Treatment Approaches by Type
| Mesothelioma Type | Primary Treatment Approach | Outlook |
|---|---|---|
| Pleural (operable) | Surgery (EPP or P/D) + chemo + immunotherapy | Median 18–24 months |
| Pleural (inoperable) | Immunotherapy (Opdivo + Yervoy) or chemo | Median 14–18 months |
| Peritoneal (operable) | Cytoreduction surgery + HIPEC | Median 40–90+ months |
| Peritoneal (inoperable) | Systemic chemotherapy | Median 12–18 months |
| Any (palliative) | Symptom management, thoracentesis, comfort care | Maximizes quality of life |
Surgery
For pleural mesothelioma, two main surgical procedures exist:
- Extrapleural Pneumonectomy (EPP) — removal of the entire affected lung, pleura, diaphragm, and pericardium. Most aggressive option, highest cure potential, requires excellent health status.
- Pleurectomy/Decortication (P/D) — removal of the pleural lining while preserving the lung. Less aggressive, better tolerated in older patients, increasing evidence it equals EPP in many cases.
For peritoneal mesothelioma: cytoreductive surgery (removing all visible tumor) combined with HIPEC is the gold standard at specialty centers. More on mesothelioma surgery ›
Chemotherapy
The standard first-line chemotherapy regimen for pleural mesothelioma is cisplatin + pemetrexed (Alimta), approved by the FDA in 2004. Carboplatin is often substituted for cisplatin in patients who cannot tolerate cisplatin’s side effects. This combination produces response rates of 40–45% and is still widely used, often alongside immunotherapy. More on mesothelioma chemotherapy ›
Immunotherapy
In 2020, the FDA approved nivolumab (Opdivo) + ipilimumab (Yervoy) as first-line therapy for unresectable pleural mesothelioma — the first new mesothelioma treatment approved in 16 years. This combination has shown median survival of 18.1 months vs. 14.1 for chemotherapy alone, with significantly better results in non-epithelioid tumors. More on mesothelioma immunotherapy ›
Clinical Trials
Given mesothelioma’s rarity, clinical trials are especially important. Studies of CAR-T cell therapy, tumor treating fields (Optune), targeted therapies (tazemetostat for BAP1-mutant mesothelioma), and vaccine approaches are ongoing. Many mesothelioma specialists recommend trial enrollment for all eligible patients. Find mesothelioma clinical trials ›
Why a Specialist Center Matters
Mesothelioma is rare enough that most oncologists have limited direct experience. Studies consistently show that patients treated at high-volume mesothelioma specialty centers have better outcomes — from more accurate diagnosis (correct cell type identification is essential for immunotherapy decisions) to access to surgical expertise and trials not available elsewhere.
A second opinion at a mesothelioma specialty center costs nothing but time and is almost always worth pursuing before committing to a treatment plan. Find a mesothelioma specialist center ›