Multimodal Therapy

Multimodal therapy is the use of a combination of several types of treatments to fight cancer. It has been shown to lead to the best possible life expectancy for mesothelioma patients.

Receiving Multimodal Therapy

Multimodal therapy is the use of a combination of several types of treatment methods such as chemotherapy and surgery. Not only can it increase a patient’s quality of life, but it can also increase the patient’s odds for a full recovery.

Components of Multimodal Therapy


There are limited surgical options for mesothelioma patients. However, surgical treatment is constantly improving and is now commonly used in conjunction with either chemotherapy or radiation therapy for improved results.


The most traditional treatment method for all types of cancer, chemotherapy has come a long way in treating mesothelioma. Most commonly combined with surgical treatment, chemotherapy is typically used in all mesothelioma patients.

Radiation Therapy

Radiation is beneficial for patients in more advanced stages of cancer, although it’s used in all stages of mesothelioma. One of its most common multimodal uses is intraoperative radiation after a pleurectomy/decortication surgery.

Emerging Treatments

Emerging treatments are also used in multimodal therapy. These are treatments that are being tested in clinical trials and range from intraoperative photodynamic therapy to immunotherapy combined with chemotherapy.

Combining Surgery With Traditional Cancer Treatment

Chemotherapy and radiation therapy are the most well-known and traditional treatment methods for patients with all types of cancer. These traditional treatment methods haven’t always been the most effective for mesothelioma patients, but multimodal treatment methods are changing that.

It wasn’t long ago that chemotherapy didn’t have much effect for mesothelioma patients. However, the introduction of new chemotherapy drugs a little over a decade ago has given patients and families cause for hope. Furthering the cause for hope is the way chemotherapy is being administered in addition to surgical treatment.

Neoadjuvant and Adjuvant Chemotherapy

One of the best developments in treating mesothelioma with multiple modes of therapy is the use of neoadjuvant and adjuvant chemotherapy. Neoadjuvant chemotherapy is chemotherapy that is applied prior to surgery whereas adjuvant chemotherapy is administered post-surgery.

Neoadjuvant Therapy

The idea behind neoadjuvant therapy is to shrink any tumors before attempting surgery. Therefore the chemotherapy is administered with the intention of having a future surgical procedure.

A study in 2004 in 16 patients in varying stages of mesothelioma who had chemotherapy prior to an extrapleural pneumonectomy resulted in several patients living over 3 years, while the median survival for this group was just under 2 years from the date of the surgery.

Adjuvant Chemotherapy

Adjuvant chemotherapy is used to destroy mesothelioma cells that doctors were unable to remove with surgery alone. This type of multimodal chemotherapy treatment is also responsible for longer survival times in mesothelioma patients.

As multimodal therapy is used in essentially all patients who undergo surgery, it is up to the mesothelioma specialist to decide whether neoadjuvant or adjuvant chemotherapy is more appropriate for the patient. However, adjuvant chemotherapy is often replaced with adjuvant radiation therapy, especially in patients who had a pleurectomy with decortication or patients undergoing a trimodality approach.

Intraoperative Chemotherapy and Radiation

What was initially a controversial approach to treatment, intraoperative chemotherapy and radiation has become more commonplace due to its life extending benefits. These treatments are applied directly to the location of a patient’s cancer while they are undergoing a surgical procedure. The purpose of intraoperative treatments is to kill any remaining microscopic mesothelioma cells after visible tumors are removed.

Dr. Paul Sugarbaker pioneered intraoperative chemotherapy, known as hyperthermic intraperitoneal therapy (HIPEC), for patients with a diagnosis of peritoneal mesothelioma.

Although there are still those in the medical community who are critical of the procedure, the success rates and survival rates are constantly improving. One study showed that those who had an operative cytoreductive surgery with HIPEC doubled their 2-year survival rate. Survivors like Alexis Kidd have this treatment to thank for their recovery.

Dr. Paul Sugarbaker’s brother, Dr. David Sugarbaker, has also used intraoperative chemotherapy in patients with pleural mesothelioma after having an extrapleural pneumonectomy. For those who opt for the alternative to the EPP, pleurectomy with decortication, intraoperative radiation is used to kill remaining cancer cells. Get connected with top specialists using our free Doctor Match program.

Getting Treated With a Multimodal Approach

Finding multimodal treatment options is possible regardless of a patient’s mesothelioma type or stage. Having several treatments could mean the difference of living for months versus living for years. Find out more about the multimodal treatment methods mesothelioma survivors have used in our free Mesothelioma Survivor’s Guide.