A range of treatments are recommended for people with mesothelioma. These aim to control the cancer and can include chemotherapy, immunotherapy, radiation therapy or surgery, which may be used alone or in combination. The different types of mesothelioma are treated in different ways.
Your specialist will discuss your treatment options with you, and these will depend on several factors including:
- the location, stage and type of mesothelioma, which helps estimate the likelihood of response to treatment
- your age, health and fitness
- your family circumstances and support
- your preferences.
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
Chemotherapy uses drugs to kill or slow the growth of cancer cells while causing the least possible damage to healthy cells. It is usually administered into a vein through a drip (intravenously).
The main chemotherapy drugs for pleural mesothelioma are pemetrexed in combination with cisplatin or carboplatin. Research shows this combination can improve quality of life and increase survival by a few months more than using a single drug.
The goals of chemotherapy are not only to increase length of life but also to shrink the cancer, reduce symptoms and improve quality of life. However, chemotherapy doesn’t work for some people. Side effects depend on the type and dose of chemotherapy drugs.
Immunotherapy 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.
Immunotherapy is a relatively new treatment for mesothelioma. However, it is now commonly used for most people who are fit enough to have any type of treatment. It may not be used upfront if you are having trimodality treatment (see below). Your medical oncologist will discuss whether immunotherapy is suitable for you.
Immunotherapy may be used alone or with chemotherapy. The side effects of immunotherapy drugs are different to those from chemotherapy. Immunotherapy can cause inflammation throughout the body, which may lead to different side effects depending on which part of the body is inflamed.
The drugs used are ipilimumab and nivolumab in combination. Immunotherapy drugs are usually given through a vein (intravenously) in hospital and can take between 30 and 90 minutes. You will usually wait a short time to be monitored for any reaction before going home.
Radiation therapy is the use of targeted radiation to kill or damage cancer cells so they cannot grow, multiply or spread. Treatment is carefully planned to destroy as many cancer cells as possible while causing the least harm to your normal tissue.
Radiation therapy may be used at different stages of pleural mesothelioma treatment 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.
The length of the treatment course will vary depending on why you are having radiation therapy. Radiation therapy is painless but it may cause side effects during treatment or shortly afterwards. Side effects vary depending on the area of the body treated and most go away after treatment stops.
Having a combination of chemotherapy, radical surgery and radical radiation therapy to treat mesothelioma is known as trimodality therapy. The aim of having three types of treatment is to remove as much pleural mesothelioma as possible, and stop any remaining mesothelioma cells from growing or spreading.
Trimodality therapy is an intensive treatment. Although some studies show promising results, the benefits of trimodality therapy for pleural mesothelioma are not yet clear. Not all mesothelioma specialists recommend trimodality therapy, and it is only available in a few specialist centres.
Three parts of trimodality therapy
Several cycles of chemotherapy are given to shrink the tumour. A scan then checks the size of the tumour. If it has been reduced, 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, 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
This aims to treat any tumour cells that may still be present.
Radiation therapy is delivered using intensity-modulated radiation therapy (IMRT). Because this type of radiation therapy can be accurately shaped around the chest cavity, higher doses can be delivered directly to the tumour cells while minimising the damage to other organs in the chest and abdomen.
While IMRT is often given after surgery for up to six weeks, in some cases it is given before surgery for only one week. This shorter treatment is experimental, and your radiologist will decide how long you need radiation therapy depending on your circumstances.
When is trimodality therapy suitable?
Only a small number of people with pleural mesothelioma have trimodality therapy. It is suitable only for people:
- with a small amount of pleural mesothelioma at an early stage
- 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.
The best person to work out if trimodality therapy may be suitable for you is your surgeon. An EPP or PD is a major operation, and not everyone wants to go ahead after the risks and benefits of the therapy are explained.
Sometimes, despite a person appearing suitable for intensive treatment at first, the doctor may need to adjust the treatment plan, or they may decide it is best not to continue with trimodality therapy. This might be because:
- the mesothelioma does not respond well to the chemotherapy
- tests of specimens taken at surgery show that the cancer is growing quickly or has spread
- the person has become too tired or unwell.
Recent advances in treating mesothelioma
Mesothelioma treatment has improved in recent years. There are more accurate ways to diagnose and stage the disease, better surgical techniques and post-surgery care, new evidence-based chemotherapy combinations and new radiation therapy methods.
Clinical trials are testing promising new drugs called immunotherapy for treating mesothelioma. Immunotherapy slows the growth of cancer or kills cancer cells by altering the body’s immune system response.
Immunotherapy does not work for most people with mesothelioma, but some people may have good results from this treatment. It is still experimental and available only through a clinical trial.
Learn more about immunotherapy
Peritoneal mesothelioma treatment
It is possible for some people with peritoneal mesothelioma that has not spread to have an operation called a peritonectomy, which involves the surgeon removing the parts of the peritoneum where the mesothelioma is growing. The amount of surgery needed will vary between people and it is usually followed by chemotherapy.
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 complex and recovery can take 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 this surgery.
Radiation therapy is rarely used for peritoneal mesothelioma as the doses required to the whole abdomen would cause too much damage to surrounding organs. However, it can be used for localised symptoms.
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.
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 'heated 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 for peritoneal mesothelioma is similar to that given for pleural mesothelioma. The body's immune system is assisted in fighting the cancer through the use of immunotherapy drugs known as checkpoint inhibitors. The drugs block proteins that stop immune cells from recognising and destroying the cancer cells. Once blocked, the immune system can potentially recognise and attack the cancer.
The drugs used are ipilimumab and nivolumab in combination.
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Expert content reviewers:
A/Prof Brian McCaughan, Cardiothoracic Surgeon, Chris O’Brien Lifehouse, NSW; Theodora Ahilas, Principal Lawyer, Maurice Blackburn Lawyers, NSW; Prof David Ball, Director, Lung Service, Peter MacCallum Cancer Centre, VIC; Shirley Bare, Consumer; Cassandra Dickens, Clinical Nurse Consultant, Cancer Care Coordinator – Thoracic Malignancies, Sunshine Coast University Hospital, QLD; Penny Jacomos, Social Worker, Asbestos Diseases Society of South Australia, SA; A/Prof Thomas John, Medical Oncologist, Senior Clinical Research Fellow, Austin Health, and Olivia Newton-John Cancer Research Institute, VIC; Victoria Keena, Executive Officer, Asbestos Diseases Research Institute, NSW; Penny Lefeuvre, Consumer; Jocelyn McLean, Mesothelioma Support Coordinator, Asbestos Diseases Research Institute, NSW; Prof David Morris, Peritonectomy Surgeon, St George Hospital and University of New South Wales, NSW; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council Western Australia; Prof Anna Nowak, Medical Oncologist, Sir Charles Gairdner Hospital, and Professor of Medicine, School of Medicine and Pharmacology, The University of Western Australia, WA; Prof Jennifer Philip, Palliative Care Specialist, St Vincent’s Hospital, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, VIC; Nicole Taylor, Acting Lung Cancer and Mesothelioma Cancer Specialist Nurse, The Canberra Hospital, ACT.
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The information on this webpage was adapted from Understanding Mesothelioma - A guide for people with cancer, their families and friends (2019 edition). This webpage was last updated in August 2021.