Chemotherapy for Mesothelioma

How Does Chemotherapy Work for Mesothelioma?

Chemotherapy treats mesothelioma using drugs that damage cells as they divide. Cancer cells divide and multiply more quickly than most other cells in the body. As a result, chemotherapy can slow the growth of or kill mesothelioma cancer cells, but it can also impact healthy cells. When this happens, patients may experience side effects.

A mesothelioma treatment plan may include more than one chemotherapy drug. It may also combine chemotherapy with other therapy types, like surgery. Oncologists may use chemotherapy to provide two different types of care:

• Therapeutic care aims to improve the patient’s health and survival.
• Palliative care is intended to manage mesothelioma symptoms and improve the patient’s quality of life.

A mesothelioma doctor can determine if a patient may benefit from chemotherapy. For some mesothelioma patients, chemotherapy may extend survival time and improve quality of life.

Resources for Mesothelioma Patients

Connect With a Top
Mesothelioma Doctor

Connect With a Top Mesothelioma Doctor

• Experts near you
• Get matched quickly

Get Connected

Locate a Top Mesothelioma
Cancer Center

Locate a Mesothelioma Cancer Center

• Find a center near you
• Be better prepared

Get Connected

Financial Assistance
to Help With Treatment

Financial Assistance to Help With Treatment

• Provide for loved ones
• $30 billion set aside

Request Free Guide

Mesothelioma Chemotherapy Drugs

Doctors may treat mesothelioma with different chemotherapy drugs. For example, a combination of Alimta® (pemetrexed) plus cisplatin is a commonly used first-line chemotherapy regimen for pleural mesothelioma. The U.S. Food and Drug Administration (FDA) approved this combination in 2004.

In 2024, the FDA also approved Keytruda® (pembrolizumab) with pemetrexed and platinum chemotherapy as a first-line treatment for certain malignant pleural mesothelioma patients. Doctors may use other medications to treat mesothelioma or combine chemo with other types of treatment.

The most common chemotherapy drugs that may be used to treat mesothelioma include:

• Cisplatin: This platinum-based chemo drug may be used for patients who have tumors that cannot be removed with surgery.
• Pemetrexed: This chemo drug may be called by the brand names Alimta or Pemfexy® for mesothelioma patients. Pemetrexed plus cisplatin has extended survival for pleural mesothelioma patients. In major clinical trials, these patients lived a median of about 12 – 16 months.
• Carboplatin: Like cisplatin, carboplatin is a platinum-based chemotherapy drug. It may be referred to as Paraplatin®, its discontinued brand name. It has a different side-effect profile than cisplatin.

In some cases, doctors may recommend chemotherapy drugs other than Alimta, cisplatin and carboplatin. These are less common but may be appropriate for some mesothelioma patients. Patients can discuss chemotherapy drug questions with their healthcare team.

• Gemcitabine: While FDA-approved for various cancers, gemcitabine is not approved for mesothelioma. But doctors may still use it to treat certain mesothelioma patients.
• Navelbine® (vinorelbine): Often used for a common lung cancer type and some researchers have used vinorelbine for mesothelioma.

Other chemo drugs doctors may use to treat mesothelioma include:

• Doxorubicin
• Eloxatin® (oxaliplatin)
• Epirubicin
• Irinotecan
• Mitomycin C
• Paclitaxel

Although similar, there are slight differences in how each chemotherapy drug works. As a result, they have their own potential benefits and side effects. Oncologists can recommend appropriate chemotherapy drugs and other mesothelioma cancer drugs based on individual patient cases.

Did You Know? HIPEC is a specialized mesothelioma treatment only available at select cancer centers. Get help connecting with a cancer center that offers HIPEC to ensure you receive the best treatment possible. Locate a Top Mesothelioma Cancer Center Near You

How Is Chemotherapy Administered?

Doctors may give chemotherapy medications in different ways based on the type of drug and the type of cancer. Chemo treatments may circulate throughout the body (systemic therapy) or be delivered directly to a specific area of the body (local chemotherapy). Patients may be most familiar with systemic chemo.

Treatment plans may include several types of chemotherapy drugs for malignant mesothelioma. They may also include both systemic and local chemotherapy.

Systemic Chemotherapy

Systemic chemotherapy travels through the bloodstream. Most mesothelioma patients receive it through an intravenous (IV) infusion, but some chemo drugs can also be taken as pills. For example, a 2022 trial tested chemo drug vinorelbine in pill form. It slowed cancer growth in patients whose pleural mesothelioma had grown after earlier chemotherapy.

Localized Chemotherapy

Local, or intracavitary, chemotherapy is applied only to a specific region of the body. This targeted application means it may limit exposure to other parts of the body than systemic chemotherapy. Keeping the chemotherapy drugs in one area generally involves a surgical procedure. As such, doctors may also refer to these treatments as intraoperative chemotherapy.

In general, tumor location impacts which localized chemotherapy methods are available to mesothelioma patients. These methods also vary by the temperature and type of chemotherapy drugs given. Doctors often use these chemo methods to help kill cancer cells left behind after performing surgery. Two common types of local heated chemo for mesothelioma are:

• Heated intraperitoneal chemotherapy (HIPEC) for peritoneal mesothelioma
• Heated intrathoracic chemotherapy (HITHOC) for pleural mesothelioma

Studies have reported extended survival in some mesothelioma patients who received HIPEC or HITHOC. These treatments may not be appropriate for everyone. In these cases, doctors can recommend other treatment types.

Doctors may also recommend other types of local intracavitary chemotherapy for mesothelioma. They can explain eligibility requirements and potential risks and benefits. Local intracavitary chemo options for mesothelioma that aren’t heated include:

• Early postoperative intraperitoneal chemotherapy (EPIC)
• Normothermic intraperitoneal chemotherapy (NIPEC)
• Pressurized intraperitoneal aerosol chemotherapy (PIPAC)

Researchers continue to test new chemotherapy applications in mesothelioma clinical trials.

Who Is Eligible for Mesothelioma Chemotherapy?

Eligibility for mesothelioma chemotherapy depends on factors such as a patient's overall health, tumor size and location, and treatment goals. A patient’s kidney and liver function also weigh on eligibility because these organs filter chemo drugs from the body. If a person is strong enough, chemotherapy is often used to shrink tumors, relieve symptoms or support surgical treatments.

Patients with unresectable mesothelioma may be eligible for systemic chemotherapy. Some patients with pleural or peritoneal mesothelioma who are candidates for surgery may also receive intracavitary chemotherapy as part of their treatment plan. For these patients, doctors may use a form of local chemotherapy before or after surgery. Depending on various factors, the appropriate chemotherapy may be HIPEC, HITHOC or EPIC. PIPAC is an emerging treatment mainly studied in patients whose peritoneal tumors cannot be removed with surgery.

Chemotherapy may not be the right option for some patients. If so, their doctors can recommend other treatment options that may work better.

Questions About Mesothelioma Chemotherapy Drugs? Ask experienced mesothelioma advocate Jennifer Lucarelli Ask a Question

Combining Chemotherapy With Other Treatments

Doctors may combine chemotherapy with other treatments, like surgery, immunotherapy or Tumor Treating Fields (TTFields). A combined treatment plan is often called multimodal care.

A 2013 single-center study researched cytoreductive surgery (CRS) and HIPEC in peritoneal mesothelioma patients. When treated with a second round of CRS and HIPEC, patients lived a median of 80 months. Those with only one round lived a median of 27.2 months. These patients were carefully selected, so the results may not apply to everyone.

Patients may also receive chemotherapy after treatment with checkpoint inhibitors. Checkpoint inhibitors are a type of immunotherapy that help a patient’s immune system to fight cancer. The FDA has approved a combination of two checkpoint inhibitors, Opdivo® (nivolumab) and Yervoy® (ipilimumab), as a first-line treatment for adults with inoperable malignant pleural mesothelioma.

A patient’s mesothelioma doctor can recommend a custom-tailored treatment plan. This may include one treatment method or a combination of different methods. Factors such as overall health, mesothelioma stage and type may impact treatment options.

What to Expect During Chemotherapy Treatment

Each patient’s experience with mesothelioma chemotherapy may be slightly different. But each person can keep in mind some general expectations about common practices, procedures and side effects. Patients can speak with their care teams about the details of their specific plans.

A patient’s care team can explain the mesothelioma chemo process for local or systemic methods. They can also answer questions about how to prepare for the appointment. These specifics may vary depending on treatment details, such as which chemotherapy drug is given and how.

Preparing for Chemotherapy Treatment

Preparation for the first chemotherapy appointment will include tests, such as a blood test, to make sure the patient is healthy. But patients may want to do other things to get themselves ready. Some tips to consider include:

• Find a ride to and from the appointment: Some cancer care teams recommend having someone to drive you on the day of your first infusion. Some patients may need medications to help them relax, which may make driving difficult.
• Make a plan with your employer: Patients may want an altered work schedule during treatments. They may need extra time off or a flexible schedule.
• Pack a bag to take to your infusion appointments: Some patients find it helpful to have things to do to distract them during the procedure. It can help to pack a bag with books, snacks and other things to have while at the appointment.

On the day of the appointment, patients may want to eat a small meal if the doctor says they can. They may want to dress comfortably and arrive early.

Patients getting pemetrexed (Alimta) also take medicines beforehand to lower the risk of side effects. According to the FDA drug label, patients start taking folic acid by mouth 7 days before the first dose and get a vitamin B12 shot about 1 week before treatment begins. They also take a steroid called dexamethasone by mouth the day before, the day of and the day after each infusion.

Typical Schedule & How Long Treatment Takes

The number of mesothelioma chemotherapy treatment cycles varies by patient. It depends on the patient’s case and other parts of their treatment plan.

Doctors may recommend multiple chemotherapy cycles if appropriate for patients. For example, pemetrexed with cisplatin or carboplatin is usually given for four to six cycles, once every 21 days.

Patients can speak with their care team to understand what their experience may be like. This may help patients and their teams better navigate the treatment.

How Effective Is Chemotherapy?

For some patients with mesothelioma, chemotherapy may extend life expectancy. In major trials, pleural mesothelioma patients who had chemotherapy alone lived a median of about 12 – 16 months. In a large study, selected peritoneal mesothelioma patients who had surgery, most of whom received HIPEC, lived a median of 53 months. Various factors can impact a patient’s mesothelioma prognosis. These factors include chemotherapy method, tumor location and any other treatments.

Several studies have reported the effects of chemotherapy on mesothelioma survival.

A mesothelioma doctor can explain what a patient can expect for their individual case.

How Doctors Monitor Your Response

Doctors may use blood tests and imaging, like CT scans and MRIs, during treatment. These may help them monitor the cancer and assess how well treatment is working. The timing of these tests varies by patient and treatment plan.

Chemotherapy can damage bone marrow, which produces blood cells. Doctors will use blood tests to make sure patients have enough healthy blood cells to continue treatment. Doctors may also check certain tumor markers in the blood. However, tumor markers are not reliable enough on their own to determine whether chemotherapy is working.

Speak With a Mesothelioma Survivor Connect with 20-year pleural mesothelioma survivor Heather Von St. James Connect With Heather

What Are the Side Effects of Chemotherapy for Mesothelioma?

A mesothelioma chemotherapy regimen may lead to a variety of side effects. These can vary based on the type of chemotherapy drugs used. Systemic and intracavitary chemotherapy may also have different side effects. Certain mesothelioma chemotherapy side effects are more common than others.

Some patients experience cognitive problems during or after chemotherapy, sometimes called chemo brain. Because systemic chemotherapy reaches the whole body, patients may experience side effects throughout the body.

There may be other side effects associated with intracavitary chemotherapy. These side effects vary across the different types of intracavitary chemo.

Patients should discuss any side effects with their doctors. This includes new side effects or changes to existing treatment side effects. There may be ways to help manage these discomforts during treatment. In other cases, doctors may pause or end treatment. Care teams can also support patients if their mental health suffers during this time.

Some common side effects, such as nausea and vomiting, may affect patients’ mental health. Patients can find support from their care team for these challenges as well. Many cancer centers offer dedicated support services for emotional and mental well-being, like support groups.

When to Call Your Care Team Immediately

Patients undergoing chemotherapy should call their doctor if certain side effects happen. The care team will have a complete list of when to call, but some reasons include:

• A fever of 100.4°F (38°C) or higher
• Frequent vomiting or diarrhea that won't stop
• Signs of an infection, like a cough, skin redness or swelling
• Trouble breathing
• Uncontrollable shaking or chills

Patients who experience these symptoms should contact their care team right away or follow any emergency instructions the care team provided.

Emerging Therapies & Clinical Trials

Mesothelioma researchers continue to use clinical trials to study ways to improve chemotherapy’s effectiveness. Many ongoing chemo clinical trials also incorporate immunotherapy. Some immunotherapy treatments have improved survival outcomes for patients with pleural mesothelioma. Researchers continue studying chemoimmunotherapy combinations.

Examples of mesothelioma chemotherapy clinical trials include:

• Chemotherapy, Avastin® (bevacizumab), Tecentriq® (atezolizumab): This trial treats peritoneal mesothelioma with a combination of chemo and a targeted therapy with and without an immunotherapy drug. Researchers are measuring how often tumors shrink when atezolizumab is added. The trial has not reported results yet. As of September 2026, it was actively recruiting eligible patients to join.
• Chemotherapy and immunotherapy before surgery: This trial is studying chemotherapy with dual immunotherapy before surgery for pleural mesothelioma. One group receives durvalumab and tremelimumab alone, while another receives these immunotherapy drugs with pemetrexed and either cisplatin or carboplatin. Researchers are evaluating whether these approaches are safe and may help patients proceed to surgery.