12 Min Read
Last Updated: 05/15/2024
Fact Checked

Written by Sean Marchese, MS, RN | Medically Reviewed By Dr. Estelamari Rodriguez | Edited By Walter Pacheco

Key Facts About Immunotherapy for Mesothelioma
  • Immunotherapy is one of the newest gold-standard treatments for mesothelioma.
  • Some immunotherapy trials have shown an increase in survival by over a year.
  • Many patients respond better to chemoimmunotherapy than to chemotherapy alone.

What Is Mesothelioma Immunotherapy?

Mesothelioma immunotherapy is a targeted anti-cancer treatment that uses cells from a patient’s own immune system. This treatment for mesothelioma has become a standard therapy option for many patients.

Research has proven these drugs extend survival for mesothelioma patients with fewer and more manageable side effects than other options. Doctors also combine immunotherapy with other treatments for mesothelioma, such as chemotherapy and surgery.

How Does Immunotherapy for Mesothelioma Work?

Mesothelioma immunotherapy modifies and improves the immune system. It enhances the ability to recognize and kill cancer cells. This process is similar to how the body fights foreign pathogens, such as viruses and bacteria that cause disease. Immune cells also help remove other damaged or dead cells.

Diagram of how immunotherapy drugs treat mesothelioma
Immune cells locate and destroy mesothelioma cancer cells.

Checkpoint inhibitors, such as Keytruda (pembrolizumab), get around the defenses of a cancer cell. Cancer cells display proteins that deactivate immune system T cells, allowing the cancer to hide from the body’s defenses. Keytruda blocks this interaction and reveals tumor cells to the immune system, exposing them to cytokines that destroy tumors. 

Types of Immunotherapy for Mesothelioma

There are many types of immunotherapy of mesothelioma, such as checkpoint inhibitors, mesothelioma cancer vaccines, monoclonal antibodies and CAR T-cell therapy. It’s best to weigh the benefits and risks of active or passive immunotherapy options.

Active and Passive Immunity
  • Active immunity occurs when the body creates antibodies and remembers how to produce anti-cancer antibodies, decreasing the cancer recurrence rate. Active immunotherapy includes CAR T-cell therapy and cancer vaccines, such as UV1.
  • Passive immunity involves artificial immune cells that provide protection but do not create long-lasting antibodies. Anti-cancer effects fade over time after treatment. Passive immunotherapy includes immune checkpoint inhibitors, such as Keytruda, Opdivo (nivolumab) and Yervoy (ipilimumab).

Clinical trials examine the safety and effectiveness of new types of mesothelioma immunotherapy. Success rates for immunotherapy treatments vary for each patient. Your cancer type, stage, previous treatments and overall health will determine which therapy is best for you.

Cancer Vaccines

There are two types of cancer vaccines: Preventative and therapeutic. Preventative vaccines decrease the chance of recurrent cancer, and therapeutic vaccines attempt to treat active diseases. Cancer vaccines help prevent specific diseases from coming back like vaccines for the flu and other illnesses.

One preventative mesothelioma vaccine targets the OX40 receptor. It has decreased tumor growth and increased survival in mice carrying mesothelioma tumors. Researchers are studying whether this vaccine could prevent mesothelioma recurrence.

Two therapeutic vaccines for mesothelioma, the listeria-based cancer vaccine CRS-207 and galinpepimut-S (WT1), have shown promise in clinical trials. A phase 2 trial of the WT1 vaccine reported more prolonged survival and better tumor control.

Monoclonal Antibodies

Monoclonal antibody therapy (mAb) creates many copies of anti-cancer antibodies that your body uses to fight cancer. It is the most common immunotherapy for many cancers but is rare for mesothelioma.

Antibody therapy is a targeted treatment focusing on a single site, called an antigen, within cancer cells or on their surface. The treatment involves making many copies of the effective antibody in a lab and transfusing them to patients.

Tremelimumab is a monoclonal antibody and an immune checkpoint inhibitor under investigation for treating mesothelioma. Amatuximab (MORAb-009) is another monoclonal antibody. It progressed to a phase 2 clinical trial for mesothelioma patients. Overall survival was 14.8 months, almost 25% longer than the average survival for mesothelioma patients.

Cell and Protein Therapies

Cell therapies, such as adoptive cell transfer, involve transferring whole immune cells into patients. This therapy has been successful for advanced melanoma and renal cell carcinoma and is under study for patients with mesothelioma. Another type of adoptive cell transfer, CAR T-cell therapy, modifies immune system T cells to make them cancer-specific.

A phase 1 clinical trial injected immune system dendritic cells following chemotherapy. Ten mesothelioma patients treated with cisplatin and pemetrexed tolerated the therapy, and the study’s participants showed strong immune responses.

Cytokines are proteins made by T cells. They coordinate immune responses against cancer and foreign pathogens. Cytokines work independently or as a coordinated attack to kill cancer cells or stop the birth of new cells. Examples include tumor necrosis factor, interferon and interleukin-2.

Couple reviews Mesothelioma Guide together
Get a Free Mesothelioma Guide
Learn about your diagnosis, top doctors and how to pay for treatment.
Get Your Free Guide

What Are the Best Immunotherapy Treatments for Mesothelioma?

The FDA has approved Opdivo and Yervoy combination immunotherapy as an option for nonsurgical pleural mesothelioma patients. The best treatment will differ for each patient based on their needs. Newer experimental treatments include immune checkpoint inhibitors for peritoneal mesothelioma and targeted therapies such as the WT1 vaccine. 

Keytruda is effective against mesothelioma when cancer recurs after first-line treatment. It has led to an average overall patient survival of 18 months. Mesothelioma survivor Barbara Lappala told us, “Keytruda has worked like a charm for me, although I’m not exactly sure why. There have been absolutely no side effects. For me, it’s the magic bullet.” 

Survivor Story
Michael Cole Pleural Mesothelioma

Immunotherapy Has a Positive Effect on My Mesothelioma

Survivor Story

The combination of targeted radiation and immunotherapy had an effect. My tumors didn’t go away, but growth slowed to a comparatively glacial pace. We fell into a rhythm of immunotherapy monthly and radiation yearly. A couple of years later, I had a new type of radiation done. Some tumors shrank around 50% with no growth or new tumors since. I continue to have immunotherapy monthly.

Read Michael’s Story

A 2021 clinical trial found patients treated with Opdivo and Yervoy had a median overall survival of 18.1 months. Chemotherapy patients survived 14.1 months. The two-year survival rate was 41% for patients treated with the immunotherapy combination. It was only 27% for the chemotherapy group.

Benefits of Immunotherapy for Mesothelioma

The primary benefit of immunotherapy for mesothelioma is more prolonged survival and improved symptoms. This targeted treatment aims to only affect cancer cells. It avoids damaging healthy tissue, unlike chemotherapy or radiation. The side effects of immunotherapy are fewer and often more manageable.


Percentage of respondents to The Mesothelioma Center’s 2023 survey who tried immunotherapy.

Immunotherapy and other targeted therapies are widely considered the future of cancer treatment for mesothelioma patients. Immunotherapy can utilize the immune system’s natural processes to create long-lasting protection against mesothelioma for many years.

Pros and Cons of Mesothelioma Immunotherapy


  • Treatment uses the immune system and the body’s cells to fight cancer.
  • Targeted immunotherapy reduces damage to healthy tissues.
  • When a patient enrolls in a clinical trial, the research sponsor covers the cost of experimental immunotherapy.
  • Fewer side effects and more manageable than conventional mesothelioma treatment.


  • Inflammation reactions such as skin irritation, pneumonitis or colitis.
  • Potential organ damage, such as scarring in the lungs or kidney issues.
  • Fevers, nausea, diarrhea, body aches and other flu-like symptoms.

Other benefits of immunotherapy for mesothelioma include personalized treatment and financial support. Some types of immunotherapies are specific to the cancer DNA of individual patients. The study sponsor pays for immunotherapy available through clinical trials.

Common Side Effects of Immunotherapy for Mesothelioma Patients

Side effects of immunotherapy for mesothelioma patients involve a heightened immune response. Examples include fevers or body aches. Some side effects, such as coughing or fatigue, can be more uncomfortable for mesothelioma patients.

Common Immunotherapy Side Effects
  • Constipation
  • Coughing
  • Diarrhea
  • Fatigue
  • Fever
  • Mouth sores
  • Muscle or joint pain
  • Nausea
  • Skin irritation
  • Weight loss

Most mesothelioma patients experience only mild side effects with immunotherapy. Doctors monitor whether there is a need to slow or stop treatment. Almost all immunotherapy side effects are reversible with rest or medication. In rare cases, more severe reactions can damage sensitive tissue or organs.

Severe Adverse Reactions to Immunotherapy for Mesothelioma

Serious side effects can occur when the immune system overproduces antibodies that accumulate in delicate organs such as the lungs or kidneys. Generally, these conditions are associated with inflammation, which can cause scarring or organ damage after long periods.

Severe Immunotherapy Side Effects
  • Pneumonia: Chest pain, shortness of breath and persistent cough
  • Colitis: Inflammation of the colon that causes bloody stools, abdominal pain and intestinal tearing
  • Hepatitis: Liver inflammation characterized by eye and skin discoloration, changes in urine and right-side abdominal pain
  • Hormone Gland Problems: Hormonal side effects such as muscle aches, increased heart rate, headaches and weight loss
  • Kidney Problems: Nephritis, or inflammation of the kidneys, leading to changes in urine, back pain, hormone imbalance and potential kidney failure

Early treatment of immunotherapy side effects can help prevent long-term damage. In every patient’s case, discussing the potential benefits versus risks of treatment with a mesothelioma specialist is essential. Lifestyle changes and habits, such as a mesothelioma diet, can improve energy and reduce the severity of some side effects.

Male cancer patient at doctor's appointment
Free Webinar: Managing Immunotherapy Side Effects
Receive a free recording of our webinar for expert tips on managing the side effects of immunotherapy and other treatments.
Get a Recording

Cost of Immunotherapy

Many people find immunotherapy for mesothelioma highly expensive, often costing more than $10,000 per month. According to a recent Reuters report, Yervoy and Opdivo combination therapy can cost more than $250,000 annually while other immune checkpoint inhibitors can cost up to $150,000 annually.

We do our best to explain patients’ financial options. Our job as Patient Advocates is to educate and guide them, so when it comes time to make those decisions, they’re making very informed decisions.

Medicare and many insurance plans cover cancer immunotherapy, but out-of-pocket expenses and lost wages can significantly impact personal finances. VA benefits cover immunotherapy with limited to no out-of-pocket fees, but the veteran’s claims system can be complicated.

Patient Advocates can help patients and their families identify financial assistance opportunities for medical care, such as clinical trials or legal compensation. The Veterans Outreach team at The Mesothelioma Center can also help patients file VA claims.

Future of Immunotherapy for Mesothelioma

Immunotherapy researchers will likely continue to combine the treatment with other cancer therapies for mesothelioma in the future. For example, a 2023 Journal of Clinical Oncology study showed patient survival benefits in pairing Keytruda with chemotherapy. Other combinations could improve survival for more patients.

Future immunotherapy options for mesothelioma could include tumor-infiltrating lymphocytes, a type of white blood cell that invades tumors. This therapy signals a broader immune response alongside other treatments and may improve mesothelioma prognosis. Advanced preventative vaccines could disrupt the ability of asbestos to cause cancer, reducing risk after exposure.

Mesothelioma specialists provide access to the latest experimental immunotherapies through matching clinical trials or compassionate use programs. The recent FDA approval of Keytruda, Opdivo and Yervoy to treat mesothelioma represents the first steps in the broader availability of immunotherapy options.

Common Questions About Immunotherapy for Mesothelioma

Can immunotherapy be used to treat mesothelioma?

Immunotherapy has become a standard mesothelioma treatment option. Clinical research trials have proven this therapy’s safety and effectiveness. Immunotherapy boosts a patient’s immune system to help treat cancer and works in conjunction with chemotherapy, surgery and other treatments.

What is the success rate of immunotherapy?

Immunotherapy success varies for each patient based on the type and stage of cancer and the patient’s immune system. Keytruda is one of the most promising immunotherapy options for malignant pleural mesothelioma. In many cases, Keytruda has extended the life expectancy of patients by almost a year.

Is immunotherapy equally effective for men and women?

A 2018 systematic review and meta-analysis of 20 studies published in Lancet Oncology included 11,351 people with various types of metastatic cancer. Researchers reported men receiving checkpoint inhibitors had a 28% reduced risk of dying during the study period vs. a 14% reduced risk for women.

However, a July 2020 report in Biomedicines found that immunotherapy had an overall survival benefit for men and women. Neither gender showed statistically significant differences in their responses to immunotherapy.

What are the disadvantages of immunotherapy?

Immunotherapy results vary because treatment predominantly depends on the activity of the patient’s immune system and biomarkers on the tumor’s surface. Based on the intensity of the immune reaction, mesothelioma symptoms and treatment side effects may also be more severe in some patients.

Is immunotherapy better than chemotherapy?

Each treatment has advantages and disadvantages. Some patients might have fewer side effects with immunotherapy, while chemotherapy for mesothelioma may better control their tumor growth. Many oncologists use a combination approach that employs both therapies for optimal impact.

Connect with Our Community

The patient advocates of The Mesothelioma Center

Get in Touch

Have a question? Contact one of our Patient Advocates and get the answers you need.

Elder people sitting in a support group meeting

Join Our Support Group

Connect, share stories and learn from the experiences of others coping with mesothelioma in one of our support groups.

Patient Advocates walking for miles 4 mesothelioma

Giving Back

We help support charities, hospitals and awareness groups working to help people impacted by asbestos and cancer.

Upcoming Events

View All Events