This page was reviewed under our medical and editorial policy by
Maurie Markman, MD, President, Medicine & Science
This page was updated on September 12, 2022.
Mesothelioma is often hard to treat because it usually spreads along surfaces instead of growing as a single tumor mass like many other cancers.
The patient's care team will develop a personalized mesothelioma treatment plan that may include a variety of therapies, including surgery, chemotherapy, radiation therapy, immunotherapy and targeted therapy.
This article will cover:
For patients with stage 4 pleural mesothelioma, and for mesothelioma patients whose cancer cannot be surgically removed, chemotherapy is often used to fight the disease. For earlier-stage pleural mesothelioma, patients’ treatment regimen may consist of surgery, chemotherapy and radiation therapy. Pleural mesothelioma is the most common type of mesothelioma.
Hyperthermic intraperitoneal chemotherapy (HIPEC), a highly concentrated, heated chemotherapy delivered directly to the abdomen during surgery, also may be used to treat certain types of mesothelioma.
The patient's care team may use chemotherapy as part of his or her treatment plan before or after surgery.
Chemotherapy before surgery, called neoadjuvant chemotherapy, may be used to reduce the size of a tumor so it’s easier to remove during surgery. Neoadjuvant chemotherapy may also help lower the risk of the cancer spreading.
Chemotherapy given after surgery, called adjuvant chemotherapy, is designed to kill remaining cancerous cells that may have been missed during surgery, helping to reduce the chance that cancer may return.
Chemotherapy drugs may be an appropriate treatment to kill cancer cells, but they may also affect normal cells in the patient's body and cause side effects. Different anti-cancer drugs have various side effects—and how much they affect the patient may depend on the dosage. Part of the care team’s job is to help patients manage these side effects, so they can help reduce this aspect of treatment as much as possible. Side effects tend to go away once chemotherapy treatment is done.
In general, chemotherapy drugs may cause:
During chemotherapy, the patient may also have a higher risk of infection, and may bruise or bleed more easily than usual. This is because chemotherapy may affect the patient's blood cells and the way the blood clots during treatment.
Ask the care team to share more details about the specific side effects of the chemotherapy drugs in the treatment plan and what to expect.
Immunotherapy drugs, either alone or in combination with other immunotherapy drugs or therapies, may be used to treat mesothelioma in certain patients who have already received chemotherapy.
These drugs help the immune system find and attack cancer cells that may be evading detection, so they can be especially helpful if cancer cells continue to grow after chemotherapy. They also may be used as a first-line treatment for mesothelioma that cannot be treated with surgery. They’re typically given as an intravenous (IV) infusion once a week or once every few weeks, depending on the drug or drugs.
Immunotherapy drugs are called checkpoint inhibitors because they inhibit cancer cells from hiding within certain immune system checkpoints. However, they may cause side effects.
Immunotherapy side effects may include:
Ask the care team about which side effects to expect with the specific immunotherapy drugs. They may be able to offer ways to manage or prevent side effects.
For patients with mesothelioma, radiation therapy may be used to destroy undetectable cancer cells left behind after surgery. In some cases, radiation therapy may also be used to alleviate chest pain and other symptoms of mesothelioma, such as shortness of breath and trouble swallowing.
The most common type of radiation therapy for mesothelioma is external beam radiation therapy (EBRT), which uses X-rays given outside the body to treat cancer cells.
The side effects of this type of radiation treatment depend in part on where the cancer cells are located. If radiation is given to the chest, for example, the patient's lungs may be affected. Likewise, if the patient has radiation treatments to the abdomen, he or she may experience gastrointestinal side effects such as nausea or vomiting. Any external radiation may also cause skin issues—similar to a sunburn—regardless of where radiation is given. Patients may also lose hair in that area.
Surgery, often a first-line treatment with mesothelioma, is used to remove tumors and provide relief from symptoms. A variety of surgical procedures may be used to treat mesothelioma, with surgeons’ recommendations generally depending on the type of mesothelioma involved. For instance, if a patient has pleural mesothelioma, the surgeon may choose one of the following operations:
In the extrapleural pneumonectomy procedure, the surgeon removes the lung on the side of the body affected by the cancer, as well as the pleura lining the chest wall on that side, the diaphragm on that side, the surrounding lymph nodes and sometimes the pericardium (sac around the heart). This is a complex surgery, and patients and their care teams should take many points into consideration prior to making a decision, including their overall health and preferences.
Because of how involved they are, extrapleural pneumonectomies come with some risks, including:
Commonly, patients may have adjuvant radiation and/or chemotherapy after this type of surgery. In some cases, the patient may also be given radiation and/or chemotherapy before the surgery as well.
The surgeon removes all the pleura lining the chest wall on the side affected by the cancer, along with the pleura lining of the affected lung, the mediastinum (area between the lungs) and the diaphragm. This type of surgery, also called a P/D, may be done with the goal of completely removing early-stage cancer or of reducing advanced-cancer symptoms such as shortness of breath or chest pain.
Generally, this type of surgery is linked to fewer complications than the more extensive extrapleural pneumonectomy.
The surgeon removes as much of the cancer as possible. Sometimes this is called a partial pleurectomy. Since this type of surgery removes less tissue than an extrapleural pneumonectomy or a P/D, there may be fewer side effects after surgery. However, for all surgeries, there’s a risk of infection. Follow the care team’s instructions for recovery, which may include limiting activities during healing.
If a patient has peritoneal mesothelioma, the surgeon may perform a debulking procedure or an omentectomy, which removes the omentum, a layer of fatty tissue that covers the organs in the abdomen. After an omentectomy, adjuvant chemotherapy that targets the abdomen may be given as part of the treatment plan.
Keep in mind that though the cancer care team gathers all the information they can about the patient's cancer beforehand, they may learn even more about it during the surgery. The type of surgery may even change depending on what the surgeon observes during the procedure. Discuss this possibility with the care team before the procedure and be sure to ask questions.
Several targeted therapy drugs are approved to treat certain types of mesothelioma, some of which work by depriving a tumor of oxygen. Targeted therapies damage, destroy or weaken cancer cells in very specific ways, so they may affect healthy, noncancerous cells less than other types of treatment.
Often, targeted therapy for mesothelioma is given along with chemotherapy drugs. This combination of targeted therapy and chemotherapy may be used as a first-line treatment for mesothelioma that can’t be surgically removed.
One targeted therapy that limits cancer cell growth by depriving them of nutrients is Avastin® (bevacizumab). This drug inhibits the growth of new blood vessels that the tumor could use to continue growing. It’s given as an IV infusion every few weeks.
Targeted therapy tends to have less severe side effects than standard chemotherapy, but there can still be side effects from treatment. These tend to be similar to those from chemotherapy:
Bevacizumab may also cause high blood pressure and a higher chance of bleeding.
The patient's cancer care team can also help him or her explore options for taking part in a clinical trial that provides treatment as part of a research study. These trials help determine whether a new treatment—or a new combination of treatments—may be better than the current standard treatment for that type and stage of mesothelioma.
For mesothelioma, one type of treatment that’s being studied is brachytherapy, in which a small radiation source is put in the body and placed near cancer cells. The patient's care team can help him or her navigate the clinical trials that may be an option.
Mesothelioma that comes back after treatment is complete is called recurrent. Treatment for recurrent mesothelioma depends heavily on each specific situation—where the cancer has recurred, what type of treatment was used initially, and the patient's overall health and preferences. The cancer care team will likely order new tests to learn more about the cancer that has come back and make a plan to treat it.
Recurrent cancer can be challenging to treat, and the treatment goals may include palliative care to reduce symptoms from the cancer and/or side effects from treatment. Clinical trials exploring new ways to treat recurrent mesothelioma may be a good option for some patients.
Mesothelioma that has spread to other parts of the body is called metastatic mesothelioma. Like recurrent mesothelioma, metastatic mesothelioma can be very difficult to treat. There’s no one way to treat metastatic mesothelioma, so the patient's care team can work with him or her to discuss options, give recommendations and listen to the patient's preferences.
The patient's treatment plan for metastatic mesothelioma may involve a combination of treatments, or the care team may suggest a clinical trial exploring a new treatment that may be more beneficial than current treatments.
Next topic: What are the facts about mesothelioma?