Mesothelioma treatment

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science.

This page was updated on September 12, 2022.

Mesothelioma is often hard to treat because it usually spreads along surfaces instead of growing as a single tumor mass like many other cancers. Your doctors may target mesothelioma with a variety of therapies, including surgery, chemotherapy, radiation therapy, immunotherapy and targeted therapy.

This article will cover:


For patients with stage 4 pleural mesothelioma, and for mesothelioma patients whose cancer cannot be surgically removed, chemotherapy is often used to fight the disease. For earlier-stage pleural mesothelioma, patients’ treatment regimen may consist of surgery, chemotherapy and radiation therapy.

Hyperthermic intraperitoneal chemotherapy (HIPEC), a highly concentrated, heated chemotherapy delivered directly to the abdomen during surgery, also may be used to treat certain types of mesothelioma.

Your care team may use chemotherapy as part of your treatment plan before or after surgery.

  • Chemotherapy before surgery is called neoadjuvant chemotherapy, and it may be used to reduce the size of a tumor so it’s easier to remove during surgery. Neoadjuvant chemotherapy may also help lower the risk of the cancer spreading.
  • Chemotherapy given after surgery is called adjuvant chemotherapy. The goal of this treatment is to kill any cancerous cells that may remain after surgery, helping to reduce the chance that cancer may return.

Chemotherapy drugs may be an appropriate treatment to kill cancer cells, but they may also affect normal cells in your body and cause side effects. Different anti-cancer drugs have various side effects—and how much they affect you may depend on the dosage. Part of your care team’s job is to help you manage these side effects, so they can work with you to reduce this aspect of treatment as much as possible. Side effects tend to go away once chemotherapy treatment is done.

In general, chemotherapy drugs may cause:

During chemotherapy, you may also have a higher risk of infection, and you may bruise or bleed more easily than usual. This is because chemotherapy may affect your blood cells and the way your blood clots while you’re getting treatment.

Ask your care team to share more details about the specific side effects of the chemotherapy drugs in your treatment plan and what you can expect.


Immunotherapy drugs, either alone or in combination with other immunotherapy drugs or therapies, may be used to treat mesothelioma in certain patients who have already received chemotherapy.

These drugs help your immune system find and attack cancer cells that may be evading detection, so they can be especially helpful if cancer cells continue to grow after chemotherapy. They also may be used as a first-line treatment for mesothelioma that cannot be treated with surgery. They’re typically given as an intravenous (IV) infusion once a week or once every few weeks, depending on the drug or drugs.

Immunotherapy drugs are called checkpoint inhibitors because they inhibit cancer cells from hiding within certain immune system checkpoints. However, they may cause side effects such as:

  • Skin reactions
  • Itching
  • Fatigue
  • Diarrhea
  • Cough
  • Joint pain
  • Loss of appetite
  • Nausea
  • Constipation

Ask your care team about what side effects to expect with the specific immunotherapy drugs in your treatment plan. They may be able to offer ways to manage or prevent side effects.

Radiation therapy

For patients with mesothelioma, radiation therapy may be used to destroy undetectable cancer cells left behind after surgery. In some cases, radiation therapy may also be used to alleviate chest pain and other symptoms of mesothelioma, such as shortness of breath and trouble swallowing.

The most common type of radiation therapy for mesothelioma is external beam radiation therapy (EBRT), which uses X-rays given outside the body to treat cancer cells.

The side effects of this type of radiation treatment depend in part on where the cancer cells are located. If radiation is given to the chest, for example, your lungs may be affected. Likewise, if you have radiation to your abdomen, you may experience gastrointestinal side effects such as nausea or vomiting. Any external radiation may also cause skin issues—similar to a sunburn—regardless of where radiation is given. You may lose hair in the area as well.


Surgery, often a first-line treatment with mesothelioma, is used to remove tumors and provide relief from symptoms. A variety of surgical procedures may be used to treat mesothelioma, with surgeons’ recommendations generally depending on the type of mesothelioma involved. For instance, if a patient has pleural mesothelioma, the surgeon may choose one of the following operations:

Extrapleural pneumonectomy: In this procedure, the surgeon removes the lung on the side of the body affected by the cancer, as well as the pleura lining the chest wall on that side, the diaphragm on that side, the surrounding lymph nodes and sometimes the pericardium (sac around the heart). This is a complex surgery, and you and your care team should take many points into consideration prior to making a decision, including your overall health and preferences.

Because of how involved they are, extrapleural pneumonectomies come with some risks, including:

  • Blood clots
  • Infections
  • Changes in heart rhythm
  • Buildup of fluid in the lungs
  • Reduction in how well lungs work after surgery

Commonly, you may have adjuvant radiation and/or chemotherapy after this type of surgery. In some cases, you may also be given radiation and/or chemotherapy before the surgery as well.

Pleurectomy/decortication: The surgeon removes all the pleura lining the chest wall on the side affected by the cancer, along with the pleura lining of the affected lung, the mediastinum (area between the lungs) and the diaphragm. This type of surgery, also called a P/D, may be done with the goal of completely removing early-stage cancer or of reducing advanced-cancer symptoms such as shortness of breath or chest pain.

Generally, this type of surgery is linked to fewer complications than the more extensive extrapleural pneumonectomy.

Debulking: The surgeon removes as much of the cancer as possible. Sometimes this is called a partial pleurectomy. Since this type of surgery removes less tissue than an extrapleural pneumonectomy or a P/D, there may be fewer side effects after surgery. However, for all surgeries, there’s a risk of infection. Follow your care team’s instructions for recovery, which may include limiting your activities while you heal.

If a patient has peritoneal mesothelioma, the surgeon may perform a debulking procedure or an omentectomy, which removes the omentum, a layer of fatty tissue that covers the organs in the abdomen. After an omentectomy, adjuvant chemotherapy that targets the abdomen may be given as part of the treatment plan.

Keep in mind that though your cancer care team gathers all the information they can about your cancer beforehand, they may learn even more about it during the surgery. The type of surgery may even change depending on what your surgeon observes during the procedure. Discuss this possibility with your care team before your procedure and be sure to ask all your questions.

Targeted therapy

Several targeted therapy drugs are approved to treat certain types of mesothelioma, some of which work by depriving a tumor of oxygen. Targeted therapies damage, destroy or weaken cancer cells in very specific ways, so they may affect healthy, noncancerous cells less than other types of treatment.

Often, targeted therapy for mesothelioma is given along with chemotherapy drugs. This combination of targeted therapy and chemotherapy may be used as a first-line treatment for mesothelioma that can’t be surgically removed.

One targeted therapy that limits cancer cell growth by depriving them of nutrients is Avastin® (bevacizumab). This drug inhibits the growth of new blood vessels that the tumor could use to continue growing. It’s given as an IV infusion every few weeks.

Targeted therapy tends to have less severe side effects than standard chemotherapy, but there can still be side effects from treatment. These tend to be similar to those from chemotherapy:

  • Hair loss
  • Loss of appetite
  • Mouth sores
  • Increased risk of infection
  • Fatigue
  • Diarrhea

Bevacizumab may also cause high blood pressure and a higher chance of bleeding.

Clinical trials

Your cancer care team can also help you explore options for taking part in a clinical trial that provides treatment as part of a research study. These trials help determine whether a new treatment—or a new combination of treatments—may be better than the current standard treatment for that type and stage of cancer.

For mesothelioma, one type of treatment that’s being studied is brachytherapy, in which a small radiation source is put in the body and placed near cancer cells. Your care team can help you navigate the clinical trials that may be an option for you.

Recurrent mesothelioma

Mesothelioma that comes back after treatment is complete is called recurrent. Treatment for recurrent mesothelioma depends heavily on each specific situation—where the cancer has recurred, what type of treatment was used initially, and your overall health and preferences. Your cancer care team will likely order new tests to learn more about the cancer that has come back and make a plan to treat it.

Recurrent cancer can be challenging to treat, and your treatment goals may include palliative care to reduce symptoms from the cancer and/or side effects from treatment. Clinical trials exploring new ways to treat recurrent mesothelioma may be a good option for some patients.

Metastatic mesothelioma

Mesothelioma that has spread to other parts of your body is called metastatic mesothelioma. Like recurrent mesothelioma, metastatic mesothelioma can be very difficult to treat. There’s no one way to treat metastatic mesothelioma, so your care team can work with you to discuss options, give recommendations and listen to your preferences. Your treatment plan for metastatic mesothelioma may involve a combination of treatments, or your care team may suggest a clinical trial exploring a new treatment that may be more beneficial than current treatments.

Next topic: What are the facts about mesothelioma?

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Show references
  • American Cancer Society (2018, November 16). Chemotherapy for Malignant Mesothelioma.
  • American Cancer Society (2020, October 7). Immunotherapy for Malignant Mesothelioma.
  • American Society of Clinical Oncology (2020, September). Mesothelioma: Types of Treatment.
  • American Cancer Society (2018, November 16). Radiation Therapy for Malignant Mesothelioma.
  • National Cancer Institute (2020, February 4). What Are Clinical Trials?
  • American Cancer Society (2019, May 28). Treatment of Mesothelioma Based on the Extent of the Cancer.
  • American Cancer Society (2018, November 16). Surgery for Malignant Mesothelioma.