Mesothelioma Treatment Options

Quick Answer

Mesothelioma treatment varies by type and stage. Pleural: surgery (P/D or EPP) + chemotherapy (pemetrexed + cisplatin/carboplatin) + radiation, plus immunotherapy (nivolumab + ipilimumab combination, FDA-approved 2020). Peritoneal: cytoreductive surgery + HIPEC. Plus tumor treating fields (TTFields) FDA-approved 2019.

Mesothelioma treatment is multimodal and varies by mesothelioma type, cell type, stage, and patient health.

Pleural Mesothelioma Treatment

Surgery

• Pleurectomy/Decortication (P/D) — removes the pleura (lung lining) and visible tumor while preserving the lung. Lower morbidity than EPP. Preferred at Mount Sinai (Dr. Flores) and UCLA (Dr. Cameron).
• Extrapleural Pneumonectomy (EPP) — removes the entire affected lung, pleura, diaphragm, and pericardium. More aggressive — used in selected patients.

Chemotherapy

Standard first-line: pemetrexed (Alimta) + cisplatin or carboplatin. Approved 2004. Median PFS 5-7 months.

Immunotherapy

Nivolumab (Opdivo) + ipilimumab (Yervoy) combination — FDA-approved Oct 2020 for first-line treatment. Extends overall survival vs chemotherapy alone, especially effective in sarcomatoid + biphasic subtypes.

Radiation

Used as part of multimodal treatment (with surgery + chemo) or palliatively for symptom control.

Tumor Treating Fields (TTFields / Optune Lua)

FDA-approved May 2019 for pleural mesothelioma. Wearable device delivers electrical fields that disrupt cancer cell division.

Peritoneal Mesothelioma Treatment

Cytoreductive Surgery (CRS) + Hyperthermic Intraperitoneal Chemotherapy (HIPEC) — pioneered by Dr. Paul Sugarbaker. Median survival 5+ years in selected patients at high-volume centers (Washington Hospital Center, MSK, MD Anderson, Mt Sinai, etc.).

Pericardial Mesothelioma

Limited treatment options — surgical resection rarely feasible. Pericardial effusion management often the focus.