Mesothelioma Treatment
Mesothelioma treatment options include surgery, chemotherapy and radiation therapy. Advanced cases may be treated with immunotherapy, targeted therapy or clinical trials. Doctors also use multimodal therapy and palliative care to improve outcomes and comfort.
Written by Dr. Daniel Landau | Edited by Amy Edel | Last Update: August 8, 2025
Expert Take
Dr. Jeffrey Velotta: What do you feel is the best approach to treating mesothelioma
which is still done in certain places because right now there currently is a clinical trial looking at whether or not to get the chemotherapy prior or after surgery. And we still don't have those results. So in the meantime, it's done depending on what institution you're at.
And so the idea--
why I believe that the chemotherapy--
two reasons, first, is an issue is that 20% to 30% of the time it may be helpful, but it never shrinks it completely. It never gets rid of it.
And then there's a 60% to 80% chance that the tumor will progress and that you missed your window to operate. They're getting sicker on the chemo, and the tumor is growing. And that's a 60% to 80% chance the tumor will progress and grow.
So rather than take that chance, I'd rather get it out first and then have--
and we know that 80% of patients, after we take it out, can still make it to surgery because we do a pleurectomy and decortication. And so it's not as aggressive or not as morbid. So patients will be able to do the chemotherapy afterwards.
It was originally thought that do the chemo first because patients were getting an extrapleural pneumonectomy, and they were never able to make it because they were too sick to get chemotherapy afterwards. So you missed that window. But now that we do pleurectomy decortication, chemo afterwards is better because, like I said, chemo is going to react better to a patient that has less disease in the body.
The other reason why I don't necessarily think it's a great idea to get chemotherapy first is that those patients with symptoms and signs of mesothelioma are already weak. They're already in pain. They're already having a lot of pleural fluid. The chemo doesn't get rid of any of that. It may shrink something a little bit, tiny bit, but it doesn't get the patient clinically better.
So not only does it not help, but these patients are already sick, and then they start to lose even more weight just based on the chemotherapy alone. So those patients are essentially not doing well during that time period. And so what we found in previous studies is that 50% to 65% of patients that get the neoadjuvant or get chemotherapy first never actually make it to surgery. They're too sick to even make it to surgery.
Whereas when you first see them, you catch it early, you haven't had to give them toxic agents or anything, and then we first caught it hopefully early enough, we operate on them first. So I think those are the two big reasons why I really favor the surgery first, followed by chemotherapy afterwards.
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Expert Take
Dr. Jeffrey Velotta: What do you feel is the best approach to treating mesothelioma
which is still done in certain places because right now there currently is a clinical trial looking at whether or not to get the chemotherapy prior or after surgery. And we still don't have those results. So in the meantime, it's done depending on what institution you're at.
And so the idea--
why I believe that the chemotherapy--
two reasons, first, is an issue is that 20% to 30% of the time it may be helpful, but it never shrinks it completely. It never gets rid of it.
And then there's a 60% to 80% chance that the tumor will progress and that you missed your window to operate. They're getting sicker on the chemo, and the tumor is growing. And that's a 60% to 80% chance the tumor will progress and grow.
So rather than take that chance, I'd rather get it out first and then have--
and we know that 80% of patients, after we take it out, can still make it to surgery because we do a pleurectomy and decortication. And so it's not as aggressive or not as morbid. So patients will be able to do the chemotherapy afterwards.
It was originally thought that do the chemo first because patients were getting an extrapleural pneumonectomy, and they were never able to make it because they were too sick to get chemotherapy afterwards. So you missed that window. But now that we do pleurectomy decortication, chemo afterwards is better because, like I said, chemo is going to react better to a patient that has less disease in the body.
The other reason why I don't necessarily think it's a great idea to get chemotherapy first is that those patients with symptoms and signs of mesothelioma are already weak. They're already in pain. They're already having a lot of pleural fluid. The chemo doesn't get rid of any of that. It may shrink something a little bit, tiny bit, but it doesn't get the patient clinically better.
So not only does it not help, but these patients are already sick, and then they start to lose even more weight just based on the chemotherapy alone. So those patients are essentially not doing well during that time period. And so what we found in previous studies is that 50% to 65% of patients that get the neoadjuvant or get chemotherapy first never actually make it to surgery. They're too sick to even make it to surgery.
Whereas when you first see them, you catch it early, you haven't had to give them toxic agents or anything, and then we first caught it hopefully early enough, we operate on them first. So I think those are the two big reasons why I really favor the surgery first, followed by chemotherapy afterwards.
What Are the Treatment Options for Mesothelioma?
The most common treatment options for mesothelioma include surgery, chemotherapy, radiation and immunotherapy. Your doctor will recommend a plan based on your type of mesothelioma, where it is in your body and your health. Many people receive more than one kind of treatment at the same time.
For pleural mesothelioma, which starts near the lungs, immunotherapy is now a standard treatment. Doctors usually prescribe Keytruda (pembrolizumab), Opdivo (nivolumab) or Yervoy (ipilimumab) for this type. Immunotherapy isn’t standard for peritoneal mesothelioma, which forms in the abdomen, but some people do receive it.
We’ll get you the best doctor for your diagnosis and schedule appointments with them quickly.
Find My DoctorSome people diagnosed with peritoneal mesothelioma also get radiation, though it isn’t common and isn’t strongly recommended. Doctors almost never suggest radiation for pericardial mesothelioma.
We asked people diagnosed with mesothelioma about their treatments. Some said their doctors tried less common options for their type like immunotherapy for peritoneal mesothelioma or radiation for rare cases. Our patient survey helped us track which treatments people had for each kind of mesothelioma. Talking openly with a mesothelioma specialist can help you understand all options and get care that fits your needs.
| Pleural Mesothelioma | Peritoneal Mesothelioma | |
|---|---|---|
| Chemotherapy | 31% | 32% |
| Immunotherapy | 25% | 18% |
| Surgery | 16% | 27% |
| Radiation | 15% | 10% |
Surgery
Surgery for mesothelioma can remove tumors, help stop the cancer from spreading and ease symptoms. The procedure your doctor recommends will depend on which type of mesothelioma you have or where your tumors are located, how far the cancer has spread, your overall health and your treatment goals.
Surgery may not remove all the cancer, but it can help reduce symptoms and improve survival for some patients. A July 2024 retrospective study in The Annals of Thoracic Surgery found that people who had surgery for pleural mesothelioma lived much longer than those who declined it.
Types of Mesothelioma Surgery
- Drain fluid to improve symptoms: Includes pleurocentesis or pleurodesis for pleural mesothelioma. Paracentesis is used for peritoneal mesothelioma.
- Remove tumors and nearby tissue: Lining around organs with cancerous tissue is surgically removed. A pleurectomy and decortication removes part or all of the pleura for pleural mesothelioma. To treat peritoneal mesothelioma, a peritonectomy removes all or part of the peritoneum, and an omentectomy removes part or all of the omentum.
- Remove an entire organ and affected structures: An extrapleural pneumonectomy is a radical surgery that removes an entire lung to treat pleural mesothelioma.
- Remove tumors and deliver heated chemo: Cytoreductive surgery with heated chemotherapy (HIPEC) combines tumor-removing surgery with chemo applied directly inside your belly to treat peritoneal mesothelioma.
Experts are also studying hyperthermic intrathoracic chemotherapy (HITHOC), which uses heated chemo inside the chest. It’s not commonly used yet, but research is growing, and some specialists think it may improve outcomes.
When peritoneal mesothelioma survivor Susan Dickman was diagnosed with stage 4 cancer in 2012, she was told she didn’t qualify for surgery. She spoke with other surgeons who gave the same advice. But when she spoke with surgical oncologist Dr. Edward Levine, he believed she could benefit from HIPEC. Susan tells us, “We chose a doctor who had done more of these surgeries than anybody else. Numbers count for any surgery.”
Receive a free webinar recording where two leading mesothelioma specialists explain how they tailor treatment plans to each patient’s needs.
Get Your Free RecordingChemotherapy
Chemo uses strong drugs to kill cancer cells throughout the body. Sometimes doctors prescribe chemo alone if a person can’t have surgery because of poor health or if the cancer has already spread. For people with pleural or peritoneal mesothelioma, doctors may give chemo before surgery. The goal is to shrink tumors first, then remove any cancer that’s left.
Most people get systemic chemo, which means the drugs travel through the whole body. Regional chemo is given directly to one part of the body, such as the chest or abdomen, to target mesothelioma more closely.
Common Chemo Drugs for Mesothelioma
- Adriamycin (doxorubicin)
- Alimta (pemetrexed)
- Cytoxan (cyclophosphamide)
- Eloxatin (raltitrexed)
- Gemzar (gemcitabine)
- Navelbine (vinorelbine)
- Paraplatin (carboplatin)
- Platinol (cisplatin)
Doctors sometimes combine chemo with other treatments, such as targeted drugs like Avastin (bevacizumab) or Tumor Treating Fields, to help improve results and extend survival. This approach can allow doctors to target mesothelioma from multiple angles, and some people receive more than one type of therapy for the best possible outcome.
According to our 2025 survey, 32% of people diagnosed with mesothelioma received chemo, making it the most common treatment among respondents. Chemo drugs Paraplatin (carboplatin) and Alimta (pemetrexed) were used most often. The most common side effects included fatigue, nausea and chemo brain. Chemo can be given alone or with other therapies, depending on your health, cancer stage and treatment goals.
Radiation Therapy
Radiation therapy uses high-energy beams to destroy mesothelioma cells and shrink tumors. Doctors often use radiation along with other treatments, or after surgery, to help lower the risk that cancer will return. For some people, radiation may relieve symptoms like pain or trouble breathing.
Most Common Types of Mesothelioma Radiation Therapy
- Brachytherapy
- Intensity-modulated radiation therapy
- Photoradiation therapy
- Volumetric-modulated arc therapy
Radiation can be an option for people who can’t have surgery or chemo, or for those who have cancer left after surgery. While only 13% of people in our 2025 survey received radiation, it still plays an important role in treatment for some.
Possible side effects include tiredness, skin irritation and damage to healthy tissue. Working with your mesothelioma specialist can help you weigh the benefits and risks of radiation as part of your treatment plan.
Immunotherapy
Immunotherapy helps your body’s immune system recognize and attack mesothelioma cells. It’s a first-line treatment for pleural mesothelioma and is often recommended for people who can’t have surgery. Doctors often use Opdivo (nivolumab) and Yervoy (ipilimumab) together, and Keytruda (pembrolizumab) can also be combined with chemo for some patients.
Many people have seen meaningful responses with these mesothelioma drugs. Mesothelioma survivor Barbara Lapalla receives Keytruda three times a week. She credits it with saving her life. She shares with us, “I tell people today, I’m a walking miracle. They don’t believe in miracles. Then they see me.”
Common immunotherapy drugs for mesothelioma include:
- Opdivo (nivolumab)
- Yervoy (ipilimumab)
- Keytruda (pembrolizumab)
Dr. Andrea Wolf, thoracic surgeon and director of the New York Mesothelioma Program at Mount Sinai, has seen these results firsthand. She tells us, “I have personally witnessed the significant impact immunotherapy has had on improving survival for some patients with certain types of mesothelioma.”
While not approved for peritoneal mesothelioma, some doctors and clinical trials are seeing success using it. Side effects are often less severe with immunotherapy than with chemo. The most common immunotherapy side effects are tiredness and skin rashes. Inflammation can sometimes affect organs in rare cases.
Targeted Therapy
Targeted therapy is a cancer treatment that blocks specific genes or proteins that help mesothelioma cells grow and survive. Unlike chemo, which also affects healthy cells, targeted therapy attacks unique weak spots in cancer cells, leaving more healthy cells unharmed.
For some people with mesothelioma, doctors may use targeted therapy alone. But it’s often combined with chemo or immunotherapy for better results.
Common Targeted Therapies for Mesothelioma
- Monoclonal antibodies: Lab-made proteins that can attach to cancer cells and either block growth signals or help your immune system find and attack the cancer.
- Tyrosine kinase inhibitors: Drugs that block enzymes (tyrosine kinases) that cancer cells need to grow.
- VEGF inhibitors: Medicines that block a protein called vascular endothelial growth factor, which cancer cells use to build new blood vessels and get nutrients.
Targeted therapies and immunotherapy aren’t the same, but some treatments can overlap and work in both ways. Immunotherapy boosts or guides the immune system to attack cancer, while targeted therapy acts directly on specific features of cancer cells.
For example, some monoclonal antibodies, like Yervoy, are considered both targeted therapy and immunotherapy. They both block growth signals and flag cancer cells for immune attack. This overlap can be confusing, but it means that certain treatments work in more than one powerful way to fight mesothelioma.
Multimodal Therapy
Multimodal therapy combines two or more treatments such as surgery, chemotherapy, radiation, immunotherapy or targeted therapy to manage mesothelioma. This approach lets doctors customize care based on each person’s diagnosis and needs.
Recent research shows multimodal therapy is important for treating malignant pleural mesothelioma. A May 2025 meta-analysis found combining surgery with other treatments can provide benefits. The study highlights that combining surgery with targeted therapies helps doctors better manage the disease and tailor treatment to each patient.
Your care team may recommend a multimodal approach based on your health, tumor type, stage and treatment preferences. This strategy gives doctors flexibility to adjust your plan as needed and aims to improve both survival and quality of life.
Emerging Treatments and Clinical Trials
Clinical trials for mesothelioma test new therapies and explore better ways to use current treatments. Many studies focus on combination treatments or novel drugs. Joining a clinical trial can give you early access to these therapies. Your doctor can help determine if a trial may be right for you.
Several new approaches are only accessible through mesothelioma clinical trials. Vaccine therapy aims to help your immune system recognize and fight mesothelioma cells. Mesothelioma gene therapy, including suicide gene therapy, introduces new or changed genes into cancer cells to slow or stop their growth. Each strategy offers hope for people who have limited treatment choices.
Drug research is also advancing. For example, Ofev, a medication approved for pulmonary fibrosis, is now in phase III trials for pleural mesothelioma. These studies will show if it can help manage this cancer. Ask your care team about ongoing research and whether these emerging options could fit your treatment plan.
We make getting expert care from the nation’s top mesothelioma specialists easy.
Find My SpecialistPalliative Care
Palliative care focuses on relieving symptoms and improving quality of life for people with mesothelioma. It can relieve treatment side effects, relieve symptoms of mesothelioma and support overall health, taking place at any stage in a survivor’s mesothelioma journey. For example, pain management is often combined with low-dose chemo used to shrink tumors before surgery. Palliative surgery can include inserting a tube or catheter to drain fluid, making it easier to breathe.
A palliative care team might include oncologists, nurses, pain specialists, physical therapists and dietitians, all working together to provide the best care. This can include exercise, respiratory therapy or massage to help reduce discomfort.
Palliative Therapies for Mesothelioma:
- Alternative therapies
- Catheter or shunt placement
- Immunotherapy
- Low-dose chemotherapy
- Pain medication
- Pleurodesis
- Respiratory therapy
Mesothelioma survivor Virginia Beach told us she used palliative care when she had trouble breathing years after her chemo. Her doctor at the time recommended palliative care and hospice. After a while with palliative care she said, “The doctor told me my lungs were clear.” She left hospice and returned to independent living in a retirement community and hit the 10-year survival mark at 88. She added, “My oncologist doesn’t say it’s in remission. He says it’s in control.”
Amy Pelegrin, director of hospice care at The Mesothelioma Center, explains, “Palliative care is becoming more important in cancer treatment. It’s comfort care, but it’s also pain management. It’s something a patient can start from the day they’re diagnosed. I recommended it because I don’t think anyone should have to suffer when they don’t have to.”
How to Find the Best Treatment for Mesothelioma
The best way to treat mesothelioma is based on the type and stage of the cancer, as well as your overall health. Finding a skilled doctor and a top cancer center can be critical steps in getting the care you need.
Receiving a mesothelioma diagnosis can be overwhelming for you and your loved ones. Patient Advocates are here to help you navigate the next steps in your journey and match you with the best experts in mesothelioma treatment.
In addition to offering support in finding mesothelioma specialists, our Patient Advocates can help you with insurance, file VA claims and access other resources to cover treatment costs. They can also schedule appointments and share information about clinical trials for new and emerging treatments.
- A clinical trial is currently underway that’s evaluating the addition of Tecentriq and a cancer vaccine (WT1/DC vaccination) to chemotherapy to treat epithelioid malignant pleural mesothelioma.
- Novel treatments are showing promise in improving quantity and quality of life for mesothelioma patients. Working with a multimodal team can help patients have more care options.
“Mesothelioma is quite complex. Not every treatment option works for everyone. However, it’s important for patients to know all the treatments that they are eligible for and make an educated decision with their care team. This is why we recommend treatment at centers with a multidisciplinary approach so they can access the input of all specialists.”
Common Questions About Mesothelioma Treatment
- What is the most common treatment for mesothelioma?
-
Chemotherapy is the most common treatment for mesothelioma. The majority of people with mesothelioma qualify for chemotherapy. Fewer people qualify for surgery and radiation therapy.
- How effective is mesothelioma treatment?
-
The effectiveness of mesothelioma treatment depends on many factors. The type of mesothelioma, its stage and a patient’s overall health and age impact treatment outcomes. Combining treatments in multimodal therapy improves life expectancy.
- Can mesothelioma be cured with treatment?
-
While no treatment can cure this type of cancer, therapies can improve survival and quality of life. Partial remission is more common with this cancer than full remission. Patients in partial or full remission often receive maintenance therapies. Surgery has the potential to remove most of the cancer. Chemotherapy, immunotherapy and radiation can help control tumor growth and spreading.
- What happens if mesothelioma goes untreated?
-
Untreated mesothelioma grows and spreads more quickly than when treated. The growth rate varies based on the cancer’s stage, location, tumor grade and cell type. While some patients may experience a slower progression, most cases progress rapidly.
- What are the common side effects of mesothelioma treatment?
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Common side effects of mesothelioma treatment include fatigue, nausea, mouth sores and loss of appetite. Radiation may cause skin irritation and shortness of breath. Surgery may lead to pain, infection and complications. Immunotherapy can cause flu-like symptoms and rashes.
