Doctors treat mesothelioma with surgery, chemotherapy, radiation and immunotherapy to reduce or remove tumors and improve quality of life. Newer treatment options such as targeted therapy, clinical trials and multimodal treatment are tailored to stage, type and overall health.
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Dr. Jeffrey Velotta: What do you feel is the best approach to treating mesothelioma
I feel that surgery first, followed by chemotherapy, is the best multimodality approach for mesothelioma due to the fact that we know only 20% to 40% of patients will actually have somewhat of a radiologic or clinical response to chemotherapy. So patients that will opt for chemotherapy first--
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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Dr. Jeffrey Velotta: What do you feel is the best approach to treating mesothelioma
I feel that surgery first, followed by chemotherapy, is the best multimodality approach for mesothelioma due to the fact that we know only 20% to 40% of patients will actually have somewhat of a radiologic or clinical response to chemotherapy. So patients that will opt for chemotherapy first--
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 Most Common Mesothelioma Treatments?
The most common mesothelioma treatment options include surgery, chemotherapy, radiation and immunotherapy. Your doctor will recommend a personalized plan based on your type of mesothelioma, where it’s in your body and your health. Many people receive more than one kind of treatment at the same time.
Key Facts About Mesothelioma Treatment
Primary treatment options include surgery, chemotherapy, immunotherapy and radiation.
Overall survival is greatest among those who received both surgery and chemo, according to the National Cancer Database.
Clinical trials offer access to emerging therapies.
Palliative care can happen at the same time as curative treatment and aims to manage symptoms and improve quality of life.
For pleural mesothelioma, which starts near the lungs, immunotherapy is now a standard treatment. Mesothelioma specialists 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 conducted a patient survey asking people about their treatments. According to our 2025 survey, 32% of people diagnosed with mesothelioma received chemo, making it the most common treatment among respondents. Immunotherapy was more common among pleural patients and surgery was more common around peritoneal patients.
Most Common Treatments By Type
Pleural Mesothelioma
Peritoneal Mesothelioma
Chemotherapy
31%
32%
Immunotherapy
25%
18%
Surgery
16%
27%
Radiation
15%
10%
Source:
The Mesothelioma Center at Asbestos.com, 2025
Surgery for Mesothelioma
Surgery can offer the best chance to extend survival for carefully selected mesothelioma patients. Patients in early stages with epithelioid mesothelioma, a cell type that responds most favorably to treatment, typically see the strongest outcomes. The specific procedure your doctor recommends will depend on factors like tumor location, cancer spread, your overall health and your treatment goals.
A July 2024 retrospective study in The Annals of Thoracic Surgery found people who had surgery for pleural mesothelioma lived much longer than those who declined it. But only about 15% to 20% of pleural mesothelioma patients qualify for surgery.
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.
Survivor Story
Linda Hooper: What I’d Tell You Before Mesothelioma Surgery
I would say if you can handle it, do it. But you have to be sure that you are gonna follow through on what needs to be done afterwards. You need to say you’re gonna walk, you’re gonna eat, you’re gonna do the things that you have to do to get better because the surgery isn’t gonna help all on its own. It’s gonna be the start that you need to get better, but you have to follow through with the whether it’s with physical therapy or having somebody encourage you to get up and walk, or if you have to be your own self discipline, you have to do it.
Surgical approaches vary based on mesothelioma type and location. Cytoreductive surgery with heated chemo, or HIPEC, has significantly improved survival for peritoneal mesothelioma patients. Researchers are also studying hyperthermic intrathoracic chemo, known as HITHOC, for pleural cases, which delivers heated chemo inside the chest, though this approach remains experimental at most centers.
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.”
Chemo uses strong drugs to kill cancer cells throughout the body. It’s considered the standard first-line treatment for most mesothelioma patients. Many patients qualify for it, even if they can’t have surgery. 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.
Chemo can be delivered systemically, delivering drugs via the bloodstream, or locally, targeting specific areas like the chest or belly. Research in the Journal of Oncology shows chemo can extend survival approximately 6 months compared to supportive care alone.
Common Chemo Drugs for Mesothelioma
Adriamycin (doxorubicin)
Alimta (pemetrexed)
Cytoxan (cyclophosphamide)
Eloxatin (raltitrexed)
Gemzar (gemcitabine)
Navelbine (vinorelbine)
Paraplatin (carboplatin)
Platinol (cisplatin)
Among our 2025 survey participants, 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.
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.
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.
Radiation can be an option for people who can’t have surgery or chemo, or for those who have cancer left after surgery. Only 13% of people in our 2025 survey received radiation and radiation alone isn’t usually recommended as it’s more effective when combined with other treatments. However, it still plays an important role in treatment for some.
Most Common Types of Mesothelioma Radiation Therapy
Brachytherapy
Intensity-modulated radiation therapy
Photodynamic therapy (light-activated drug therapy)
Volumetric-modulated arc therapy
Possible side effects include tiredness, skin irritation and damage to healthy tissue. Ask your doctor about modern methods like IMRT and VMAT that aim radiation more precisely to spare healthy tissue. Working with your mesothelioma specialist can help you weigh the benefits and risks of radiation as part of your treatment plan.
Radiation is most commonly used for pleural mesothelioma. Some 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.
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.
These types of immunotherapy drugs are called checkpoint inhibitors. They take the brakes off your immune cells so they can attack cancer. Mesothelioma survivor Barbara Lapalla tells us she receives Keytruda 3 times per week and credits it with saving her life. She shares, “I tell people today, I’m a walking miracle. They don’t believe in miracles. Then they see me.”
Common Immunotherapy Drugs for Mesothelioma
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.
Latest Update
In 2024, the FDA approved Keytruda (pembrolizumab) + chemo as a first-line option. This followed the FDA’s 2020 approval of Opdivo (nivolumab) + Yervoy (ipilimumab) for unresectable pleural mesothelioma.
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. Some centers add bevacizumab (Avastin) to chemotherapy for select pleural cases. This may help certain patients live longer, though it isn’t FDA-approved specifically for mesothelioma.
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: Combining Treatments for Better Outcomes
Multimodal therapy combines two or more treatments such as surgery, chemotherapy, radiation, immunotherapy or targeted therapy to manage mesothelioma.For pleural disease, doctors may combine surgery, chemo and radiation (trimodality therapy). For peritoneal disease, surgery plus HIPEC is a common multimodal approach.
Recent research highlights the important role multimodal approaches play in improving outcomes. A May 2025 meta-analysis found combining surgery with other treatments 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.
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.
Emerging Cancer Treatments
Cancer vaccines: Rather than preventing disease, these vaccines stimulate the body’s immune response to kill off tumors and prevent recurrence.
Cryoablation: A type of cryotherapy, this minimally invasive approach uses extreme cold to destroy tumors or abnormal tissue.
Gene therapy: Treatment that alters genes inside a patient’s cells to help the body fight cancer or other diseases.
Oncolytic viruses: Special viruses that infect cancer cells, multiply inside them and cause them to die while sparing healthy tissue.
Photodynamic therapy: PDT is a 2-step approach that uses light-activated drugs to kill tumor cells.
Tumor Treating Fields: TTFields applies electric currents through patches placed on the skin to interfere with how cancer cells divide and multiply.
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.
Palliative 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. Other palliative resources include counseling, support groups, caregiver resources, hospice care and advanced care planning.
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.”
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.
How has your life been after receiving mesothelioma treatment?
I’m doing more things now that I was doing before. Before I didn’t have a farm. You know, I had a farm. I had a land, but I didn’t have a farm. Now I have in that land, I have a avocado farm. I built a house that I wanted to build. I designed it. I built it. I’m leaving it. I fly helicopters. So I I I do that also. I took classes and I do fly it. So and I’m seventy four. So I think I’m doing great.
What are the treatment options for mesothelioma?
[MUSIC PLAYING] The treatment options are many, including chemotherapy, radiation therapy, surgery, surgery with heated chemotherapy. In some cases, we’ll provide the patients with an option for immunotherapy, although reserved for a few patients. We can also provide palliative surgery for patients in which they can get relief of their symptoms and then be treated in a multimodality, multispecialty protocol.
Benefits of a multidiciplinary treatment approach to mesothelioma.
[MUSIC PLAYING] Mesothelioma is a rare cancer, and its treatment is quite tricky and complex and requires sometimes surgery, chemotherapy, and radiation. And therefore, it’d be best that we have mesothelioma specialists from various disciplines, so thoracic surgeons who specialize in mesothelioma treatments, medical oncologists, radiation oncologists, pathologists who all work together under one roof as a team in order to see the patient as a team, discuss them at a meeting that we usually have once a week called The Tumor Board. And that’s what major mesothelioma centers offer– different specialists from different disciplines all working, taking care of one patient. [MUSIC PLAYING]
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.”
Dr. Catherine Perrault,
medical officer and board-certified family physician with The Mesothelioma Center’s Medical Outreach Team
Common Questions About Mesothelioma Treatment
What are the main treatment options for mesothelioma?
The most common treatments for mesothelioma are chemotherapy, surgery, radiation therapy, and immunotherapy. Most patients receive chemotherapy, while some qualify for surgery or radiation based on their stage and overall health. Specialists often combine therapies to improve results.
How effective is mesothelioma treatment?
The effectiveness of treatment depends on factors such as cancer stage, mesothelioma type and your age and health. Combining multiple treatments, known as multimodal therapy, offers the best chance to extend life expectancy and improve quality of life.
Can mesothelioma be cured with treatment?
There’s currently no cure for mesothelioma, but treatments can help people live longer and feel better. Some patients go into remission or experience slowed tumor growth. Surgery may remove most visible tumors, while chemo, immunotherapy and radiation help control the cancer.
What happens if mesothelioma goes untreated?
Without treatment, mesothelioma can spread faster and cause worsening symptoms. Growth rate depends on the cancer’s stage, type and cell characteristics. Even if there isn’t a cure for this cancer, with treatment some patients can achieve remission.
What are the common side effects of mesothelioma treatment?
Common side effects include fatigue, nausea, appetite loss and mouth sores. Surgery may cause pain or infection, while radiation can lead to skin irritation and shortness of breath. Immunotherapy sometimes triggers flu-like symptoms or rashes. Doctors can help you manage side effects to keep you comfortable.
How can I find the best mesothelioma specialist or treatment center?
Our Patient Advocates can help you connect with top mesothelioma doctors nationwide. Finding a mesothelioma specialist early can improve outcomes. Centers that treat this rare cancer often offer access to the latest therapies and clinical trials.
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The Mesothelioma Center at Asbestos.com has provided patients and their loved ones the most updated and reliable information on mesothelioma and asbestos exposure since 2006.
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