

Immunotherapy
(Opdivo and Yervoy, or
Keytruda)

tumor treating fields icon

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, the FDA allows patients to receive carboplatin as a substitute.

The FDA approved Opdivo and Yervoy as a combination immunotherapy regimen. Keytruda is approved for a small subset of people diagnosed with pleural mesothelioma, which is the type of mesothelioma forming in the lining around the lungs.

How to Receive the Best Mesothelioma Treatment

1

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.

2

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.

3

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.

4

Speak with a mesothelioma patient advocate. People with mesothelioma do not need to go through the treatment process alone. Patient advocates are the best ally. 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 mesothelioma patient advocates – such as Mesothelioma Guide’s registered nurse Karen Ritter – for help navigating this complex cancer and how to treat it.

Treatment by Type of Mesothelioma

pleural mesothelioma icon

Pleural Mesothelioma

Pleural mesothelioma forms in the tissue lining of the lungs.

peritoneal mesothelioma icon

Peritoneal Mesothelioma

Peritoneal mesothelioma forms in the lining around the abdominal cavity.

pericardial mesothelioma icon

Pericardial Mesothelioma

Pericardial mesothelioma forms in the lining around the heart.

testicular mesothelioma icon

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.

The treatment options are different for each type of mesothelioma. 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. The type of mesothelioma dictates which surgery is possible.

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.

doctors with scrubs and mask on performing surgery

The two surgery options for pleural mesothelioma are:

  • Pleurectomy with decortication
  • Extrapleural pneumonectomy
doctors with scrubs and mask on performing surgery

QUICK FACT

QUICK FACT

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.

Surgery for Pleural Mesothelioma Icon

Surgery for Pleural Mesothelioma

Pleurectomy With Decortication (P/D)

Pleurectomy with decortication (P/D) removes the pleura, which is a thin lining between your chest wall and lung. Pleural mesothelioma forms in the pleura.

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.

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) removes the pleura and the affected lung. Surgeons may also remove part of the diaphragm and pericardium. EPP is more aggressive than P/D.

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 Icon

Surgery for Peritoneal Mesothelioma

Cytoreduction With HIPEC

Cytoreduction with HIPEC is a two-part procedure. The first part is cytoreduction, which is a debulking surgery. The second part is HIPEC, which is a heated chemotherapy treatment.

During the cytoreduction part, doctors remove any visible tumors in and around 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.

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 Icon

Mesothelioma Pain-Relief Surgery

The purpose of pain-relief surgery for mesothelioma is to 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

74 percent pie chart

Chemotherapy is the most common mesothelioma treatment. 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 Icon

Types of Mesothelioma Chemotherapy

Systemic chemotherapy

Doctors administer the chemotherapy 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

Doctors put the mesothelioma treatment 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

Doctors send the mesothelioma treatment 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. Nearly 6% of people diagnosed with mesothelioma receive immunotherapy, and the number is growing each year as more doctors recommend this treatment option.

There are two 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) image

Keytruda (pembrolizumab) – Approved for people with a specific genetic mutation of pleural mesothelioma.

Immunotherapy often causes fewer side effects and less severe side effects than chemotherapy.

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

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.

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.

doctor performing radiation therapy on patient

Radiation therapy can damage healthy tissue and cause side effects. Technological advancements in the 21st century make mesothelioma radiation more targeted to cancer cells and cause less harm to surrounding tissue and organs, such as the lungs and heart.

doctor performing radiation therapy on patient

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.

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 in 2019. Patients wear the device – called “Optune Lua” – for approximately 18 hours a day. It does not affect their sleep or ability to perform daily tasks, and patients can select what hours of the day to wear the device. This therapy is used along with the patient’s mesothelioma chemotherapy treatment. Optune Lua was previously called NovoTTF-100L and is manufactured by Novocure.

Emerging Treatment Options

Scientists continue to research and test new therapies for mesothelioma. Patients can receive these emerging treatment options by participating in clinical trials. Some emerging treatment options are:

gene therapy icon

Gene therapy

immunotherapy icon

Virotherapy
(oncolytic viruses)

cell icon

Cell therapy

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.

woman exercising with dumbbells

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.

woman exercising with dumbbells

HELPFUL TIP

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

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 doctors with the knowledge needed to treat mesothelioma effectively.

Below are a few of the top mesothelioma doctors:

Dr. Hassan Khalil

Dr. Hassan Khalil

Thoracic surgeon in Boston, MA, specializing in pleural mesothelioma

Dr. Eugene Choi

Dr. Eugene Choi

Surgical oncologist in Houston, TX, specializing in peritoneal mesothelioma

Dr. Joseph Friedberg

Dr. Joseph Friedberg

Thoracic surgeon in Philadelphia, PA, specializing in pleural mesothelioma

Dr. James Pingpank

Dr. James Pingpank

Surgical oncologist in Pittsburgh, PA, specializing in peritoneal mesothelioma

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

Brigham and Women’s Hospital

Brigham and Women’s Hospital

Boston, MA
Specialty: Pleural Mesothelioma

Baylor St. Luke’s Medical Center

Baylor St. Luke's Medical Center

Houston, TX
Specialty: Peritoneal Mesothelioma

Wake Forest Baptist Health

Wake Forest Baptist Health

Winston-Salem, NC
Specialty: Pleural and Peritoneal Mesothelioma

University of Pittsburgh Medical Center

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 a few 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.

Gary Maxwell

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.

Alexis Kidd

JODI PAGE

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

Jodi Page

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 icon
horizontal line
left bracket

EPP surgery
$62,000

right bracket

Immunotherapy icon
horizontal line
left bracket

Immunotherapy
More than $200,000/year

right bracket

P/D surgery icon
horizontal line
left bracket

P/D surgery
$54,000

right bracket

Chemotherapy icon
horizontal line
left bracket

Chemotherapy
$35,000

right bracket

Cytoreduction with HIPEC icon
horizontal line
left bracket

Cytoreduction with HIPEC
$20,000

right bracket

radiation icon
horizontal line
left bracket

Radiation
$9,000

right bracket

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 Icon

Paying 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

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. These mesothelioma support resources help people receive the best treatment possible from top doctors and cancer centers even if they are across the country.

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.

This money – often totaling hundreds of thousands of dollars – can pay for the best mesothelioma treatment and out-of-pocket expenses. Contact our patient advocate team to learn how to access this money owed to you.

Frequently Asked Questions About Mesothelioma Treatment

blue box icon

Can mesothelioma be treated?

There are several mesothelioma treatment options to help people with this aggressive cancer. Surgery, chemotherapy, immunotherapy and radiation therapy are the top options for treating mesothelioma. It is recommended to receive treatment from a mesothelioma specialist at a top cancer hospital.

blue box icon

How is pleural mesothelioma treated?

Treatment for pleural mesothelioma includes 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 specific chemotherapy and immunotherapy drugs for pleural mesothelioma when patients cannot have surgery.

blue box icon

How is peritoneal mesothelioma treated?

Treatment for peritoneal mesothelioma includes surgery and chemotherapy. The main surgery for this cancer is cytoreduction with hyperthermic intraperitoneal chemotherapy (HIPEC). Immunotherapy is an option through clinical trials if patients cannot have surgery.

blue box icon

What is the best way to treat mesothelioma?

Each patient is different, and there is no one set way to treat all cases of mesothelioma. Doctors prefer what’s called multimodal mesothelioma treatment. This utilizes multiple treatment options in a multi-faceted treatment plan, such as surgery followed by chemotherapy or immunotherapy. Multimodal treatment offers patients the best chance to extend life.

blue box icon

How do patients pay for mesothelioma treatment?

Treatment for mesothelioma can be expensive for patients. Surgery is on average approximately $50,000 and chemotherapy is on average nearly $40,000. Many health insurance plans cover cancer treatment, but they may not pay for travel costs to a top cancer center or the cost of hiring a professional caregiver. Many people with mesothelioma receive legal compensation from the companies responsible for asbestos exposure to help pay for treatments and necessary care. 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

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. Cost of Medical Care for Mesothelioma. Rare Tumors. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6637828/. Accessed: 04/20/2021.
  6. 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.
  7. 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.
  8. How Much Does Lung Cancer Treatment Cost? VeryWellHealth. Retrieved from: https://www.verywellhealth.com/lung-cancer-treatment-cost-5217734. Accessed: 05/23/2024.
  9. 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.
  10. 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.
  11. 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.
  12. Chemotherapy for Malignant Mesothelioma. American Cancer Society. Retrieved from: https://www.cancer.org/cancer/types/malignant-mesothelioma/treating/chemotherapy.html. Accessed: 02/09/2021.
  13. 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.
  14. 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.
Karen image

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.

Mesothelioma Guide · © 2024 · All Rights Reserved · Privacy Policy · Disclaimer

The information provided by MesotheliomaGuide.com is not a substitute for professional medical advice.

Free Mesothelioma Guide Flyout Picture

Get a FREE Mesothelioma Guide Packet Sent To You
FREE Mesothelioma Guide