Stage 4 mesothelioma, also called advanced or end-stage mesothelioma, means the cancer has spread to distant organs. This terminal stage has an average life expectancy of about 12 months. Treatments like chemotherapy and immunotherapy may extend survival for some.
Stage 4 mesothelioma is the most advanced form of this cancer. It’s the last of 4 stages, so doctors also call it late-stage, advanced or end-stage mesothelioma.
At this point, tumors have spread to distant organs and lymph nodes, which is called metastasis. Treatment options are limited, but patients can still get care that helps with symptoms and extends life.
Board-Certified Patient Advocate Dr. Snehal Smart explains, “Most mesothelioma patients I speak with have received a stage 4 diagnosis. It doesn’t necessarily mean the end stages of life. Many patients can still prolong survival time with clinical trials, immunotherapy and chemotherapy.”
Learn about your diagnosis, top doctors and how to pay for treatment in our free mesothelioma guide.
There are 4 main types of mesothelioma: pleural, peritoneal, pericardial and testicular. Doctors use a method called the TNM system to see how far pleural mesothelioma has spread. This is called staging.
Doctors look at how large tumors are (the T in TNM). They check if cancer has reached the lymph nodes (N). And they see how much it has spread, or metastasized (M). When mesothelioma spreads to distant organs or tissues, it’s stage 4.
Other types of mesothelioma don’t have official staging systems. But doctors usually call these cancers stage 4 when tumors have grown and spread. Doctors often use the Peritoneal Cancer Index to measure tumor spread in the belly for peritoneal mesothelioma.
Stage 4 Pleural Mesothelioma
Stage 4 mesothelioma that affects the lungs is the most common type. Mesothelioma cell tumors, either epithelial or sarcomatoid, spread to the liver or kidneys.
Stage 4 Peritoneal Mesothelioma
There is no official stage 4 definition for peritoneal mesothelioma. This type occurs in the belly. At the advanced stage of this type of mesothelioma, the spread of tumors may involve the liver.
Stage 4 Pericardial Mesothelioma
This mesothelioma type develops on the heart’s protective lining. Tumors may spread to the esophagus. Doctors use general staging guidelines for pericardial mesothelioma.
Stage 4 Testicular Mesothelioma
This is the rarest type of mesothelioma. There is no official staging system and no formal stage 4 for testicular mesothelioma. It can spread to distant pelvic tissue.
Stage 4 Mesothelioma Prognosis
Stage 4 mesothelioma has a poor outlook. Tumors have spread to distant organs and treatment options are limited. But prognosis varies from person to person based on several factors.
Age and overall health play a big role. Younger patients with fewer other health problems tend to do better. The type of mesothelioma cells matters too. Epithelioid cell type responds better to treatment than other types. How well someone responds to their specific treatment plan also affects their outcome.
Recent advances in treatment are changing what’s possible. New therapies like immunotherapy are helping some people live longer and feel better. Stage 4 is serious, but treatment can still make a meaningful difference in both how long and how well patients live.
Stage 4 Mesothelioma Life Expectancy and Survival Statistics
The average life expectancy for stage 4 mesothelioma is about 12 months with treatment and 6 to 8 months without treatment. But these are averages. Some patients live much longer.
Key Facts About Stage 4 Mesothelioma Survival
A 2023 study found adding Keytruda to platinum-pemetrexed chemo significantly improved overall survival for patients with advanced mesothelioma.
About 11% of stage 4 peritoneal patients survive for at least 5 years with treatment.
More than 7% of stage 4 pleural mesothelioma patients live 5 years or more.
Without treatment, people with late-stage mesothelioma live an average of 6 to 8 months.
Pericardial and testicular mesothelioma are rare, so there’s less data available on survival rates for these types. Pericardial patients often survive about 6 months, while some with testicular mesothelioma live several years.
According to the American Cancer Society, 7% of those with late-stage mesothelioma survive for 5 years or more. About 50% of these patients live for at least a year, and roughly 25% of those with stage 4 disease live for 2 or more years.
Mesothelioma Type
1-Year Survival Rate
2- or 3-Year Survival Rate
5-Year Survival Rate
Pleural
37%
26%
5%
Peritoneal
66%
40%
29%
Stage 4 Mesothelioma Symptoms
Symptoms of stage 4 mesothelioma can be severe and widespread. They can include pain, fatigue and fever. You may have a few symptoms, which can be vague and mimic common signs of other cancers. You may feel generally unwell and need help moving around.
As tumors spread, physical changes may make you feel tired or depressed. Living with mesothelioma can be challenging and can impact your quality of life. Always seek resources to support your mental health when needed.
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Learn about the latest mesothelioma treatments and clinical trials in our updated 2025 guide.
Initial mesothelioma cancer symptoms are often specific to your type of mesothelioma. For example, common symptoms of pleural mesothelioma at stage 4 are chest pain and trouble breathing. For peritoneal mesothelioma, common symptoms at stage 4 are abdominal pain and unexplained weight loss. However, the most common symptom for both pleural and peritoneal is fatigue.
Stage 4 Symptoms by Mesothelioma Type
Pleural Mesothelioma
Peritoneal Mesothelioma
Fatigue
16%
18%
Chest pain
14%
5%
Abdominal pain
4%
17%
Weakness
14%
12%
Trouble breathing
13%
5%
Loss of appetite
7%
11%
Coughing or weezing
11%
3%
Unexplained weight loss
8%
11%
Source:
The Mesothelioma Center at Asbestos.com, 2025
At stage 4, treatment focuses on relieving symptoms and extending life rather than achieving a cure. While palliative care, or treatment that aims to improve quality of life, can happen at any stage, it’s a primary advanced mesothelioma treatment.
Palliative care can include therapies such as immunotherapy and chemo. Some people live for years with a combination of therapies, especially when they qualify for newer treatments or clinical trials.
Stage 4 Mesothelioma Treatment Options
Chemo: Standard first-line therapy for stage 4 mesothelioma uses Alimta (pemetrexed) with platinum drugs like cisplatin or carboplatin. These can shrink tumors, relieve symptoms and even extend survival for some people.
Clinical trials: Participation offers access to promising new treatments, including cancer vaccines and advanced immunotherapies and drug combinations. These studies offer hope for people whose cancer hasn’t responded to standard care.
Immunotherapy: Opdivo (nivolumab) and Yervoy (ipilimumab) are an FDA-approved combination helping stage 4 patients live longer. Some even achieve partial remission.
Palliative care: People who receive early palliative care focusing on pain, breathing and comfort management may live longer and improve quality of life. These options can include fluid drainage and pain management.
Radiation Therapy: Radiation can shrink tumors, reduce pain, improve breathing and may increase survival, especially with advanced techniques like proton therapy.
Surgery: While not usually an option at stage 4, doctors sometimes recommend minor tumor-removing procedures or fluid drainage for symptom relief. These procedures can sometimes extend survival several months.
Targeted therapies: Drugs like Avastin (bevacizumab) added to chemo may increase survival from 12 to 18 months for some people.
Tumor Treating Fields: TTFields involves a wearable device that delivers low-level electrical fields to slow tumor growth and, when combined with chemo, may extend survival to 12-18 months.
Your doctor will help you decide which treatments make the most sense based on your overall health, how your cancer responds and what matters most to you. Many stage 4 patients benefit from combining several of these options. The goal is to find the right balance between managing symptoms and slowing cancer growth while maintaining the best possible quality of life.
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Tips & Resources for Stage 4 Mesothelioma Patients
Similar to palliative care, supportive care takes a broad approach to helping you live as well as possible with stage 4 mesothelioma. While palliative care focuses on medical treatments to relieve symptoms, supportive care addresses the everyday challenges of living with advanced cancer. This includes managing side effects from treatment, getting help with daily tasks and finding emotional support for you and your family.
A supportive care team might include nutritionists to help you maintain strength, counselors to help with depression or social workers who can help coordinate care or connect you with resources. Supportive care runs alongside your medical treatment to maintain your independence as much as possible.
Stage 4 Resources
Choosing a caregiver: You can also choose a caregiver and arrange for in-home medical services.
Mental health counseling: Improve your emotional well-being through mental health counseling.
Receiving care: Choose where you want to receive care. A Patient Advocate can help you navigate options.
Support groups: Share your experiences, connect with others and learn coping strategies in a mesothelioma support group.
Your priorities: Tell your medical team your priorities for symptom and pain management.
Family resources are also available for the loved ones of people with stage 4 mesothelioma. Support and assistance can help both you and your loved ones cope with stage 4 mesothelioma.
During this stage, many people find comfort in the resources a hospice program can offer. In hospice, people can receive specialized supportive care and emotional support from loved ones.
Andy A.
Verified Asbestos.com Survivor
Survivor Andy A. Beating the Odds Again
Andy survived a 70 mph motorcycle crash in 2004 that broke numerous bones and punctured a lung. Years later, he brought that same determination to his battle with pleural mesothelioma. Andy enrolled in an immunotherapy clinical trial and faced the challenge head on. He tells us, “I’m doing great right now. I really am.”
The 2025 National Comprehensive Cancer Network Guidelines explain that patients with late-stage mesothelioma, such as stage 4, are usually not eligible for surgery. In face, less than one-third of patients are eligible surgery candidates.
A 2023 study showed that stage 4 patients who are ineligible for surgery and who have not undergone treatment will benefit from a combination of immunotherapy drug Keytruda and chemotherapy. Results showed significant improvements to median overall survival.
“These patients tend to have more limited treatment options because the mesothelioma has spread to other distant organs, and therefore, usually only systemic treatments such as chemotherapy or immunotherapy are options in this setting.”
Common Questions About Stage 4 Mesothelioma
What role can alternative and complementary medicine play in treating stage 4 mesothelioma?
Stage 4 mesothelioma patients may choose to use complementary or alternative therapies. Options such as acupuncture or massage may reduce your symptoms. Talk to your doctor first. These treatments don’t offer a cure and aren’t a substitute for standard care. The best options for wellness are often exercise and nutrition. A cancer nutritionist can guide you toward a healthy cancer diet.
What does your mesothelioma stage mean?
Your mesothelioma stage tells you how far cancer has progressed. A staging system called TNM determines the stage for pleural mesothelioma. TNM stands for Tumor, Node and Metastasis. The rating describes the size of the tumor, whether it has spread to lymph nodes and if it has metastasized.
Doctors assign a stage ranging from 0 to 4. This helps them determine the best treatment for you and estimate your prognosis.
Should I consider end-of-life planning?
Talking in advance with your family and medical team about end-of-life care preferences can bring peace of mind. Some stage 4 mesothelioma patients find it allows them to focus on the present and their treatment.
Ask your medical team for a blank copy of all documents they recommend. Find a trusted lawyer to draft binding documents. These can help you plan for end-of-life medical care.
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