Mesothelioma Treatment
Mesothelioma cancer is most commonly treated with systemic therapy. Systemic therapy involves chemotherapy, immunotherapy or the two combined. Surgery is an option for a small number of patients with pleural mesothelioma and is the primary treatment for peritoneal mesothelioma. Radiation and palliative care are used to help control mesothelioma symptoms.
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How Is Mesothelioma Treated?
When determining which treatment type is best for the patient, mesothelioma doctors will consider mesothelioma type, cell type and patient characteristics. The patient’s age and overall health may limit what treatment options are viable. The stage of cancer is also an influential factor. If the disease is localized, more treatment options are available than if spreading has occurred.
- Systemic therapy (chemotherapy, immunotherapy or both) is the first treatment for most people with pleural mesothelioma.
- Immunotherapy is FDA-approved as a first treatment for pleural mesothelioma and can extend median survival to about 18 months.
- Surgery is no longer recommended for most people with pleural mesothelioma. In the MARS 2 trial, adding surgery to chemotherapy lowered median survival from 24.8 months to 19.3 months.
- For peritoneal mesothelioma, cytoreductive surgery with heated chemotherapy is still standard. Median survival was 53 months in the largest multicenter series, with a 5-year survival rate of 47%.
- Radiation and palliative care can ease pain and other symptoms of mesothelioma.
The National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO) recommend the following standard mesothelioma treatment options:
Chemotherapy
Chemotherapy drugs work by attacking fast-growing cells, such as cancer cells. Chemotherapy is a standard first treatment for pleural mesothelioma. After surgery, it may also help destroy remaining cancer cells and reduce the risk of recurrence. The standard chemotherapy for mesothelioma pairs Alimta® (pemetrexed) with cisplatin or carboplatin. Gemcitabine with cisplatin or carboplatin is an option for some patients in certain circumstances.
Immunotherapy
Immunotherapy drugs use the patient’s own immune system to kill cancer cells. They have improved survival for many mesothelioma patients. These drugs may come with more tolerable side effects than chemo.
The effectiveness of different immunotherapy drugs continues to be tested, particularly when used during a multimodal treatment plan. Opdivo and Yervoy target different immune system checkpoints and are given together as a first treatment. Keytruda is approved as a first treatment when combined with chemotherapy.
Following a mesothelioma diagnosis, a medical oncologist will review all potential treatment options available to the patient. But given the rarity of the disease, patients should consult with an experienced mesothelioma expert to determine the best treatment plan for them.
Vincent Mase, MD
Chemoimmunotherapy
Chemoimmunotherapy uses chemotherapy and immunotherapy together. In the IND.227/KEYNOTE-483 trial, reported in The Lancet in 2023, 440 patients with advanced pleural mesothelioma received either Keytruda with chemotherapy or chemotherapy alone. Median survival was 17.3 months with the combination and 16.1 months with chemotherapy alone.
The FDA approved Keytruda with Alimta and platinum chemotherapy as a first-line treatment for unresectable advanced or metastatic pleural mesothelioma on September 17, 2024.
Surgery
For qualified patients with an early-stage mesothelioma diagnosis, surgery can be used to remove all or most of the tumor(s). Depending on the tumor location, surgery may include removing the mesothelial lining, one or more lymph nodes, or part or all of a lung or other organ. For pleural mesothelioma, NCCN 2026 guidelines recommend pleurectomy/decortication (P/D) over extrapleural pneumonectomy (EPP) and reserve EPP for rare cases. The same guidelines no longer list surgery for stage 2 through stage 4 pleural mesothelioma of any cell type. They also rule out surgery for sarcomatoid and biphasic cell types at any stage. For peritoneal mesothelioma, cytoreductive surgery with heated chemotherapy is still a central treatment.
Those changes follow MARS 2, a phase III randomized trial reported in 2024. Among 335 patients with resectable pleural mesothelioma, median survival was 19.3 months for those who had extended P/D plus chemotherapy and 24.8 months for those who had chemotherapy alone. The surgery group also had serious side effects at 3.6 times the rate of the chemotherapy group.
Radiation Therapy
Radiation can kill mesothelioma cells left behind after surgery. It can also ease symptoms like pain. Most radiation for mesothelioma is external beam radiation therapy (EBRT). Intensity-modulated radiation therapy (IMRT) is a precise form of EBRT that shapes the dose to spare healthy tissue. NCCN 2026 guidelines say pleural IMRT can also follow systemic therapy in carefully selected patients with stage 1 epithelioid pleural mesothelioma, at centers experienced with the technique.
Multimodal Therapy
Multimodal therapy combines two or more treatments, such as surgery, chemotherapy and radiation. For peritoneal mesothelioma, combining surgery with heated chemotherapy has produced the longest reported survival. For pleural mesothelioma, the evidence has moved the other way. The MARS 2 trial found that adding surgery to chemotherapy shortened survival. NCCN withdrew surgery from its recommendations for most patients in 2026.
Surgery with heated chemotherapy has produced long survival times in peritoneal mesothelioma. In a 2009 multi-institutional registry of 405 patients treated with cytoreductive surgery and heated chemotherapy, median survival was 53 months and the 5-year survival rate was 47%. Results in pleural mesothelioma are weaker. A 2025 review of heated chemotherapy after chest surgery reviewed seven studies. In the six that favored heated chemotherapy, median survival ranged from 13 to 35 months. The authors said a randomized trial is still needed to confirm any benefit.
Treatment Options by Type of Mesothelioma
Doctors will consider the type of mesothelioma and cancer stage when determining the best mesothelioma treatment. Pleural mesothelioma and peritoneal mesothelioma are the two most common types of the disease. These forms may have more treatment options available compared to rarer types of mesothelioma.
A surgery that removes the lung lining and visible tumors in the chest cavity. The procedure preserves healthy lung tissue. It is the operation NCCN prefers for the few patients with pleural mesothelioma who do have surgery.
A surgery to remove the cancerous lung, impacted surrounding tissues, nearby lymph nodes and the diaphragm. NCCN recommends it only in rare cases because it carries more risk than P/D without improved survival.
A procedure to remove visible tumors from the abdominal cavity. This surgery is often followed by HIPEC.
A heated chemotherapy wash administered directly into the abdominal cavity immediately after cytoreductive surgery.
Palliative Care for Mesothelioma Patients
Palliative mesothelioma treatment is used to manage cancer symptoms and improve a patient’s quality of life. Many patients find it helpful in reducing mesothelioma pain. Palliative care may be used alongside standard treatments or as a patient’s sole form of treatment.
Common Palliative Procedures
A procedure that drains excess fluid from the pleural cavity.
A procedure that prevents fluid buildup by closing the pleural cavity.
A procedure that drains excess fluid from the abdomen.
Alternative Mesothelioma Treatment
Some mesothelioma patients decide to supplement cancer treatment with alternative medicine. Alternative therapies may help relieve the side effects of standard treatments.
Common alternative treatment options include:
- Chiropractic cancer treatment
- Healing touch and touch therapy for cancer
- Herbal medicines
- Medical marijuana
- Mind-body therapies
- Nutritional therapies
Mesothelioma Nutrition and Self-Care
Some mesothelioma patients incorporate nutrition and mental health therapies into their treatment plans. Meeting nutritional needs may help support vital organ function during cancer treatment. In addition, mental health care may help patients deal with the stress and emotional toll of mesothelioma treatment.
Some patients also find mesothelioma support groups heartening. A support group may provide a comfortable environment in which patients can discuss their individual approaches to diet, nutrition and self-care.
Did You Know?
Some treatments for mesothelioma are not covered by insurance.
Treatment for mesothelioma can become a financial burden.
Mesothelioma Clinical Trials and Emerging Treatments
Researchers are continuously making advancements in mesothelioma treatment. In medical studies called clinical trials, doctors test the safety and efficacy of emerging drugs and treatments. Experimental therapies may be an option for patients who are not responding to traditional types of treatment.
Emerging Mesothelioma Treatment Options
Emerging treatments are currently available through clinical trials. These experimental therapies could become standard treatment options for mesothelioma if proven safe and effective.
Gene therapy modifies the genetic structure of cells to help kill cancer. This can improve the effectiveness of treatment.
Photodynamic therapy uses light-activated drugs to kill cancer cells.
Targeted Therapy
This treatment uses drugs that target specific parts of cancer cells. Targeted therapies interfere with a tumor’s ability to grow and spread to other areas. Avastin® (bevacizumab) is the one targeted therapy already in standard use. NCCN lists it with pemetrexed and either cisplatin or carboplatin as a first-line option for pleural mesothelioma, so it is not limited to clinical trials. In the MAPS trial, adding bevacizumab raised median survival from 16.1 months to 18.8 months.
Mesothelioma Doctors and Cancer Centers
There are doctors and cancer centers around the United States that specialize in treating malignant mesothelioma. Working with top mesothelioma doctors can provide patients with the best treatment plan possible.
Locating a doctor who was an expert in treating mesothelioma made all of the difference in my ability to beat this cancer.
Heather Von St. James
Top Mesothelioma Doctors
Individuals diagnosed with mesothelioma should seek care from experienced doctors. Trained mesothelioma doctors understand the disease and the latest research.
Best Mesothelioma Treatment Centers
Patients diagnosed with mesothelioma can be referred to a specialized cancer center. Many of these institutions are connected to top medical universities.
Finding the Best Mesothelioma Treatment for You
Mesothelioma specialists have the knowledge and experience to find the best approach even for tough cases. They consider the type and stage of cancer alongside the patient's overall health and personal goals.
In general, mesothelioma doctors know more about treating the disease than general oncologists. Working with a mesothelioma expert at a top cancer center can help patients get the best care. Larger hospitals often have patient navigators who can help ease the stress of a new treatment schedule.
Mesothelioma Treatment Costs
Common pleural mesothelioma treatment costs range from about $40,000 to $90,000 each. Multiple factors may affect total treatment cost, including insurance coverage and treatment approach. Patients and their loved ones may find it beneficial to make financial plans early in the treatment process. This may help reduce stress and ease financial burdens.
A 2026 study looked at Medicare patients 65 and older with advanced pleural mesothelioma. Their total health care costs averaged $11,432 per month after they started treatment. The study covered patients treated before immunotherapy was approved in 2020, so costs may be higher today.
Chemotherapy | $40,000
A typical chemotherapy regimen for mesothelioma includes Alimta and cisplatin. According to a 2019 review, six cycles of treatment with this combination cost $38,779.
Surgery | $54,000 - $62,000
Pleural mesothelioma patients may undergo pleurectomy/decortication (P/D) or extrapleural pneumonectomy (EPP). A recent report estimates these surgeries cost $53,993 and $62,408, respectively.
Insurance may cover some portion of mesothelioma treatment costs. Patients may also qualify for various forms of financial assistance. A mesothelioma lawyer can help patients determine the best financial approach.
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Common Questions About Mesothelioma Treatment
What are the treatment options for mesothelioma?
What is the best treatment for mesothelioma?
The best treatment depends on where the mesothelioma started. For pleural mesothelioma, NCCN 2026 guidelines name systemic therapy (chemotherapy, immunotherapy or both) as the preferred first treatment. For peritoneal mesothelioma, cytoreductive surgery with heated chemotherapy gives the longest reported survival. Two studies show the survival behind these recommendations:
- Opdivo with Yervoy extended median pleural mesothelioma survival to 18.1 months, against 14.1 months for chemotherapy alone, in the CheckMate 743 trial.
- Cytoreductive surgery with heated chemotherapy produced a median survival of 53 months in a 405-patient multicenter registry of peritoneal mesothelioma, with a 5-year survival rate of 47%.
Mesothelioma specialists can help patients determine the best approach for each patient's unique situation.
What can I do to help reduce side effects from mesothelioma treatment?
Side effects from mesothelioma treatment can vary depending on the type of treatment and may be different for each patient. While most side effects go away after treatment, there are ways to manage and reduce them.
Patients should talk regularly and openly with their healthcare team about any side effects throughout treatment. Based on those symptoms, a mesothelioma specialist may recommend:
- Medications: Anti-nausea drugs, pain relievers and other prescribed medications can help ease symptoms.
- Lifestyle adjustments: Stay hydrated, eat a nutritious diet (limit processed foods and red meat and avoid alcohol) and engage in light exercise.
- Rest and relaxation: Get enough sleep and try stress-reducing techniques like yoga, meditation or acupuncture.
- Support system: Seek help from family, friends, support groups, therapists or palliative care professionals.
Combining medical treatments with healthy habits and emotional support helps patients manage side effects and supports their overall well-being.
Is mesothelioma curable if treated early?
While mesothelioma does not yet have a definitive cure, early detection provides more treatment options. This leads to better outcomes, improved quality of life and extended survival. Treatments such as surgery, chemotherapy and immunotherapy can help manage the disease, and in some cases, lead to remission. Patients diagnosed at an early stage tend to have a better prognosis and a longer life expectancy than those diagnosed in later stages of mesothelioma:
- Pleural mesothelioma found while still localized has a 5-year relative survival rate of 23%. That drops to 11% once the cancer has spread to distant sites. Both figures come from American Cancer Society data for patients diagnosed from 2015 to 2021.
- In one high-volume center's 28-year peritoneal mesothelioma series, patients still alive three years after cytoreductive surgery had a median conditional survival of 6.1 years.
Early diagnosis and treatment at an experienced mesothelioma center offer the best chance for living longer and managing symptoms.
Sources
American Cancer Society - Survival Rates for Pleural Mesothelioma; 2/3/2026
National Library of Medicine - Consensus guideline for the management of peritoneal mesothelioma; 7/1/2025
ASCO Publications - Treatment of Pleural Mesothelioma: ASCO Guideline Update; 1/8/2025
National Cancer Institute - Nutrition in Cancer Care (PDQ®)-Health Professional Version; 9/20/2024
National Library of Medicine - Costs of medical care for mesothelioma; 7/17/2019
Free Mesothelioma Treatment Guide
Dr. Vincent Mase is a Board-Certified Thoracic Surgeon at Smilow Cancer Hospital and a professor at the Yale University School of Medicine. He specializes in surgery for lung cancer.
Medically
Reviewed by
Francis Perry Wilson, MD
Senior Medical Advisor
Dr. Francis Perry Wilson is the Director of the Clinical and Translational Research Accelerator at the Yale University School of Medicine. He specializes in nephrology and clinical research.
