Treatment for people with mesothelioma may be aimed at improving symptoms or trying to control the disease.
Various treatments may be offered alone or in combination, including immunotherapy, chemotherapy, radiation therapy and surgery. The main types of mesothelioma are treated in different ways.
The treatment options suggested by your health care team will vary depending on:
- the location, stage and type of mesothelioma, which helps doctors predict how the cancer will respond to treatment
- your age, health and fitness and home support available
- what is most important to you.
The cancer treatments discussed below help control the disease for a longer period of time and improve quality of life for some people.
It is important to talk to your treatment team about what each treatment involves, what side effects to expect and how long recovery will take. Some treatments are not suitable for everyone.
Even if a particular treatment is recommended, it is up to you whether or not you want to have it. You can also call Cancer Council 13 11 20 or talk to a mesothelioma support service.
Your guide to best cancer care
A lot can happen in a hurry when you’re diagnosed with cancer. The g uide to best cancer care for mesothelioma can help you make sense of what should happen.
It will help you with what questions to ask your health professionals to make sure you receive the best care at every step.
Read the pleural mesothelioma guide
Read the peritoneal mesothelioma guide
Pleural mesothelioma treatment
Immunotherapy
Immunotherapy is a type of drug treatment that uses the body's own immune system to fight cancer.
Immunotherapy drugs called checkpoint inhibitors block proteins that stop immune cells from recognising and destroying the cancer cells, so the immune cells can potentially recognise and attack the cancer.
Immunotherapy is now the usual first option for people well enough to have any treatment. It’s also used for people who had chemotherapy as their first treatment. However, it may not be used up-front if you are having trimodality therapy.
Your medical oncologist will discuss whether immunotherapy is the most suitable option for you. Immunotherapy doesn’t always work for everyone.
The immunotherapy drugs most commonly used are ipilimumab and nivolumab in combination. These are covered by the PBS for most people, and sometimes on workplace insurance.
Having immunotherapy
Immunotherapy drugs are usually given through a vein (intravenously) in hospital and can take between 30 and 90 minutes. You will wait a short time to be monitored for any reaction before going home.
Immunotherapy may be used alone or in combination with chemotherapy.
Side effects of immunotherapy
Immunotherapy can cause inflammation throughout the body, which may lead to different side effects depending on which part of the body is inflamed.
The combination of immunotherapy drugs may increase the risk of side effects, which include fatigue, rash, painful joints and diarrhoea. Most people have mild side effects that are easily treated and usually improve.
More serious side effects may include heart and thyroid problems, but your doctor should discuss any concerns with you.
It’s important to let someone on your medical team know if you have any new or worsening symptoms, rather than just put up with them – even if they happen weeks or months after you had immunotherapy treatment.
If untreated, some side effects can become serious or even life-threatening.
Chemotherapy
Chemotherapy uses drugs to kill or slow the growth of cancer cells while causing the least possible damage to healthy cells. The goal of chemotherapy is usually to shrink the cancer, reduce symptoms and improve quality of life.
For some people with mesothelioma, chemotherapy doesn’t work. The main chemotherapy drugs used for pleural mesothelioma are pemetrexed in combination with carboplatin or cisplatin.
The targeted therapy drug bevacizumab may be added to this combination. Research shows that using some drugs together can give improved results compared with using just a single drug.
Vinorelbine (and less commonly gemcitabine) may be used if mesothelioma returns.
Having chemotherapy
Chemotherapy is usually given through a drip into a vein (intravenously). The drugs travel through the bloodstream and reach the entire body. This is known as systemic chemotherapy.
You will usually have chemotherapy during day visits to your hospital or treatment centre. Each session may last for several hours and be followed by a rest period of several weeks.
Together, the session and rest period are called a cycle. You will probably have up to six cycles. However, the length and timing of the treatments and rest days of each cycle may vary from person to person.
Chemotherapy weakens the immune system by lowering the level of white blood cells, making it harder for your body to fight infections.
If you have a temperature over 38°C, contact your doctor immediately or go to your nearest hospital emergency department.
Side effects of chemotherapy
Most chemotherapy drugs cause side effects, which depend on the type and dose of the drug.
You may have vitamin B12 injections and low-dose folic acid, which have been shown to reduce the side effects of pemetrexed and cisplatin. Common side effects of chemotherapy include:
- tiredness and feeling weak (fatigue)
- nausea and/or vomiting
- bowel problems (anti-nausea drugs can also cause these)
- sore or dry mouth, or small ulcers in the mouth
- taste changes and/or loss of appetite
- increased risk of anaemia (low level of red blood cells)
- reduced kidney function
- skin rash
- numb or tingling hands or feet (peripheral neuropathy)
- ringing in the ears (tinnitus) or hearing loss
- red and itchy eyes (conjunctivitis).
You will have medicines (such as anti-nausea drugs) to help control any side effects. If side effects become too difficult to manage, your oncologist can adjust the dose or type of chemotherapy drug used.
While hair loss and scalp problems are rare with chemotherapy for mesothelioma, some hair thinning may occur.
Some people have trouble thinking clearly or experience short-term memory loss after chemotherapy, but this usually improves once treatment ends.
If you have the targeted therapy drug bevacizumab, side effects differ to chemotherapy, and may include hypertension, bleeding and blood clots.
Radiotherapy
Radiation therapy (also sometimes called radiotherapy) is the use of targeted radiation to kill or damage cancer cells so that they cannot grow, multiply or spread. Many other types of cancer may respond well to radiation therapy.
It can be more difficult to target radiation therapy for mesothelioma because the cancer is often spread over a large area.
However, radiation therapy may still be used at different stages of treatment for pleural mesothelioma and in different ways:
- as palliative treatment to relieve pain or other symptoms caused by tumours and improve quality of life
- after chemotherapy and surgery (adjuvant radiation therapy) to help kill any remaining cancer cells.
Having radiation therapy
Treatment is carefully planned to destroy as many cancer cells as possible while causing the least harm to your normal tissue. The initial appointment to map out the treatment (simulation) may take a few hours.
You will have CT scans of the affected area, and your skin may be marked with a special ink. This makes sure that the radiation is directed at the same place on your body every time you have radiation therapy.
The ink may be permanent, but is only the size of a freckle. Tell someone if you are worried about this. Radiation therapy is usually every day, Monday to Friday, as an outpatient (you don’t stay in hospital).
A session usually lasts about 20 minutes – the radiation therapists have to set up the equipment and position you, but the treatment itself takes only a few minutes.
Radiation therapy doesn’t hurt and you aren’t radioactive afterwards. The length of the treatment course will vary depending on the purpose of radiation therapy.
It might involve 1–10 sessions for up to two weeks for palliative treatment, or longer if radiation therapy is combined with other treatments with the aim of long-term control.
Side effects of radiation therapy
Radiation therapy may cause various side effects during treatment or shortly afterwards, but most side effects go away after the treatment stops.
Depending on the area of the body being treated, side effects can include:
- fatigue
- peeling, cracked skin that looks red or sunburnt and may be uncomfortable
- painful swallowing; or
- loss of hair in the treatment area.
Radiation therapy to the chest area can cause difficulty swallowing and symptoms of reflux for a few days or weeks, sometimes leading to weight loss.
If high doses of radiation therapy are given to the chest area, it may cause permanent changes (fibrosis) in the lung tissue.
Trimodality therapy
Having a combination of chemotherapy, radical surgery and radical radiation therapy to treat mesothelioma is known as trimodality therapy.
The aim of having the three types of treatment is to remove as much pleural mesothelioma as possible, and stop any remaining mesothelioma cells from growing or spreading.
The most effective combination will depend on how you respond to treatment. Trimodality therapy is an intensive treatment that is available only in a few centres and it is not commonly recommended.
Despite reduced lung capacity afterwards, some people continue to live independently.
When is trimodality therapy suitable?
Trimodality therapy may be suitable for people:
- with a small amount of pleural mesothelioma at an early stage (T1–T3)
- with an epithelioid type of pleural mesothelioma
- whose scans show a good response to chemotherapy before surgery and no signs of pleural mesothelioma progression
- with no signs of spread into the lymph nodes or any other disease on CT and/or FDG–PET scans
- who are able to live independently with one lung
- who are physically fit enough for surgery.
Your surgeon is the best person to work out if trimodality therapy may be suitable for you. Ask your surgeon or oncologist to explain the likely outcome for you.
The surgery is a major operation, and not everyone wants to go ahead after the risks and benefits are explained.
Sometimes, even if someone seems suitable for intensive treatment, the doctor may adjust treatment if the mesothelioma doesn’t respond well to chemotherapy, is growing quickly or has spread, or if the person becomes too tired or unwell.
Three parts of trimodality therapy
1. Chemotherapy
- Several cycles of chemotherapy are given to shrink the tumour.
- A scan then checks the size of the tumour. If it has shrunk, you’ll have surgery in 4–6 weeks. If there is little or no response, you will not have radical surgery. Chemotherapy is usually given before surgery, but some people have chemotherapy after surgery.
2. Radical surgery
- This is either an extrapleural pneumonectomy (EPP) or pleurectomy decortication (PD). An EPP removes the whole lung, while a PD keeps the lung but removes the outer lining of the pleura (parietal pleura) and any visible tumours. Sometimes a smaller operation removes only part of the parietal pleura. Lymph nodes in the centre of the chest that drain the lung are also removed.
- You’ll stay in hospital for 10–14 days, or longer if complications occur. After 6–8 weeks you’ll be able to start radiation therapy.
3. Radical radiation therapy
- Radiation therapy aims to kill any remaining mesothelioma and is delivered using intensity-modulated radiation therapy (IMRT). This type of radiation therapy can be accurately shaped around the chest cavity, so higher doses can be delivered directly to the tumour cells while minimising the damage to other organs in the chest and abdomen.
- IMRT is often given after surgery, but may be given before surgery. How long you need radiation therapy will depend on your circumstances.
- Radiation therapy may cause side effects, but most improve after treatment.
“After I was diagnosed, I had chemotherapy for 10 months. Then I had my right lung removed. This surgery was followed by 30 treatments of radiation therapy.” Serafina
Peritoneal mesothelioma treatment
Surgery
It is possible for some people with peritoneal mesothelioma that has not spread to have an operation called a peritonectomy. Surgery is usually followed by chemotherapy.
Having surgery
In this procedure, the surgeon removes the parts of the peritoneum where the mesothelioma is growing. The amount of surgery needed will vary from person to person.
Removing as much of the cancer as possible will help reduce symptoms such as abdominal pain and poor appetite. It will also improve quality of life and increase life expectancy.
Peritonectomy surgery is long and complex, with recovery taking a long time. Whether this surgery is an option for you will depend on several factors, including your overall health and fitness, and whether the small bowel is cancer-free.
Only a small number of surgeons in Australia perform peritonectomy. You will usually need to get the medical opinion from one of these specialist surgeons if you are thinking about having a peritonectomy.
To find their contact details, talk to your treatment team or contact a mesothelioma support organisation.
Radiation therapy
Radiation therapy is rarely used for peritoneal mesothelioma. This is because the doses required to treat the whole abdomen would cause too much damage to surrounding organs.
However, radiation therapy can be used for localised symptoms.
Learn more
Chemotherapy
Chemotherapy is sometimes used to treat peritoneal mesothelioma. It may be given as a systemic treatment (into the bloodstream) on its own, or before or after surgery.
Systemic chemotherapy for peritoneal mesothelioma is similar to that given for pleural mesothelioma.
Having chemotherapy
If you have a peritonectomy, you will have chemotherapy directly into the abdomen. This is known as intraperitoneal chemotherapy and may be given in several ways:
- HIPEC – Heated intraoperative intraperitoneal chemotherapy (HIPEC) is known as “hot chemotherapy”. It involves heating the drugs to 42.5°C and inserting the solution into the abdomen for 60–90 minutes during the operation.
- EPIC – After surgery, chemotherapy may be delivered into the abdomen through a thin tube. When given soon after surgery as a single course, it is called early postoperative intraperitoneal chemotherapy (EPIC).
- NIPEC – There is evidence that receiving a long-term course of normothermic (normal temperature) intraperitoneal chemotherapy (NIPEC) may offer some benefit.
Immunotherapy
This is a type of drug treatment that uses the body’s own immune system to fight cancer.
Immunotherapy drugs known as checkpoint inhibitors block proteins that stop immune cells from recognising and destroying the cancer cells.
Once the proteins are blocked, the immune cells can potentially recognise and attack the cancer.
Having immunotherapy
The drugs used are ipilimumab and nivolumab in combination.
Immunotherapy for peritoneal mesothelioma is similar to that given for pleural mesothelioma, however evidence of how well it works is limited at this time.
Mesothelioma clinical trials
Cancer clinical trials are research studies that test whether a new approach to prevention, screening, diagnosis, or treatment works better than current methods and is safe.
There are clinical trials for mesothelioma open to recruitment in Victoria. This list shows the most recently updated mesothelioma studies on the Victorian Cancer Trials Link (VCTL).
Visit the VCTL to find more mesothelioma clinical trials.