Immunotherapy for Mesothelioma
Immunotherapy uses a patient’s immune system to fight cancer. For mesothelioma, it may help improve survival and preserve quality of life. Some common chemotherapy side effects may be less likely with immunotherapy, but it can cause serious immune-related side effects. Prompt treatment can help manage many of them. Opdivo® + Yervoy® and Keytruda® + chemo are both FDA-approved combos for mesothelioma.
Learn About Immunotherapy for Mesothelioma in Our Free Guide
What Is Mesothelioma Immunotherapy?
Mesothelioma immunotherapy uses a patient’s immune system to find and attack cancer cells. One type, called immune checkpoint inhibitors, is an established treatment for mesothelioma. But researchers have explored many types of immunotherapy, including:
- Cancer vaccines
- CAR T-cell therapy
- Immune checkpoint inhibitors
- Monoclonal antibodies
- Oncolytic viruses
Checkpoint inhibitors have made important strides in treating cancer. These immunotherapy drugs have improved survival for some patients with pleural mesothelioma and may help maintain quality of life. In the CheckMate 743 trial, severe treatment-related side effects were about as common with Opdivo + Yervoy as with chemotherapy, but the types of side effects were different.
- Immunotherapy brings the immune system into the fight. It strengthens the immune system's ability to target and fight cancer cells.
- Two immunotherapy treatments have approval for pleural mesothelioma: Opdivo® + Yervoy® and Keytruda® with chemotherapy.
- Immunotherapy has a different side effect profile than chemotherapy. Checkpoint inhibitors can cause immune-related side effects that differ from those associated with chemotherapy.
- Some immunotherapies can extend survival. Clinical trials have shown longer survival with certain immunotherapy regimens compared with chemotherapy alone.
FDA-Approved Mesothelioma Immunotherapy
The United States Food and Drug Administration (FDA) has approved some immunotherapy drugs for mesothelioma. Others have FDA approval to treat cancers with certain tumor characteristics that may also be found in mesothelioma.
These approvals are specifically for pleural mesothelioma, but researchers are also studying immunotherapy for other types of mesothelioma.
Opdivo® + Yervoy® for Mesothelioma
The combination of Opdivo (nivolumab) and Yervoy (ipilimumab) is FDA-approved to treat inoperable malignant pleural mesothelioma. In the CheckMate 743 pleural mesothelioma trial, this combination improved overall survival compared with chemotherapy. Half of the patients treated with Opdivo + Yervoy lived longer than 18.1 months.
A 2026 update of the trial looked at long-term survival. It found that 14% of patients treated with Opdivo + Yervoy were alive five years later. Only 6% of patients treated with chemotherapy were alive at that time.
Keytruda® for Mesothelioma
Keytruda (pembrolizumab) is also approved for inoperable malignant pleural mesothelioma when combined with pemetrexed and platinum chemotherapy. In the phase III KEYNOTE-483 trial, half the patients receiving this treatment lived longer than 17.3 months, compared with 16.1 months for patients receiving chemotherapy alone.
Clinical trials continue to investigate immunotherapy drugs for treating mesothelioma. Interested patients should discuss this option with their oncologists.
New research is looking at even more novel ways to treat mesothelioma. Of late, immunotherapy is one of the most promising treatment approaches.
Francis Perry Wilson, MD
Mesothelioma Immunotherapy & Multimodal Treatments
Some mesothelioma treatment plans combine immunotherapy with other therapies, such as chemotherapy or surgery. This approach, called multimodal therapy, uses two or more treatments in one plan. Various combinations are being studied to determine whether they may improve tumor control or patient survival.
Chemoimmunotherapy for Mesothelioma
Chemoimmunotherapy combines immunotherapy with chemotherapy. Several studies have looked at this approach. The FDA-approved Keytruda with chemo regimen is an example of this, but it’s not the only one.
Researchers are also studying other chemoimmunotherapy combinations. For example:
- Phase II PrE0505: This study evaluated durvalumab with pemetrexed and platinum chemotherapy. It reported a median survival of 20.4 months, compared to 12.1 months in a historical control group. A larger phase III trial of this approach, called DREAM3R, reported results in 2025. Median survival was 21 months with durvalumab and chemo and 18 months with chemo alone. This difference was not statistically significant.
- Phase III BEAT-meso: This trial evaluated combinations of atezolizumab, pemetrexed, carboplatin and bevacizumab. It improved progression-free survival but did not significantly improve overall survival in the full study population.
Research is still emerging in this area. Major organizations, like the American Society of Clinical Oncology (ASCO), are now including chemoimmunotherapy in their guidelines.
Using Immunotherapy Before Surgery
Recently, researchers have been studying whether immunotherapy can improve outcomes when given before surgery. In these approaches, patients receive immunotherapy before surgery, sometimes in combination with chemotherapy.
One study treated pleural mesothelioma patients with Tecentriq® (atezolizumab) and chemo. Then patients had surgery. They also had the option of receiving radiation or additional Tecentriq for up to a year. This study had a median overall survival of 31.5 months.
Early clinical trials continue investigating whether this strategy can improve responses and make surgery more effective. ASCO guidelines say that pre-surgical immunotherapy may be offered to selected surgical candidates, despite limited published data.
Who Is Eligible for Mesothelioma Immunotherapy?
Eligibility for mesothelioma immunotherapy depends on several factors, including:
- Other health conditions that may affect treatment choice
- Overall patient health
- Previous mesothelioma treatments
- The type and stage of mesothelioma
Interested patients should discuss these treatments with a qualified specialist. Experienced mesothelioma doctors can discuss eligibility and help patients weigh the benefits and risks.
Did You Know?
Many cancer centers across the country are now offering virtual support groups.
Staying connected with others can be an important part of the caregiver healing process.
How Does Immunotherapy Work for Mesothelioma?
Immunotherapy works by allowing the immune system to recognize and attack cancer cells. Each type of immunotherapy takes a slightly different approach to this. CAR-T cell therapy reprograms immune cells to make them attack tumors.
Checkpoint inhibitors block cancer cells from manipulating immune checkpoints. These checkpoints normally allow immune cells to recognize and ignore healthy cells. But cancer cells can use checkpoints to pose as healthy and dodge immune cell attacks. Checkpoint inhibitors block these signals, allowing the immune system to better recognize and fight tumors.
On their own, checkpoint inhibitors may improve survival and quality of life. For some patients, checkpoint inhibitors may also provide effective palliation. Palliative care aims to relieve cancer symptoms and improve quality of life. Doctors may also combine checkpoint inhibitors with other treatments.
What Is the Success Rate of Immunotherapy for Mesothelioma?
FDA-approved immunotherapies have extended survival for some pleural mesothelioma patients. Results vary based on cancer stage, exact treatment approach and patient factors. But a recent in-depth analysis suggests Opdivo + Yervoy and Keytruda with chemo may have similar survival results. Data from two clinical trials show:
- Opdivo + Yervoy Trial
- Half the study patients survived longer than 18.1 months (the median survival).
- Half the study patients lived longer than 6.8 months without their cancer growing.
- 1-year survival rate: 68%
- 2-year survival rate: 41%
- 5-year survival rate: 14%
- Keytruda and Chemotherapy Trial
- Half the study patients survived longer than 17.3 months.
- Half the study patients lived longer than 7.1 months without their cancer growing.
- 3-year survival rate: 25%
Studies have not yet given a breakdown of immunotherapy survival by mesothelioma stage. The trials above included patients of all stages. In these trials, about half of the patients treated with an FDA-approved immunotherapy-based treatment lived longer than 17 – 18 months. Some lived for years. In a few reported cases, patients whose cancer came back years after a strong response to Opdivo + Yervoy were treated with it again. This approach has only been studied in small numbers of patients, so patients should ask their doctor whether it may be appropriate for their situation.
Immunotherapy Benefits for Mesothelioma
Immunotherapy offers several potential benefits for mesothelioma, including a more favorable prognosis and quality of life. Benefits vary depending on the type of immunotherapy, the tumor location and patient factors.
In general, patients may find some aspects of immunotherapy preferable to other methods. For instance, pre-treatment preparation may be less involved than it is for chemo or surgery. Pemetrexed chemotherapy requires patients to start folic acid pills and get a vitamin B12 shot about a week before treatment. Checkpoint inhibitors do not require this.
In studies, researchers have also observed immunotherapy benefits in specific areas:
- Quality of life: Patients receiving immunotherapy may see quality-of-life benefits. In the CheckMate 743 trial, patients receiving Opdivo + Yervoy kept their quality of life longer before it declined than patients receiving chemotherapy.
- Side effects: Immunotherapy has a different side effect profile than chemo. Common side effects of Opdivo + Yervoy include fatigue, muscle and joint pain, rash, diarrhea, shortness of breath and itching.
- Survival: Some immunotherapies have improved survival rates versus other treatments. In one study, patients treated with Opdivo + Yervoy had a 1-year survival rate of 68%. Patients in the study treated with chemotherapy had a 1-year survival rate of 58%.
To learn more about potential immunotherapy benefits, mesothelioma patients should contact their doctor. Mesothelioma doctors can further explain the benefits relating to a patient’s individual case.
Immunotherapy has changed what treatment can look like for some patients with pleural mesothelioma. It has created additional options and improved survival for some patients, but the right approach still depends on the individual patient and their disease.
Kate Placzek, PhD
Mesothelioma Immunotherapy Side Effects
Like all other cancer treatments, immunotherapy may cause side effects. Immunotherapy side effects can occur when overactive immune cells attack some healthy tissues. Common reactions include fatigue, rashes, diarrhea and body aches or pains.
Patients may worry that cancer treatment will make them feel worse because of its side effects. But immunotherapy may cause different types of side effects than chemo. For example, hair loss is not a common side effect of checkpoint inhibitors.
Overall, immunotherapy side effects depend on many factors and can range from mild to severe. Factors include the type of immunotherapy, tumor location and individual patient characteristics. In rare cases, some patients may have severe immunotherapy side effects, like heart issues, lung problems, major digestive system complications or new-onset diabetes.
For checkpoint inhibitors, experts say most side effects are manageable with standard approaches. Patients can discuss possible side effects with their doctors before treatment.
Mesothelioma Immunotherapy Side Effects in Real Life
Doctors tracked side effects reported by mesothelioma patients in the Opdivo + Yervoy clinical trial. More than 30% of study patients experienced:
- Diarrhea
- Fatigue
- Muscle and body pain
- Skin rash
Some patients experienced serious side effects like pneumonia and other respiratory problems. Doctors usually treat serious immune-related reactions with steroids and by pausing or permanently stopping immunotherapy. In the trial, 23% of patients stopped Opdivo + Yervoy because of side effects.
Even if they seem manageable, immunotherapy side effects should be promptly reported to healthcare providers. This can help doctors and nurses respond if a reaction becomes severe.
Types of Immunotherapy for Mesothelioma
Immunotherapies turn the immune system against cancer, but they use a variety of tactics to do so. Checkpoint inhibitors like Opdivo and Yervoy block a loophole that cancer uses to hide from immune cells. And monoclonal antibodies can mark cancer cells for destruction.
Some immune checkpoint inhibitors already have FDA approval for mesothelioma. Other types of immunotherapies are under investigation for lung cancer, mesothelioma and other cancers. Immunotherapies being studied for mesothelioma include:
- Cancer vaccines
- CAR T cells
- Monoclonal antibodies
- Oncolytic viruses
Each type of immunotherapy comes with its own potential benefits and risks.
Immune Checkpoint Inhibitors
Immune checkpoint inhibitors are a type of antibody. They allow the immune system to recognize and attack cancer cells. Opdivo + Yervoy and Keytruda with pemetrexed and platinum chemotherapy are FDA-approved immunotherapy-based treatments for unresectable pleural mesothelioma.
Checkpoint inhibitors block specific signals (immune checkpoints) that cancer cells use to hide from the immune system. For mesothelioma, several of these drugs target the PD-1/PD-L1 checkpoint, including Imfinzi® (durvalumab). Others — like Imjudo® (tremelimumab) — target the CTLA-4 checkpoint. Blocking these checkpoints helps the immune system recognize and kill cancer cells.
The tactic of immune checkpoint blockade has worked well in mesothelioma studies. In a clinical trial, Opdivo + Yervoy achieved a median survival of 18.1 months. Study patients also kept their quality of life longer with Opdivo + Yervoy than with chemotherapy. Other checkpoint inhibitors are the subject of ongoing clinical trials.
Monoclonal Antibodies
Monoclonal antibodies (mAbs) are antibodies that help the immune system identify dangerous materials or cells in the body. Some immune checkpoint inhibitors are mAbs. In cancer treatment, mAbs can be used to let immune cells identify and fight tumors.
Other mAbs are also being studied in mesothelioma. This includes approaches designed to help the immune system recognize and attack cancer cells.
CAR T-Cell Therapy
CAR T-cell therapy uses modified immune cells to fight cancer. T cells are a type of white blood cell that protect the body from disease. But cancer cells know how to trick normal T cells into overlooking them. CAR T-cell therapies fix this by reprogramming T cells to recognize and fight cancer.
A phase I study used CAR T cells to treat 18 people with pleural mesothelioma whose cancer had already been treated. After the CAR T cells, they also received Keytruda® (pembrolizumab). Half the patients lived longer than 23.9 months after the CAR T-cell infusion. The study was small and had no comparison group, so larger trials are needed to confirm these results.
As of 2026, the FDA has not approved CAR T-cell therapy for treating mesothelioma. This technology has FDA approval to treat some other forms of cancer. CAR T-cell therapies are an active area of mesothelioma research.
Cancer Vaccines
Cancer vaccines are a form of immunotherapy. They aim to prevent or treat cancer by teaching the immune system to see cancer or its precursor as an intruder. This allows immune cells to attack the cancer cells. Some cancer vaccines may allow the body to keep fighting cancer long after the patient is vaccinated.
Mesothelioma cancer vaccines show immune cells how to recognize malignant mesothelioma tumors. Small early studies of these vaccines looked promising. But in the 2024 DENIM trial, a phase II/III study of 176 patients, a dendritic cell vaccine did not help pleural mesothelioma patients live longer than supportive care alone.
- Mesothelioma type: Pleural
- Treatment: Dendritic cell cancer vaccine and chemotherapy
- Key results: Seven of the ten patients in the study achieved survival of 24 months or longer. As of the last follow-up, two patients were still alive 50 months or more after treatment.
- Mesothelioma type: Pleural
- Treatment: Surgery, then vaccination with the galinpepimut-S (GPS) vaccine
- Key results: GPS-vaccinated patients had a median survival of 22.8 months, compared with 18.3 months for patients who did not get the vaccine. The study included only 41 patients, so larger studies are needed to determine whether GPS improves survival.
The Future of Immunotherapy for Mesothelioma
Researchers continue studying combinations of immunotherapy with chemo, surgery and radiation. Chemoimmunotherapy has already been tested in a few small studies. One phase II study reported a median survival of 20.4 months, but a larger phase III trial of the same drug combination did not confirm a clear survival benefit.
Future studies may also explore how immunotherapy can impact eligibility for surgery. In the past, many patients were not considered for surgery because of their cell type. Some mesothelioma cell types have a reputation for responding poorly to treatment.
But researchers are studying whether immunotherapy can improve options for some of these patients. In 2022, doctors reported the case of one patient with sarcomatoid mesothelioma who was able to have surgery after treatment with Opdivo + Yervoy. This remains investigational, and additional studies are needed to determine which patients may benefit.
Recent and Upcoming Clinical Trials
This study is investigating Opdivo + Yervoy followed by surgery. It will include patients with sarcomatoid or biphasic pleural mesothelioma.
This study is investigating Keytruda with pemetrexed and platinum chemotherapy before surgery for patients with resectable pleural mesothelioma. Patients may also receive additional Keytruda after surgery.
This study is investigating a newer checkpoint inhibitor with a cancer vaccine and chemo. It will include patients with inoperable pleural mesothelioma.
This study will investigate a newer form of CAR T-cell therapy. It will include patients whose tumors test positive for a protein that is common in mesothelioma.
Common Questions About Mesothelioma Immunotherapy
Can immunotherapy be used for mesothelioma?
What are the best immunotherapy treatments for mesothelioma?
How long does immunotherapy work for mesothelioma?
Can immunotherapy cure mesothelioma?
Answered by Vincent Mase, MD
How much does immunotherapy cost?
Note: This page contains statistics gleaned from large groups of patients. These statistics cannot forecast a single patient’s risk, cancer experience or the success of any given treatment. Patients should discuss all cancer screening and treatment decisions with an experienced oncologist.
Kate Placzek, PhD, is a medical writer and editor with years of experience as a scientific researcher. For Mesothelioma.com, she helps ensure our content stays accurate and easy to understand.
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.
