Toll Free: (855) 688-9653

Stage 4 Pleural Mesothelioma

Stage 4 is the final stage of pleural mesothelioma. The cancer has spread throughout the chest and possibly to distant organs. This stage is considered terminal. Average survival for stage 4 mesothelioma is about 12 months with treatment.

Get a Free Mesothelioma Guide

Understanding Stage 4 Mesothelioma

In stage 4, the cancer has spread throughout the chest and possibly outside the chest cavity. Symptoms become severe at this stage because tumors cover vital organs and restrict the lungs and heart. Tumor-removing surgery is not an option at stage 4. Chemotherapy extends survival and clinical trials offer experimental therapies such as immunotherapy.

Stage 4 pleural mesothelioma is primarily treated with chemotherapy to extend survival. Emerging therapies — such as immunotherapy and anti-angiogenic therapy — may be recommended to control cancer growth and relieve symptoms.

Palliative therapies are also used to control pain, reduce symptoms and improve quality of life.

Life expectancy for stage 4 mesothelioma depends on the patient’s response to treatment and how fast tumors continue to spread. Patients who decide against treatment live an average of six months, while those who undergo treatment survive about one year.

Stage 4, or end-stage mesothelioma, is considered terminal. However, treatment breakthroughs have helped some people outlive their prognosis by years.

What are the Symptoms of Stage 4 Mesothelioma?

The end stages of mesothelioma symptoms are severe. Difficulty breathing and swallowing can lead to distress, weakness and sleep problems. Some patients may experience blood issues such as low red blood cell count (anemia) and high platelet count (thrombocytosis).

Common Symptoms of Stage 4 Mesothelioma include:

What is the Prognosis and Life Expectancy?

Unfortunately, the prognosis for most stage 4 mesothelioma patients is poor.

The five-year survival rate for advanced-stage pleural mesothelioma is 7%, according to the Surveillance, Epidemiology and End Results Program of the National Cancer Institute.

However, these averages cannot predict how long each individual patient will live. For example, a small percentage of patients have slow-growing tumors. Some of these patients live for years with stage 4 mesothelioma.

Some patients respond well to innovative therapies such as immunotherapy. For example, sometimes only one mesothelioma patient in a clinical trial will respond well to a drug or therapy. The drug may fail most patients in the trial, but a lucky few will see positive results.

What Are My Treatment Options?

Treatment options for stage 4 pleural mesothelioma include chemotherapy, palliative surgery and radiation therapy. Clinical trials and compassionate use programs offer immunotherapy and anti-angiogenic therapy. Palliative therapies are available to control pain, reduce symptoms and improve quality of life.


Chemotherapy can help stage 4 mesothelioma patients live longer. It also reduces symptoms such as difficulty breathing and chest pain.

The most common and effective chemotherapy regimen for pleural mesothelioma is a combination of Alimta (pemetrexed) and cisplatin.


Stage 4 mesothelioma is considered unresectable, which means unable to be removed by surgery, because of advanced tumor spread. Tumor-removing surgery isn’t possible at this stage because the cancer is too widespread to be removed.

Even attempting such an aggressive surgery could shorten the life span of a stage 4 patient. However, palliative surgeries are available that aim to improve symptoms rather than remove tumors.

Radiation Therapy

Radiation therapy can help stage 4 patients with painful chest wall tumors.

Some tumors that spread to the chest wall cause severe pain. Radiation therapy can shrink these tumors, which helps reduce pain caused by pressure against nerves and sensitive organs or tissues.

Clinical Trials

Some stage 4 patients may qualify for clinical trials testing the latest cancer treatments.

These research studies are a great opportunity for patients to get access to promising immunotherapy drugs such as Keytruda (pembrolizumab) and Opdivo (nivolumab).

Other emerging treatments include anti-angiogenic therapy and gene therapy. Anti-angiogenic drugs stop tumors from forming new blood vessels, which stops cancer cells from spreading. Gene therapy involves modifying a patient’s cancer genes to fight cancer from within the body.

Get Help
Finding a Doctor

Palliative Care

Palliative care aims to control pain, alleviate symptoms and improve quality of life.

Life Expectancy Without Treatment

The average life expectancy for stage 4 mesothelioma without anti-cancer treatment is six to eight months.

Patients who decide against anti-cancer treatment, such as chemotherapy and immunotherapy, may still elect palliative therapies to improve symptoms and maintain quality of life.

What to Expect

Patients in mesothelioma’s final stages can expect to experience an increase in symptoms. More symptoms will develop, and their severity will increase as the disease progresses.

As the cancer progresses, patients will need more care and assistance. Working with a palliative care specialist can help maintain quality of life, and so can working with a hospice provider.

Some families hire a professional caregiver or home health aide to help provide medical care and handle other caregiving duties.

Stage 4 Survivor Stories

A stage 4 pleural mesothelioma diagnosis and the survival statistics that come with it can be devastating. But many survivors have beaten the odds and far outlived their initial prognosis.

Andy Ashcraft

Andy Ashcraft survived for seven years after his stage 4 diagnosis. He enrolled in a clinical trial where he saw positive results taking the immunotherapy drug Amatuximab (MORab-009). He later turned to cannabis oil, which he credited for controlling his tumor growth and managing symptoms.

George Schottl

This Swedish mesothelioma survivor was given just three to six months to live after his stage 4 diagnosis. George Schottl went on to survive nine years thanks to surgery, chemotherapy and a positive outlook.

Lannie Chitwood

Doctors gave Lannie Chitwood a few months to live. He didn’t let that stop him. Chitwood is a rare example of a stage 4 patient being eligible for and finding success with an aggressive surgery. He underwent an extrapleural pneumonectomy, followed by radiation and chemotherapy.

Chitwood survived 10 years after his 2007 diagnosis, spending much of that time fishing, traveling and cherishing moments with his five grandchildren.

Snehal Smart, M.D.

Snehal Smart, M.D.

Snehal Smart is the Pleural Mesothelioma Center’s in-house medical doctor, serving as both an experienced Patient Advocate and an expert medical writer for the website. When she is not providing one-on-one assistance to patients, Dr. Snehal stays current on the latest medical research, reading peer-reviewed studies and interviewing oncologists to learn about advancements in diagnostic tools and cancer treatments.

Medically Reviewed By Dr. Joanne Getsy
Last Modified May 16, 2019

7 Cited Article Sources

  1. American Cancer Society. (2018, November 16). Mesothelioma Stages. Retrieved from
  2. American Cancer Society. (2018, November 16). Palliative Procedures for Malignant Mesothelioma. Retrieved from
  3. American Cancer Society. (2018, November 16). Signs and Symptoms of Mesothelioma. Retrieved from
  4. Scherpereel, A. et al. (2018, March). Novel therapies for malignant pleural mesothelioma. Retrieved from
  5. Bonomi, M. (2017, August 18). Clinical staging of malignant pleural mesothelioma: current perspectives. Retrieved from
  6. UMN Comprehensive Cancer Center. (n.d.). Stage IV/Recurrent Malignant Pleural Mesothelioma. Retrieved from
  7. Surveillance, Epidemiology and End Results program. (n.d.). Mesothelioma 5-Year Relative and Period Survival by Race, Sex, Diagnosis Year and Age. Retrieved from

Free Mesothelioma Informational Packet

Get Yours Now

Get Help Finding a Doctor

Get Help Now

VA Claim Help For Veterans

Get Help Now

Our Certifications

McAfee SECURE sites help keep you safe from identity theft, credit card fraud, spyware, spam, viruses and online scams

Sponsored by The Peterson Firm, 1050 30th Street NW, Washington, DC 20007 © 2019

View free resources for patients and families Chat live with a patient advocate now loading spinner