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Mesothelioma Treatment

The treatment of pleural mesothelioma is constantly improving thanks to the dedication of specialists and the courage of clinical trial participants. Although there is no definite cure for pleural mesothelioma yet, an array of treatment options can extend patients’ lives and improve their quality of life.

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The standard treatment options for pleural mesothelioma are surgery, chemotherapy and radiation therapy. Doctors have achieved the best results by combining two or more of these options to fit each patient’s unique situation, which is called a multimodal approach.

When mesothelioma is diagnosed in an early stage, major surgery supported by chemotherapy and radiation can enable a patient to live years beyond their initial life expectancy. However, these aggressive curative treatments will not benefit all patients. In many cases, doctors instead recommend palliative treatments, which aim to relieve cancer symptoms and improve quality of life.

Researchers are also developing experimental treatments, such as immunotherapy, photodynamic therapy and gene therapies, which have the potential to improve survival rates and minimize the side effects of cancer treatment. Eligible patients are encouraged to apply to clinical trials that study these new and innovative courses of treatment.

Survival rate based on type of mesothelioma treatment:

Treatment 1-Year Survival Rate 2-Year Survival Rate 3-Year Survival Rate
Surgery 52% 34% 21%
Surgery and Chemotherapy 56% 29% 17%
Surgery and Radiation 66% 39% 22%
Surgery, Chemotherapy and Radiation 76% 51% 37%
Multimodal therapy was linked to better survival rates in a 2014 study of 518 patients.

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Surgery Removes Cancer Tissue and Relieves Pressure

Surgery has proven to be the best standard treatment option for long-term survival.

Specialists have developed two potentially curative surgical procedures for pleural mesothelioma:

  • An extrapleural pneumonectomy (EPP) is an extensive surgery involving the removal of the entire affected lung, the linings of the chest and heart, and the diaphragm. Though this procedure gives the surgeon a good chance of eliminating the tumor from the body, removing a lung also permanently impairs the patient’s stamina.
  • A pleurectomy/decortication (P/D) is a less radical surgery in which the surgeon removes the linings of the chest and heart, and sometimes the diaphragm, but spares the lung. This procedure has become an attractive option for multimodal therapy, because it can provide the same benefits as an EPP with fewer risks of complications.

There are also two palliative surgical options that focus on treating one of the most common symptoms of pleural mesothelioma. When fluid builds up in the space around the lungs, it can make breathing painful and difficult — this ailment is called a pleural effusion.

  • A thoracentesis procedure drains the fluid from a pleural effusion, relieving the pressure on the lung.
  • A pleurodesis procedure drains the fluid and goes a step further by also sealing the pleural space to prevent any further fluid buildup.

Chemotherapy Poisons Cancer Cells

Chemotherapy involves the use of one or more drugs to kill cancer cells and shrink tumors. The drugs are usually delivered into a patient’s vein through an IV or taken orally as pills. The most widely used chemotherapy treatment for pleural mesothelioma is a combination of the drugs cisplatin and pemetrexed.

The debate over when chemotherapy is more effective in treating patients with pleural mesothelioma continues. The first randomized phase II clinical trial comparing the efficacy of chemotherapy delivered before or after aggressive surgery isn’t scheduled to conclude until April 2020.

  • Performing chemotherapy before surgery or radiation therapy can shrink the tumor, making it easier to target.
  • Performing chemotherapy after surgery can help kill any cancer cells left in the body.
  • On its own, chemotherapy can slow cancer progression, help ease symptoms and prolong survival.

Chemotherapy drugs damage cells that divide quickly, which is what makes chemotherapy an effective cancer treatment.

However, because there are also many normal cells in the body that divide quickly, chemotherapy usually has harsh side effects, including:

  • Fatigue
  • Nausea and vomiting
  • Hair loss
  • Mouth sores
  • Diarrhea and constipation
  • Anemia

Radiation Damages DNA in Cancer Cells

Radiation therapy uses high-energy rays to damage the DNA in cancer cells, which stops them from growing and dividing. Radiation can also harm healthy cells, especially lung cells, but fortunately for pleural mesothelioma patients, technological advances are making it easier for doctors to safely administer radiation near vital organs.

  • Like chemotherapy, radiation therapy can help kill cancer cells left over in the body after surgery.
  • In particular, radiation therapy is often used after surgery to prevent “cancer seeding.” Precise doses of radiation can kill any cancer cells left behind by surgical tools, ensuring they do not form new tumors.
  • As a palliative treatment for late-stage patients, radiation can shrink tumors and significantly relieve pain.

Radiation therapy is a painless outpatient procedure, but it can have some side effects, including fatigue, nausea and skin irritation near the application area (similar to sunburn). Depending on the dosage and frequency of the radiation, long-term radiation damage may also occur.

Dr. Jacques Fontaine discusses the most common treatment options for pleural mesothelioma patients.

Specialized Care Is Essential

Pleural mesothelioma is rare compared to other forms of cancer. Most oncologists have never examined a patient with asbestos-related cancer, let alone tried to treat one. In fact, mesothelioma is so uncommon that it is frequently misdiagnosed.

For every pleural mesothelioma patient in the United States, there are more than 70 lung cancer patients.

A pleural mesothelioma patient’s best hope of improving their prognosis is to seek a team of medical professionals with experience treating this disease. There are several specialized cancer centers spread across the United States with expert staff dedicated to developing the best treatments for mesothelioma patients.

The Cost of Cancer Treatments

A patient’s treatment options will depend on the specifics of their diagnosis, and their out-of-pocket expenses will depend on their health insurance coverage. Any way you look at it, however, pleural mesothelioma treatment is expensive.

  • Radiation therapy may cost around $2,000 a month.
  • The cost of chemotherapy can easily exceed $10,000 each month.
  • The average cost of a major thoracic cancer surgery is $40,000.

At the same time, however, there are unique financial resources available to many pleural mesothelioma patients:

  • Grants for travel, housing and treatment are available to help patients take advantage of top cancer centers.
  • Because almost all mesothelioma cases are caused by asbestos, many former asbestos-industry companies established trust funds to compensate victims of exposure.
  • Compensation is also available through personal-injury lawsuits.

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Emerging Treatments and Clinical Trials

Research studies called clinical trials allow scientists and doctors to experiment with conventional drugs and therapies in different combinations and doses, as well as test the safety and effectiveness of entirely new methods of treatment.

The ultimate goal of these trials is to find new and improved treatment strategies the FDA can approve to treat a certain diagnosis.


Immunotherapy is a type of treatment that helps the body’s immune system fight cancer. The immune system is the body’s protection mechanism, designed to defend against bacteria, viruses and toxins, and it removes dead or damaged cells. When the immune system recognizes something that shouldn’t be in the body, immune cells attack the target.

However, because cancer cells appear very similar to healthy cells, the immune system may not recognize cancer cells as something dangerous, or the immune system may become too weak to fight the cancer on its own. This is where immunotherapy comes in.

  • Active immunotherapy helps the body recognize the cancer as foreign, allowing the immune system to specifically target and destroy cancer cells while leaving non-cancerous cells alone. A doctor injects the patient with antigens that mimic the surface of the cancer cells. When the immune system detects these antigens, it provokes an immune response against the cancer.
  • Passive immunotherapy attacks the cancer directly with immune compounds created in the lab such as antibodies, cytokines, T cells or macrophages. Rather than waiting for the patient’s immune system to produce compounds on its own, the doctor injects the patient with ready-made compounds tailored to fight the cancer.

Immunotherapy has been making strides in the fight against cancer. The FDA has approved immunotherapy to treat several types of cancers, including lung cancer. Immunotherapy is now the focus of some mesothelioma clinical trials. Immunotherapy is most successful when used in addition to standard treatments.

The targeted approach of immunotherapy can reduce the side effects patients experience during cancer treatment. Researchers hope that one day immunotherapy will be effective enough that patients won’t have to endure the vomiting and hair loss that typically accompany chemotherapy and radiation.

However, immunotherapy does have some side effects of its own, which are the result of kick-starting the immune system:

  • Flu-like symptoms
  • Rashes
  • Chronic fatigue
  • Low fever
  • Changes in blood pressure

Photodynamic Therapy

Photodynamic therapy (PDT) uses a special light-activated drug called a photosensitizer to kill cancer cells. The most common photosensitizer used to treat pleural mesothelioma is porfimer sodium, more commonly known as Photofrin.

  • The drug is usually injected into a vein, allowing it to spread throughout all the body’s cells.
  • It remains in cancerous cells longer than in healthy cells, and treatment begins two or three days after the drug has left most of the healthy cells.
  • The doctor targets specific areas with light to activate the drug, inducing a chemical reaction that kills the cancerous cells. Photofrin reacts the best to red light.
  • Because PDT does not target healthy cells, this pleural mesothelioma treatment has fewer side effects than standard chemotherapy.

Photodynamic therapy has shown the best results when used alongside surgery as part of a multimodal treatment approach. In a study published in 2012, a total of 38 pleural mesothelioma patients underwent a radical pleurectomy and intraoperative photodynamic therapy. The resulting median survival time after treatment was 31.7 months.

Virotherapy and Gene Therapy

Viral diseases modify the DNA of the body’s cells, forcing host cells to stop their normal function and instead produce more copies of the virus. Though natural viruses can cause a variety of dangerous illnesses, some researchers are now trying to engineer viruses to cure cancer. In theory, a virus could be specially designed to do one of the following:

  • Infect and kill only cancer cells.
  • Repair the DNA of cancer cells so they no longer divide and grow out of control.
  • Modify the DNA of cancer cells to make them vulnerable to a chemotherapy drug that will have no effect on normal cells.

In each case, the treatment leaves healthy cells unharmed. The technologies of virotherapy and gene therapy are still highly experimental, but they offer the possibility of an effective cancer therapy with much less severe side effects than chemotherapy and radiation.

Complementary and Alternative Medicines

Many patients turn to complementary and alternative medicines (CAM) for help coping with the symptoms of pleural mesothelioma and the side effects of cancer treatments. CAM therapies cover a wide variety of practices — with some based in the life sciences or mystical belief systems, and others falling somewhere in between.

CAM therapies vary dramatically in terms of the scientific evidence supporting them. For example, yoga and massage have proven health benefits, but energy-healing techniques such as reiki remain a matter of faith.

Either way, the same general guidelines apply: Check with your doctor before beginning any CAM therapy, be skeptical of anyone who offers you a “miracle cure” for cancer and look for ways to reduce your stress and maintain a positive attitude.

If a certain practice brings you peace of mind, and your medical team has no qualm with it, then it may indeed help you heal.

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 March 28, 2019

7 Cited Article Sources

  1. American Cancer Society. (2012, September 20). What’s New in Malignant Mesothelioma Research and Treatment? Retrieved from
  2. (2018, July 12). Pleurectomy/ Decortication (P/D) Preceded or Followed by Chemotherapy in Patients With Early Stage MPM. Retrieved from
  3. Lindenmann, J. et al. (2012, November 21). Mutlimodal Therapy of Malignant Pleural Mesothelioma: Is the Replacement of Radical Surgery Imminent? Retrieved from
  4. National Cancer Institute. (2011, August 31). Hyperthermia in Cancer Treatment. Retrieved from
  5. Pass, H., Vogelzang, N. and Carbone, M. (2005). Malignant Mesothelioma: Advances in Pathogenesis, Diagnosis, and Translational Therapies. New York, NY: Springer.
  6. Texas Oncology. (n.d.). Stage I-III Malignant Pleural Mesothelioma. Retrieved from
  7. Spaggiari, L. et al. (2014). Extrapleural Pneumonectomy for Malignant Mesothelioma: An Italian Multicenter Retrospective Study. Annals of Thoracic Surgery, 97, 1859–66. DOI:

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