This section tells you the treatments that are the standard of care for this type of cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, patients are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Your doctor can help you consider all your treatment options. To learn more about clinical trials, see the About Clinical Trials and Latest Research sections.
In Mesothelioma cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.
Descriptions of the most common treatment options for both pleural and peritoneal mesothelioma are listed below. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. Learn more about making treatment decisions.
Information on pleural mesothelioma is based on ASCO recommendations for the treatment of malignant pleural mesothelioma.
Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. A surgical oncologist is a doctor who specializes in treating cancer using surgery. The type of surgery for mesothelioma depends on the stage and location of the cancer.
- Pleural mesothelioma (Updated 1/2018). For patients with pleural mesothelioma, the surgeon may remove the cancerous lining around the lung. This procedure is called a pleurectomy/decortication. Generally, the tumor cannot be completely removed with a pleurectomy/decortication. A more aggressive surgery for pleural mesothelioma is called an extrapleural pneumonectomy. This is the removal of the lining of the lung, the entire lung, a portion of the diaphragm, and often a portion of the lining around the heart. This is a difficult surgery and is recommended only after the doctor has reviewed many factors, including the patient’s overall health and the stage of the disease. Additional treatment after surgery such as chemotherapy and/or radiation therapy are often recommended (see below). Chemotherapy and/or radiation therapy may also be given before surgery.
- Peritoneal mesothelioma. Patients with peritoneal mesothelioma may often have a surgery called an omentectomy. An omentectomy is the removal of the lining around the abdominal organs. Since patients with peritoneal mesothelioma often have tumors throughout the entire abdomen, it is difficult to remove all of them. The goal of surgery is to leave behind tumors that are as small as possible. After surgery, chemotherapy may be placed directly into the abdomen (see Systemic therapy, below).
Before surgery, talk with your health care team about possible side effects from the specific surgery you will have. Learn more about the basics of cancer surgery.
Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation, which is radiation given from a machine outside the body.
A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.
- Pleural mesothelioma. It is challenging to treat pleural mesothelioma with radiation therapy because of the risk of damaging the lung. When 1 of the 2 lungs has been surgically removed, radiation therapy is often given to the chest cavity to lower the risk of the mesothelioma returning in the chest. For example, this approach may be used after an extrapleural pneumonectomy (see Surgery, above). For some patients, radiation therapy may be given to a smaller area to help relieve symptoms such as pain (see Getting care for symptoms and side effects, below).
- Peritoneal mesothelioma. For patients with peritoneal mesothelioma, radiation therapy to the entire abdomen causes severe side effects and is not done. If a patient has pain in a specific area, radiation therapy may be an option to help relieve pain (see Getting care for symptoms and side effects, below).
Side effects from radiation therapy may include tiredness, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished. Learn more about the basics of radiation therapy.
Systemic therapy (Updated 1/2018)
Systemic therapy is the use of drugs to destroy cancer cells. For mesothelioma, systemic therapies include chemotherapy, targeted therapy, and immunotherapy.
Chemotherapy is the most common type of systemic therapy used for mesothelioma. It usually works by ending the cancer cells’ ability to grow and divide. Systemic therapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication.
Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give systemic chemotherapy for mesothelioma include an intravenous (IV) tube placed into a vein using a needle. Chemotherapy can also be given directly to the abdomen after surgery for peritoneal mesothelioma, called intraperitoneal chemotherapy.
A systemic chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or combinations of different drugs given at the same time.
- Pleural mesothelioma. The recommended treatment for patients who haven’t yet received treatment is the combination of pemetrexed (Alimta) and cisplatin (Platinol) or carboplatin (Paraplatin). These medications are given in 4 to 6 treatment cycles that each last 3 weeks. There can be significant side effects with this combination of drugs. Some patients may receive a single drug if there are too many side effects from giving both drugs. Bevacizumab (see Targeted Therapy, below) may be added to chemotherapy for some patients.
- Peritoneal mesothelioma. As mentioned in the surgery section (above), chemotherapy is often given directly into the abdomen after surgery. IV chemotherapy is also used. Just as with pleural mesothelioma, the combination of pemetrexed with cisplatin or carboplatin are most often used for treatment.
The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. The most common side effects from the drugs used to mesothelioma include damage to the kidneys, numbness and tingling in the fingers or toes, decreased hearing, rash, a higher risk of infection from a low white blood count, or anemia. Patients may experience other side effects as well. Patients receiving these types of chemotherapy are given the vitamins B12 and folic acid to lower the risk of these side effects. Other medications, such as those used to prevent vomiting, are also available to relieve many of these side effects. These side effects usually go away after treatment is finished.
Learn more about the basics of chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.
Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.
Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments.
For pleural mesothelioma, the drug bevacizumab (Avastin) may be added to chemotherapy for patients who do not have health problems that would prevent them from receiving it. Bevacizumab is a type of drug called and anti-angiogenic. Anti-angiogenesis is focused on stopping angiogenesis, which is the process of making new blood vessels. Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor. Talk with your doctor about possible side effects for a specific medication and how they can be managed.
Immunotherapy, also called biologic therapy, is designed to boost the body’s natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.
For mesothelioma, pembrolizumab (Keytruda) and a combination of ipilimumab (Yervoy) and nivolumab (Opdivo) may be options for patients who have already received chemotherapy.
Different types of immunotherapy can cause different side effects. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy.
Getting care for symptoms and side effects
Cancer and its treatment often cause side effects. In addition to treatments intended to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.
Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process. People often receive treatment for the cancer at the same time that they receive treatment to ease side effects. In fact, patients who receive both at the same time often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, or radiation therapy. Examples of palliative care for mesothelioma include draining fluid that has built up in the patient’s chest or abdomen or using radiation therapy or chemotherapy to relieve symptoms, such as pain. Talk with your doctor about the goals of each treatment in your treatment plan.
Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and palliative care options. During and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible. Learn more about palliative care.
If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Also, clinical trials might be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.
Your treatment plan may include a combination of the treatments above, such as surgery, radiation therapy, and systemic therapy. Palliative care will also be important to help relieve symptoms and side effects.
For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.
Chance of recurrence
When cancer cannot be detected in the body and there are no symptoms, it may be called having “no evidence of disease” or NED.
Having NED may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. It’s important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.
If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).
When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the treatments described above such as surgery, systemic therapy, and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.
People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.
If treatment doesn’t work
Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.
This diagnosis is stressful, and for many people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.
Patients who have advanced cancer and who are expected to live less than 6 months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families.