Malignant Mesothelioma Treatment (PDQ®)—Health Professional Version - National Cancer Institute

Malignant Mesothelioma Treatment (PDQ®)–Patient Version

Treatment Option Overview

KEY POINTS

There are different types of treatment for patients with malignant mesothelioma.
Four types of standard treatment are used:
- Surgery
- Radiation therapy
- Chemotherapy
- Targeted therapy
New types of treatment are being tested in clinical trials.
- Biologic therapy
Treatment for malignant mesothelioma may cause side effects.
Patients may want to think about taking part in a clinical trial.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Follow-up tests may be needed.

There are different types of treatment for patients with malignant mesothelioma.

Different types of treatments are available for patients with malignant mesothelioma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Four types of standard treatment are used:

Surgery

The following surgical treatments may be used for malignant mesothelioma in the chest:

Wide local excision: Surgery to remove the cancer and some of the healthy tissuearound it.
Pleurectomy and decortication: Surgery to remove part of the covering of the lungsand lining of the chest and part of the outside surface of the lungs.
Extrapleural pneumonectomy: Surgery to remove one whole lung and part of the lining of the chest, the diaphragm, and the lining of the sac around the heart.
Pleurodesis: A surgical procedure that uses chemicals or drugs to make a scar in the space between the layers of the pleura. Fluid is first drained from the space using a catheter or chest tube and the chemical or drug is put into the space. The scarring stops the build-up of fluid in the pleural cavity.

After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:

External radiation therapy uses a machine outside the body to send radiation toward the cancer.
Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy is used to treat malignant mesothelioma, and may also be used as palliative therapy to relieve symptoms and improve quality of life.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the chest or peritoneum, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is the use of more than one anticancer drug.

Hyperthermic intraperitoneal chemotherapy is used in the treatment of mesothelioma that has spread to the peritoneum (tissue that lines the abdomen and covers most of the organs in the abdomen). After the surgeon removes all the cancer that can be seen, a solution containing anticancer drugs is heated and pumped into and out of the abdomen to kill cancer cells that remain. Heating the anticancer drugs may kill more cancer cells.

The way the chemotherapy is given depends on the type and stage of the cancer being treated.

See Drugs Approved for Malignant Mesothelioma for more information.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to attack specific cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do.

Monoclonal antibody therapy is a type of targeted therapy that uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.

Bevacizumab is a monoclonal antibody used to treat advanced malignant mesothelioma. It binds to a protein called vascular endothelial growth factor (VEGF). This may prevent the growth of new blood vessels that tumors need to grow. Other monoclonal antibodies are being studied in malignant mesothelioma.

Kinase inhibitors are a type of targeted therapy being studied in the treatment of malignant mesothelioma. Kinase inhibitors are targeted therapy drugs that block signals needed for tumors to grow.

New types of treatment are being tested in clinical trials.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website.

Biologic therapy

Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

Treatment for malignant mesothelioma may cause side effects.

For information about side effects caused by treatment for cancer, see our Side Effectspage.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Treatment Options for Malignant Mesothelioma

For information about the treatments listed below, see the Treatment Option Overviewsection.

Stage I Malignant Mesothelioma

If stage I malignant mesothelioma is in one part of the chest lining, treatment may be the following:

Surgery to remove the part of the chest lining with cancer and the tissue around it.

If stage I malignant mesothelioma is found in more than one place in the chest, treatment may be one of the following:

Extrapleural pneumonectomy.
Pleurectomy and decortication, with or without radiation therapy, as palliative therapyto relieve symptoms and improve quality of life.
Radiation therapy as palliative therapy to relieve symptoms and improve quality of life.
A clinical trial of anticancer drugs placed directly into the chest after surgery to remove the tumor.
A clinical trial of combinations of surgery, radiation therapy, and chemotherapy.
A clinical trial of a new treatment.

If stage I malignant mesothelioma is in the peritoneal lining, treatment may be the following:

Surgery to remove the part of the peritoneal lining with cancer and the tissue around it.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

Stage II, Stage III, or Stage IV Malignant Mesothelioma

If stage II, stage III, or stage IV malignant mesothelioma is found in the chest, treatment may be one of the following:

Combination chemotherapy and targeted therapy with bevacizumab.
Chemotherapy placed directly into the chest cavity to shrink the tumors and keep fluidfrom building up.
Surgery to drain fluid that has collected in the chest, to relieve chest discomfort and improve quality of life. Pleurodesis may be done to stop more fluid from collecting in the chest.
Pleurectomy and decortication, as palliative therapy to relieve symptoms and improve quality of life.
Radiation therapy as palliative therapy to relieve pain.
A clinical trial of combinations of surgery, radiation therapy, and chemotherapy.

If stage II, stage III, or stage IV malignant mesothelioma is found in the peritoneum, treatment may be one of the following:

Surgery to remove the tumor followed by hyperthermic intraperitoneal chemotherapy.
Chemotherapy placed directly into the peritoneum to shrink the tumor and keep fluid from building up.

Recurrent Malignant Mesothelioma

Treatment of recurrent malignant mesothelioma may be one of the following:

Surgery to remove part of the chest wall.
Chemotherapy, if it was not given as initial treatment.
A clinical trial of biologic therapy.
A clinical trial of targeted therapy.
A clinical trial of chemotherapy.
A clinical trial of surgery.

To Learn More About Malignant Mesothelioma

For more information from the National Cancer Institute about malignant mesothelioma, see the following:

For general cancer information and other resources from the National Cancer Institute, see the following:

About This PDQ Summary

About PDQ

Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

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Purpose of This Summary

This PDQ cancer information summary has current information about the treatment of malignant mesothelioma. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

Reviewers and Updates

Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.

The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board.

Clinical Trial Information

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Clinical trials can be found online at NCI's website. For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).

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PDQ® Adult Treatment Editorial Board. PDQ Malignant Mesothelioma Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/mesothelioma/patient/mesothelioma-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389166]

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