What Are My Mesothelioma Treatment Options?
The two categories for malignant mesothelioma treatment include curative and palliative treatment.
Curative treatments are given to help extend a patient’s lifespan, whereas palliative treatments manage symptoms and reduce discomfort. Doctors generally use the same mesothelioma treatments to achieve curative or palliative goals.
The three most common types of mesothelioma treatment include:
- Chemotherapy
- Radiation
- Surgery
Mesothelioma specialists will often prescribe multimodal therapy, which is a combination of multiple types of mesothelioma treatment. Customized treatment plans are designed to help you live as long as possible.
Video Summary: Registered Nurse Amy Fair discusses standard mesothelioma treatments and how patients can pick the best option. View Transcript.
What do I need to know about mesothelioma treatments?
It’s really important for your doctors, your oncologists, your surgeons to explain to you what stage you’re in – to explain to you what type of mesothelioma you have. You have to understand your disease, you have to understand the type of disease, and you have to understand the stage of the disease. Many people have to make decisions as far as quality and quantity of life.
What are my treatment options for mesothelioma?
The standard treatment options for mesothelioma is a surgical approach. In pleural mesothelioma, they will offer the patient a pleural decortication where they strip the lining of the lung. They may offer to the patient a pneumonectomy and that is removing the whole lung, not just the lining. They may offer radiation to shrink the tumor first. Also, radiation gives them palliative care if that tumor is pressing on vital organs or nerves and causing pain, they may want to go in and do radiation first to shrink that tumor. Then of course there is the chemotherapy approach, and again sometimes multiple modalities are used. Surgical approach, radiation, and chemotherapy. It is a clinical individual fit for that particular person.
How can I decide what treatment is best for me?
When deciding what treatment modality is best for you it’s important to communicate with your surgeon, to communicate with your oncologist. You need to get an understanding on their thoughts if you’re a candidate for chemotherapy. Are you a candidate to have surgery? Although all that is very important, the individual decision for what type of therapy lies within the mesothelioma patient.
Factors Affecting Mesothelioma Treatment
Doctors will take multiple factors into consideration before they can recommend how to treat mesothelioma. These factors can influence your mesothelioma prognosis and treatment plan.
Factors that may impact mesothelioma treatment include:
- Cancer stage at diagnosis
- How fast the cancer is spreading
- Mesothelioma cell type
- Mesothelioma type
- Overall health
- The patient’s personal wishes
Mesothelioma Treatment Timeline
Mesothelioma treatment can vary for each patient, but most treatment plans follow the same steps from diagnostic testing to final treatment.
Here is an example of a mesothelioma treatment timeline:
- Examine Symptoms: Your doctor will give you a physical exam and conduct imaging tests such as X-rays or CT scans once you start experiencing mesothelioma symptoms.
- Get a Diagnosis: Your doctor will perform a biopsy and remove a tissue or fluid sample to examine it for cancer cells. A biopsy is necessary to confirm a mesothelioma diagnosis.
- Get a Second Opinion: It is highly encouraged to get a second opinion from a mesothelioma specialist because most general physicians have little experience with the rare cancer.
- Follow a Treatment Plan: Once you select a specialist, your care team will build a treatment plan tailored to your specific diagnosis and personal wishes.
- Receive Second-Line Treatment: Talk to your doctor about second-line treatments such as chemotherapy, radiation, and experimental therapies if your cancer comes back.
Mesothelioma Treatment Costs
Many patients have questions about how much their mesothelioma treatment will cost. Battling mesothelioma can not only be emotionally devastating, but it can also be financially draining. Thankfully, there are financial support options and legal resources available to mesothelioma patients to help them pay for treatment.
The prices of medical care are for illustrative purposes only and can vary depending on insurance coverage, geographic location, hospitalization, type of treatment and/or diagnostic testing, and more.
- Chemotherapy Monthly Average Cost – $10,000
- Chest X-ray – $600
- Computerized Tomography (CT) Scan of Chest – $3,000
- Consultation With Oncologist – $500
- Doctor Visit – $75
- Fluid Drains – $2,250
- Follow-Up Labs – $100
- Multiple X-rays – $500
- Monthly Prescription Charges for Aloxi, Neulasta, and Oxycodone – $9,500 (Monthly Average)
- Positron Emission Tomography (PET) Scan – $5,000
- Possible Inpatient Hospitalization – $2,000
- Specialist Doctor Visit -$400
- Thoracentesis – $2,250
- Tube Thoracostomy – $4,500
- Video-Assisted Thoracoscopy (VAT) With Biopsy – $73,000
- Vitamin B12 Injection – $100
Total estimated cost: $402,000
Mesothelioma Surgery
Surgery is often one of the best treatment options to control cancer growth and extend a patient’s life span. Mesothelioma specialists and/or oncologists will remove all visible tumor masses and sometimes the surrounding tissues or infected organs during surgery.
Doctors have developed several surgical procedures for different types of mesothelioma. Your mesothelioma cancer treatment plan will depend on the type of mesothelioma you have and how far it has spread.
Pleural Mesothelioma Surgery
The two main surgeries for malignant pleural mesothelioma are extrapleural pneumonectomy (EPP) and pleurectomy with decortication (P/D).
The type of pleural mesothelioma surgery recommended depends on your specific case of mesothelioma.
- Extrapleural Pneumonectomy (EPP): Curative surgery usually combined with chemotherapy or radiation to help improve patient life expectancy. This surgery removes all visible tumors, the entire diseased lung, as well as portions of the parietal (outer) pleura, the diaphragm, and the pericardium.
- Pleurectomy With Decortication (P/D): Removes visible tumors, the diseased parietal pleura, the diaphragm, part of the pericardium, and some lung tissue if necessary.
EPP is considered a more aggressive treatment since it removes the greatest amount of mesothelioma tumors in many cases.
Some studies have shown that patients who undergo EPP have a median survival time of up to 27 months. The median life expectancy of patients who receive P/D is around 29 months.
Unlike EPP, P/D allows patients to keep both lungs, giving them a better quality of life after surgery. Additionally, P/D patients develop fewer fatal complications within 30 days after surgery compared to those who undergo EPP. That said, some doctors argue that it does not allow for maximum tumor resection (removal).
Peritoneal Mesothelioma Surgery
There is one curative surgery for peritoneal mesothelioma called cytoreduction with HIPEC. This mesothelioma treatment method was developed by Dr. Paul Sugarbaker and consists of cytoreductive surgery and heated chemotherapy.
According to the National Cancer Institute (NCI), patients with peritoneal mesothelioma who receive cytoreduction with HIPEC may survive up to 7 years or more after diagnosis.
Cytoreductive surgery (also called debulking) involves the surgical removal of the entire diseased peritoneum (abdominal lining) and any tumors or diseased tissue surrounding the abdominal cavity.
Directly after the surgical tumor removal, doctors will administer heated chemotherapy drugs into the abdomen for up to 90 minutes. This helps to kill off any remaining mesothelioma cells and prevent regrowth.
Mesothelioma Chemotherapy
Chemotherapy is most commonly used for patients with pleural or peritoneal mesothelioma. Chemotherapy has shown mixed results in patients with pericardial mesothelioma.
During chemotherapy, patients are given cancer-killing medications that shrink and slow the growth of tumors. Chemotherapy may be administered before (neoadjuvant), during, after (adjuvant), or in place of surgery. Mesothelioma patients are usually given a combination of the drugs cisplatin and pemetrexed.
Cancer centers with experience treating mesothelioma patients will be able to administer the best chemotherapy medication(s) for your specific condition and help you stay comfortable during the chemotherapy process.
“Chemotherapy is a scary term. Experienced centers are going to be very good at all the supportive care measures — the things that help you feel better.”
– Dr. Hedy Lee Kindler, Mesothelioma Specialist at the University of Chicago Medicine Comprehensive Cancer Center
Mesothelioma Radiation Therapy
Radiation is most commonly used for patients with pleural mesothelioma. Mesothelioma radiation therapy uses powerful electromagnetic waves to destroy cancer cells by scrambling their DNA.
Radiation is usually used in addition to other forms of mesothelioma treatment either before, during, or after surgery or chemotherapy.
| Mesothelioma Stage | 1-Year Survival Rate | 5-Year Survival Rate |
|---|---|---|
| Localized | 74% | 26% |
| Regional | 55% | 19% |
| Distant | 40% | 11% |
Other Mesothelioma Treatment Options
Researchers continue to study new and effective ways to treat this rare cancer. There are plenty of alternative mesothelioma treatments that can be used in substitution of traditional treatment options.
Immunotherapy
Immunotherapy (also called biologic therapy) boosts a patient’s immune system so the body can target and destroy cancer cells more effectively. There are several medications that boost the immune system and kill cancer cells.
Immunotherapy for mesothelioma had only been available through clinical trials for many years. This changed in 2020 when the U.S. Food and Drug Administration (FDA) approved the use of Opdivo® (nivolumab) and Yervoy® (ipilimumab) to treat certain pleural mesothelioma patients.
The combination of these drugs marked the first additional treatment for mesothelioma in 16 years.
According to the FDA, the median overall survival for patients treated with nivolumab plus ipilimumab was 18.1 months, compared to 14.1 months for chemotherapy patients.
Immunotherapy may also help treat peritoneal mesothelioma. In July 2021, results from a phase II clinical trial testing atezolizumab plus bevacizumab found the combination was safe and effective in patients with disease progression or intolerance to previous chemotherapy treatment.
About 85% of patients treated with atezolizumab plus bevacizumab survived for one year, and 61% of patients’ disease was progression-free for one year. The drug combination had an objective response rate of 40%.
Gene Therapy
Gene therapy changes the DNA of either cancer or healthy cells in order to fight off cancer. This type of therapy is conducted by using modified viruses to inject new genes into cancer cells.
Tumor Treating Fields (TTF) System
TTF uses carefully-tuned electric fields to interrupt cancer cell division and kill cancer cells. It is delivered through a device similar to a bathing cap that fits over the scalp. The FDA approved a new TTF treatment, Optune Lua™, in 2019.
Cryotherapy
Cryotherapy (also called cryosurgery) uses liquid nitrogen to freeze and destroy cancer cells. Pleural mesothelioma specialist Dr. Robert B. Cameron pioneered the use of cryotherapy treatment for mesothelioma.
“We’re making tremendous advances in the diagnosis of mesothelioma, the staging of this disease, treatment, and research, and this is providing hope to patients and families.”
– Daniel H. Sterman, director of the Multidisciplinary Pulmonary Oncology Program at the New York University Langone Medical Center
Palliative Treatment for Mesothelioma
Palliative mesothelioma treatment is beneficial to reduce pain and discomfort for patients that undergo aggressive first-line treatments and for those unable to receive curative treatment.
Palliative Care Options for Pleural Mesothelioma
- Partial Pleurectomy: Surgical removal of part of the pleura to relieve symptoms and prevent fluid from filling the pleura.
- Thoracentesis: Surgical removal of pleural effusions (fluid buildup in the chest wall) to help a patient breathe more easily.
- Video-Assisted Thoracoscopic Surgery (VATS) Talc Pleurodesis: Effective technique that manages repeated pleural effusions, in which the space between the two layers of the pleura is sealed so that it can no longer fill with fluid.
Palliative Care Options for Peritoneal Mesothelioma
- Paracentesis: Drains fluid in the lining of the abdominal wall and the lining surrounding the internal organs to reduce peritoneal mesothelioma symptoms.
Palliative Care Options for Both Pleural and Peritoneal Mesothelioma
- Alternative Treatments: Includes massage, yoga, and meditation to provide symptom relief and overall well-being. These options are not a replacement for medical treatment.
- Chemotherapy/Radiation: Used as both curative and palliative treatment options. This treatment aims to relieve symptoms during palliative care.
- Pain Medication: Doctors may prescribe pain medication to help relieve symptoms.
- PleurX™ Catheter: FDA-approved catheter that allows cancer patients to manage fluid buildup in the chest or abdomen to reduce pain and discomfort at home without going to the hospital.
Mesothelioma Doctors and Cancer Centers
Top mesothelioma doctors specialize in diagnosing and treating mesothelioma. These doctors excel in performing mesothelioma treatment that may result in several more months — and even years — of life for patients.
There are many distinguished specialists that treat mesothelioma in cancer centers around the country.
Some top doctors who treat mesothelioma include:
- Dr. Avi Lebenthal: Accomplished pleural mesothelioma surgeon based out of Brigham and Women’s Hospital in Boston and the VA Boston Healthcare System.
- Dr. Paul Sugarbaker: Top oncological surgeon specializing in peritoneal mesothelioma at the Cancer Institute in Washington Hospital Center.
- Dr. Robert Cameron: Renowned pleural mesothelioma specialist based out of the West Los Angeles VA Medical Center who helped to develop pleurectomy with decortication (P/D) surgery.
- Dr. Taylor Ripley: Minimally invasive surgery specialist and director of the Mesothelioma Treatment Center at Baylor College of Medicine’s Lung Institute.
Some top cancer centers that treat mesothelioma include:
- Baylor Lung Institute in Houston, TX
- Brigham and Women’s Hospital in Boston, MA
- Cleveland Clinic Mesothelioma Treatment Center in Cleveland, OH
- H. Lee Moffitt Cancer Center in Tampa, FL
Get Help Finding Mesothelioma Treatment Today
Getting proper mesothelioma treatment can help to relieve symptoms, kill cancer cells, and improve your life expectancy. There are plenty of mesothelioma treatment options available to help you fight this asbestos-related disease.
Contact us for help finding a mesothelioma specialist or distinguished mesothelioma cancer center near you.
Mesothelioma Treatment FAQs
What is the best treatment for mesothelioma?
The best way to treat mesothelioma from asbestos exposure will depend primarily on the type and stage of your cancer. Your mesothelioma doctor and health care team will work with you to determine the best course of treatment based on risks, side effects, and potential benefits of certain types of treatment.
Working with a mesothelioma specialist may help give you peace of mind knowing you are receiving the most effective treatment possible.
What are the side effects of mesothelioma treatment?
Mesothelioma treatments may come with long recovery times and uncomfortable side effects.
You will have to stay in the hospital for around a week after mesothelioma surgery. You will also have months of recovery at home and may be unable to do everyday tasks such as work, cleaning, and exercise.
Chemotherapy and radiation also come with potential side effects including nausea, vomiting, and fatigue. While the side effects of chemotherapy are generally more severe, your doctor will provide you with detailed information about what to expect after your chosen treatment(s).
Are there any new treatments for mesothelioma?
The latest developments in mesothelioma treatment often come from clinical trials at top cancer centers. During mesothelioma clinical trials, doctors test new therapies with the hopes of curing the cancer.
Examples of emerging treatments for mesothelioma include photodynamic therapy, which uses high-intensity light to destroy cancer cells, and epigenetic therapy, which alters the expression of genes in histones to eliminate cancer cells.
How much does mesothelioma treatment cost?
The total estimated cost of mesothelioma treatment is around $402,000. This figure does not account for other related costs such as lost wages, at-home care, travel, and lodging.
Financial assistance such as private or government health insurance, VA benefits, and other mesothelioma compensation routes may help lower costs.
Visit our financial support page to learn more about taking action and pursuing financial assistance.
