Maintenance Therapies for Mesothelioma

What Is Maintenance Therapy?

Mesothelioma maintenance therapy is ongoing treatment with medication after the tumors have responded to the first phase of treatment. 

Maintenance therapy aims to prevent recurrence or delay the growth of cancer cells following primary mesothelioma treatment. Depending on their body’s response, some patients may remain on maintenance therapy for long periods. 

Ongoing research is investigating the value of maintenance therapy for mesothelioma to determine which treatments are most effective. The U.S. Food and Drug Administration has yet to approve any drugs for maintenance therapy, but mesothelioma specialists still recommend maintenance therapy to patients.

Types of Maintenance Therapy

The types of maintenance therapy for mesothelioma include chemotherapy, immunotherapy and targeted therapies. These therapies are available at the nation’s top mesothelioma cancer centers.

Maintenance chemotherapy, sometimes called continuous therapy or switch-maintenance therapy, has been studied the most in mesothelioma. According to research, Alimta alone is not an effective maintenance therapy drug for mesothelioma. However, investigators continue to evaluate Alimta and the medication Gemzar for potential benefits.

I feel that surgery first, followed by chemotherapy, is the best multimodality approach for mesothelioma. [Chemotherapy] may be helpful, but it never gets rid of it. So rather than take that chance, I’d rather get it out first [using surgery].

Dr. Jeffrey Velotta, thoracic surgeon at Kaiser Permanente Oakland Medical Center in California

A 2021 phase II study published in The Lancet investigated switch-maintenance chemotherapy in pleural mesothelioma patients. Half the participants switched to Gemzar and supportive care after initial treatment with Alimta and cisplatin or carboplatin. The other half received only supportive care. The Gemzar group lived three months longer, and their tumors didn’t progress as quickly as the supportive care group. They also enjoyed a better quality of life.

Maintenance immunotherapy and targeted therapy are less understood than maintenance chemotherapy for mesothelioma. However, specialists recommend these treatments to patients who meet specific eligibility criteria. For example, patients who do not respond well to chemotherapy may be considered for immunotherapy and targeted therapy drugs.

When patients decide to focus on quality of life, I bring this up to share that this is an option if they want some sort of treatment to treat the symptoms they are experiencing.

Dr. Snehal Smart, medical doctor and patient advocate

How Do Maintenance Therapies Treat Mesothelioma?

Maintenance therapy drugs control mesothelioma growth and spread in various ways. Chemotherapy drugs can directly kill mesothelioma cells to control tumor growth.

Immunotherapy drugs trigger a response that helps the immune system find and kill mesothelioma cells. Targeted therapy drugs hone in on specific molecules involved in mesothelioma growth. For example, some drugs block the development of new blood vessels, allowing tumors to grow and spread.

Patients become eligible for maintenance therapy after completing the first treatment(s) recommended by their mesothelioma doctor. Initial treatments vary among patients, from surgery to immunotherapy to chemotherapy, and the primary treatment affects follow-up maintenance therapy recommendations. 

Other eligibility criteria may include specific biomarkers found in blood tests, the patient’s response to primary treatment, and their overall health.

Expert Take

Dr. Jacques Fontaine: Managing Mesothelioma Recurrence

View Transcript

Patients who come see me at Moffitt Cancer Center with a diagnosis of mesothelioma have often lost hope. They’ve been told by other doctors that there’s no cure for the disease.


And albeit it’s true that there’s no cure, there are long term survivors. I have seen several patients who are still alive and doing well with a good quality of life five years later, ten years later, fourteen years later.


It’s not the majority of patients, but some do. And although there’s no cure, what happens is that we treat it either with surgery or chemotherapy or immunotherapy, and that cancer goes into remission. We can’t see anything else.


And then a few months or a few years later, it develops a resistance and starts growing again on a CAT scan.


So although you may have had treatment and it looks like the disease is gone, you have become a cancer survivor forever and you need to go back for surveillance, for checkups with your oncologist. Because if the cancer comes back, then we have the next type of treatment we can offer. And then we take care of it then. And then a few years go by and it comes back again. It’s a nagging type of cancer. And then when it comes back again, we hit it again with another type of treatment.


And then it goes away for a few months or a few years, and then it comes back again.


But by then, one of our clinical trials, one of our experimental trials have been shown to be very beneficial. And now it’s FDA approved and we can use it.


We knock it on the head again, but it keeps coming back.


So then you come back, you see your doctor, and then maybe there’s an investigational, the new generation of experimental treatment that’s there through a clinical trial, and then we get it again. And that’s how the weeks become months to become years of good quality of life, not being cured of the mesothelioma, but living with mesothelioma.

Common Maintenance Medications

Mesothelioma maintenance medications include chemotherapy, immunotherapy and targeted therapy drugs. 

Avastin (bevacizumab) is the primary drug for targeted maintenance therapy. Physicians initially administered Avastin with cisplatin and Alimta. Some patients stay on Avastin for up to a year as maintenance therapy after completing chemotherapy. Despite the need for more research on maintenance therapy drugs, most mesothelioma specialists recommend them to patients.

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Side Effects

The most common side effects of mesothelioma maintenance therapy are fatigue, digestive issues, fever and muscle or joint pain. Other potential side effects may include:

The side effects of maintenance therapies are generally less severe than primary treatments because patients often receive a lower dose of medication. 

Coping with side effects is an essential aspect of palliative care. Palliative care is supplementary to traditional treatments and may involve prescription medications to reduce digestive issues, treat skin conditions and alleviate other side effects. Tell your doctor about any worsening side effects sooner rather than later to get help and support in your treatment journey.

What to Expect When Getting Maintenance Therapy

Your experience with maintenance therapy for mesothelioma depends on the type of therapy your doctor recommends. The way therapy is administered, how long you need to take it, and whether maintenance therapy is combined with other treatments vary greatly.

For example, chemotherapy, immunotherapy and specific targeted therapies are provided through an IV infusion, which is given in cycles with breaks in between. Other targeted therapy drugs come in pill form. You can expect your doctor to closely monitor your health with blood tests and imaging scans while on maintenance therapy to ensure it works. Maintenance therapy can’t cure mesothelioma, but it may help keep cancer in remission longer.

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How to Prepare for Maintenance Therapy

To prepare for mesothelioma maintenance therapy, establish a support system. A network of family, friends and neighbors can help when you need assistance. You can rely on others for help around the house or traveling to medical appointments. Let your employer’s human resources department know about your ongoing treatment for more support and understanding at work.

In addition, those receiving chemotherapy should plan to protect household members from exposure to bodily fluids that may contain toxic chemotherapy drugs.

Common Questions Associated With Maintenance Therapies

How is maintenance chemotherapy different from other types of chemotherapy?

Maintenance chemotherapy is often less intense than initial rounds of chemotherapy because it usually involves one drug instead of two, and may involve a lower dose.

Is maintenance therapy painful?

Certain maintenance therapy plans may involve painful side effects such as an infection, nausea, muscle pain and weakness.

Is maintenance therapy expensive?

Certain forms of maintenance therapy, such as newer immunotherapy or targeted therapy drugs, may be more expensive than maintenance chemotherapy drugs. Your health insurance provider should be able to help you understand your out-of-pocket costs.

When do doctors decide to stop maintenance chemotherapy?

Your doctor may decide to stop maintenance chemotherapy if you experience serious adverse side effects or if the cancer progresses significantly.