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Mesothelioma Chemotherapy

Chemotherapy is a common treatment for mesothelioma that uses powerful drugs to destroy cancer cells. Mesothelioma chemotherapy may be used on its own or combined with surgery, radiation, immunotherapy, and palliative (symptom-relieving) care. The Mesothelioma Hope team can help you find a doctor who specializes in chemotherapy and answer any questions you have about treatment.

Medically reviewed by: Mark Levin, MD

Last updated:

What Is Chemotherapy for Mesothelioma Cancer?

ChemotherapyChemotherapy (or chemo) is the most common treatment for mesothelioma, a rare cancer caused by exposure to asbestos.

Chemotherapy is medication that targets and kills mesothelioma cells. It is used both to help eliminate the cancer altogether and alleviate painful symptoms from mesothelioma tumors.

Key Facts on Mesothelioma and Chemotherapy

  • What it is: A common mesothelioma treatment that uses cancer-fighting drugs to shut down cell growth
  • When it’s used: To treat pleural or peritoneal mesothelioma patients, either as a standalone treatment or in combination with surgery or radiation
  • How it’s delivered: Chemotherapy may be administered intravenously (through a vein), in pill form, or directly into the abdominal or chest cavity during surgery
  • Drug types: Some of the most commonly used chemo drugs for mesothelioma are cisplatin, pemetrexed, and gemcitabine
  • Common side effects: Constipation and diarrhea, fatigue, hair loss, loss of appetite, mouth sores, nausea, neuropathy (pain or numbness in the hands and feet), and weight changes

If you or your loved one have been diagnosed with mesothelioma, we can help connect you with doctors who specialize in chemotherapy and other treatments for mesothelioma.

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How Chemotherapy for Mesothelioma Works

During chemotherapy, patients receive powerful drugs that destroy cancer cells. Depending on the type of chemotherapy, these drugs may be given as a pill, through the patient’s vein, or during surgery directly into the patient’s body through the chest or abdominal cavity.

Mesothelioma chemotherapy may be administered in two main ways:

  1. Intraoperative chemotherapy: In this case, chemotherapy is administered after performing surgery while the incision site is still open. The drug is heated and released directly into the chest or abdominal cavity after the surgeon has removed all visible cancer. The chemotherapy kills any remaining microscopic cancer cells the surgeon can’t see.
  2. Systemic chemotherapy: In this procedure, chemotherapy drugs are most commonly given to the patient through a port or needle into a vein. The drugs then enter the bloodstream, destroying cancer cells wherever they are in the body.

Chemotherapy can take a physical toll on the body, leading to side effects in many patients. And while it doesn’t work as expected every time, many mesothelioma patients have beaten the odds and lived longer with the help of mesothelioma chemotherapy.

How Effective Is Chemotherapy for Malignant Mesothelioma?
  • Administering two or more chemotherapy drugs rather than just one often results in higher survival rates.
  • Chemotherapy after mesothelioma surgery can improve survival rates.
  • Researchers are studying the effects of combining cutting-edge cancer treatments like cancer vaccines and immunotherapy drugs with chemotherapy for mesothelioma.

Multimodal Treatment and Chemotherapy

A multimodal treatment plan involves using more than one form of mesothelioma treatment (such as surgery, chemotherapy, and radiation) in order to increase a patient’s chances of long-term survival.

The best chemotherapy results are seen when chemotherapy is combined with mesothelioma surgery. Some patients have experienced long periods of remission following this treatment.

In some patients, a multimodal treatment approach involving chemotherapy, surgery, and radiation therapy has increased survival to over 5 years.

Mesothelioma chemotherapy may be used at different times in conjunction with surgery:

  • Neoadjuvant therapy: Chemotherapy may be used before surgery to shrink the cancer and make it easier to remove.
  • Intraoperative chemotherapy: Chemotherapy drugs are delivered directly to the tumor’s location during surgery, after oncology (cancer) doctors remove as much cancer as possible.
  • Adjuvant therapy: Chemotherapy may be used after surgery to prevent cancer from growing back.

Combining chemotherapy and radiation therapy may also be useful for controlling cancer when surgery is not a viable option.

Chemotherapy for mesothelioma Video Thumbnail

Registered Nurse Amy Fair discusses what to expect when getting mesothelioma chemotherapy and its side effects. View Transcript.

Duration: 1 min 11 sec

What do I need to know about radiation and chemotherapy?

If radiation chemotherapy is the treatment choice your oncologist will talk with you about the side effects of radiation and the side effects of chemotherapy. They will talk with you about the different blood tests that need to be done. They usually check your B9 and your B12. They will check your platelet counts, blood counts that tend to fall during treatment such as chemotherapy.

The role of chemotherapy is to prevent those cancer cells from replicating. It not only kills the bad cells but it kills the good cells too. You’ll see nausea and some hair loss. So with the toxicity of chemotherapy do come some side effects. There are many medications out there now that control nausea. There are many medications out there that can help stimulate your appetite during chemotherapy. It’s important to keep a good relationship with your oncologist and be knowledgeable going into the therapy about the possible side effects.

Benefits of Mesothelioma Chemotherapy

Chemotherapy may be beneficial for all types and stages of mesothelioma, but specific treatment goals vary depending on the type, location, and stage of the cancer.

Oncologists use chemotherapy for mesothelioma to:

  1. Kill remaining cancer cells left over after surgery
  2. Prevent recurrence (when the mesothelioma comes back) by administering chemotherapy directly into the body
  3. Reduce painful symptoms by destroying cancer cells, which may shrink tumors
  4. Shrink tumors and eliminate mesothelioma cells before surgery to help make the procedure more successful

Mesothelioma specialists continue studying different chemotherapy techniques to get the best results for patients seeking curative (life-extending) and palliative (symptom-relieving) treatments.

If you are receiving treatment for mesothelioma or getting ready to start your treatment journey, our checklist of 14 Questions to Ask Your Doctor can help you get the information you need about clinical trials, second opinions, and more.

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Mesothelioma Chemotherapy Success Rate

The success rate of chemotherapy for mesothelioma cancer depends on many factors, and every patient’s experience will be different. It’s important to recognize this if you or your loved one are going through or preparing to start chemotherapy treatment.

According to a 2022 review of the National Cancer Database, patients who receive chemotherapy as a standalone treatment (administered without surgery) have a median survival of 14 months. Those whose mesothelioma is caught in the earlier stages may have better outcomes if they get chemotherapy alongside other treatments.

The median 1-year survival rate for pleural mesothelioma patients treated with chemotherapy alone is 58%, according to results from the CheckMate 743 clinical trial, but many patients go on to live for many years with the right medical care.

For patients with late-stage mesothelioma that cannot be removed through surgery, chemotherapy may also help slow cancer growth and ease symptoms.

Regardless of the statistics, there is always hope that chemotherapy can allow patients to become long-term survivors.

Mesothelioma Chemotherapy Side Effects

Mesothelioma chemotherapy drugs can be an effective way to treat cancer because they attack fast-growing cells. However, these drugs may also target healthy cells, which can cause side effects.

Common chemotherapy side effects include:

  • Constipation and diarrhea
  • Fatigue
  • Hair loss
  • Loss of appetite
  • Low blood cell counts (both red blood cells and white blood cells)
  • Mouth sores
  • Nausea
  • Weakened immune system
  • Weight changes

Mesothelioma chemotherapy drugs affect different patients in different ways. Not everyone will experience the same side effects. Some patients may experience severe side effects and will need to stop treatment or change chemotherapy medications.

Managing Mesothelioma Chemotherapy Side Effects

If you or your loved one is experiencing treatment-related side effects, be sure to share this with your doctor or health care team. They can help recommend medications or other ways to relieve the uncomfortable side effects of chemotherapy.

Management for chemotherapy side effects may include:

Some doctors prescribe folic acid and vitamin B12 supplements to help curb the common side effects of chemotherapy. However, some vitamins can make mesothelioma chemotherapy less effective. If you’re planning to change your medication, vitamin, or supplement routine, make sure to let your doctor know.

For more information on managing chemotherapy and other treatments, get our Free Mesothelioma Guide shipped to you overnight.

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Mesothelioma Chemotherapy Process

If you or your loved one is preparing to start a mesothelioma chemotherapy regimen, it can be helpful to know what may be ahead. Each patient’s experience will be different, and your health care team will be able to give you specifics for your situation.

Many patients will undergo systemic chemotherapy, during which the chemotherapy drugs are administered throughout the patient’s body to kill as many cancer cells as possible. A systemic mesothelioma chemotherapy regimen involves a series of treatment cycles over a set period.

Patients may receive a single or combination of drugs during each treatment. Your mesothelioma chemotherapy protocol will outline chemotherapy drugs, dosages, and administration methods.

Chemotherapy for mesothelioma generally involves the following steps:

  1. Chemotherapy is often given as an infusion into a vein through a needle inserted into the skin. The drugs can also be given by inserting a tube into a device in a vein in your chest.
  2. Doctors administer mesothelioma chemotherapy in 3-4 week cycles, each with a rest period in between. This gives healthy cells time to recover between the treatments.
  3. A single chemotherapy session might last anywhere from a few minutes to hours, depending on the specific treatment prescribed by your doctor.
  4. Most patients receive 2-4 cycles of chemotherapy treatment, depending on the state of the disease and the response to the drugs. Effectiveness should be reassessed during follow-up after the first two cycles.

If mesothelioma chemotherapy is proving effective, the treatment might continue longer.

If you have questions about preparing for chemotherapy, our team of Patient Advocates are standing by to assist you. Call (866) 608-8933 any time for free guidance on what to expect.

How to Prepare for Chemotherapy

Chemotherapy uses powerful drugs that can impact your overall health and comfort. Knowing the side effects you may face, it’s important to prepare yourself or your loved one for a chemotherapy regimen.

To prepare for mesothelioma chemotherapy, patients may need to:

  1. Get a chemotherapy access point: Patients receiving intravenous chemotherapy may visit the cancer center to have a port, catheter, or pump surgically implanted to deliver the chemotherapy medication.
  2. Complete preliminary testing: Patients take blood tests to ensure they are strong enough to receive chemotherapy drugs. Other tests might be conducted on the liver, kidneys, and heart to ensure they’re all functioning properly.
  3. Visit the dentist: Patients may need to see a dentist to make sure there are no infections in the mouth. It is harder for the body to fight off infection during chemotherapy.
  4. Plan for side effects: Patients concerned about fertility issues should preserve eggs or sperm for future use. They may wish to purchase a wig or head covering for hair loss and ask their doctor about anti-nausea and vomiting drugs.
  5. Arrange for extra help: People undergoing chemotherapy often continue to work and perform activities. Patients should ask their doctor what to expect. Patients may need to arrange for extra help at home in case side effects prevent them from carrying out normal activities.
  6. Prepare for the first treatment: Patients should prepare for their first treatment by arriving well-rested. They may wish to eat a light meal beforehand if the chemotherapy might make them nauseous. While most people drive themselves to treatment, someone else should drive at least for the first appointment until the patient and their doctor see how they react to the drugs.

Survivors’ Experiences With Mesothelioma and Chemotherapy

Many people diagnosed with mesothelioma have gone on to live full lives thanks to treatments like chemotherapy. Below is a snapshot of some of the stories of long-term mesothelioma survivors and their experiences with chemo.

pleural mesothelioma survivor John Stahl with his wife

John Stahl

  • Diagnosis: Stage 4 pleural mesothelioma
  • Session frequency: Hourlong sessions every two weeks
  • Side effects: Fatigue

John was diagnosed with the most aggressive and widespread stage of mesothelioma in 2019. Four years later after several rounds of chemotherapy, he’s not only still alive — but says he’s “doing very well” and is “pretty well back to normal.” Read more about John’s story here.

peritoneal mesothelioma survivor Alexis Kidd with her husband

Alexis Kidd

  • Diagnosis: Peritoneal mesothelioma
  • Type of chemo: Hyperthermic intraperitoneal chemotherapy (HIPEC)
  • Side effects: Nausea, pain

Alexis received chemotherapy after surgery to remove her mesothelioma tumors. The treatment combination worked — she has outlived her prognosis by over 16 years. Read more about Alexis’s story here.

Chemotherapy Drug Types for Mesothelioma

Mesothelioma chemotherapy drugs are highly concentrated, and when injected into the bloodstream, they circulate throughout the body and destroy cancer cells in their path.

Mesothelioma researchers have found that combining two drugs is more effective than using a single drug. Doctors can prescribe certain drugs — or combinations — based on the desired treatment outcomes and how the drugs support one another.

Below are the most commonly used mesothelioma chemotherapy drugs.

Cisplatin and Pemetrexed

The combination of cisplatin and pemetrexed (Alimta®) has been the standard therapy for mesothelioma patients for over 15 years.

These are typically the first drugs that mesothelioma patients receive. When patients cannot tolerate cisplatin, it can be replaced with carboplatin — a similar chemotherapy drug that is sometimes easier on patients’ bodies.

Cisplatin and pemetrexed can significantly improve mesothelioma survival rates. Mesothelioma patients typically continue receiving this combination of drugs until they stop responding to them or develop too many side effects.


Gemcitabine (Gemzar®) is a chemotherapy drug initially developed for breast and lung cancers. However, it has effectively improved life expectancy in late-stage mesothelioma patients.

If the first-line chemotherapy solution of cisplatin and pemetrexed stops working, gemcitabine can be prescribed as a second-line treatment.

Other Mesothelioma Chemotherapy Drugs

There are several other chemotherapy medications for mesothelioma that doctors can prescribe.

Some additional mesothelioma chemotherapy drugs include:

  • Doxorubicin (Adriamycin®)
  • Mitomycin C
  • Navelbine (vinorelbine)
  • Onconase (ranpirnase)

For help finding a doctor who specializes in mesothelioma chemotherapy, use our Free Doctor Match service. You can find a specialist based in your state and our team can help you get an appointment faster.

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Chemotherapy by Mesothelioma Type

Standard chemotherapy treatment is similar for all types of mesothelioma: pleural, peritoneal, pericardial, and testicular.

However, your treatment regimen may vary slightly based on which type of mesothelioma you have.

Learn more about these different approaches to chemotherapy below.

Pleural Mesothelioma Chemotherapy

Malignant pleural mesothelioma is the most common form of the disease. It is caused by asbestos exposure that affects the pleura (lung lining).

Chemotherapy is commonly used to treat pleural mesothelioma alone or in combination with surgery and/or radiation therapy. Pleural mesothelioma chemotherapy may be palliative or curative.

Doctors have used a combination of the drugs pemetrexed and cisplatin to treat pleural mesothelioma since 2004. This drug combination helps mesothelioma patients by slowing the progression of the disease and improving quality of life.

The ATOMIC-MESO trial is exploring a new chemotherapy drug called pegarginimase (ADI-PEG20) in combination with pemetrexed and cisplatin. In February 2024, results from phase III of the trial showed ADI-PEG20 quadrupled 3-year survival rates, marking it as a potential breakthrough in pleural mesothelioma treatment.

Pleural mesothelioma patients may receive systemic or intraoperative chemotherapy. For patients who undergo surgery, the more localized form of chemotherapy called HITHOC (hyperthermic intrathoracic chemotherapy) has been proven to increase survival.

HITHOC is a procedure where heated chemotherapy drugs are applied directly to the chest cavity after the surgeon removes all visible cancerous tumors and tissue.

The drug kills the remaining microscopic cancer cells, and the heat allows the drug to travel deeper into the tissue and make it more effective. Cisplatin is often used in HITHOC, but doxorubicin and mitomycin C can also be used.

Peritoneal Mesothelioma Chemotherapy

Specialists also use a combination of pemetrexed and cisplatin to treat patients with peritoneal mesothelioma, a cancer that develops in the abdominal lining (peritoneum).

  • Intraoperative chemotherapy: For surgical candidates whose mesothelioma has been diagnosed in the earlier stages, cytoreductive surgery with HIPEC (hyperthermic intraperitoneal chemotherapy) may help improve their life expectancy.
  • Systemic chemotherapy: This is usually the first-line treatment for patients diagnosed in the later stages of peritoneal mesothelioma. For some patients, carboplatin can be substituted for cisplatin if it’s better tolerated.

Like HITHOC, HIPEC is administered locally in the abdominal cavity immediately after surgery to remove visible tumors and cancerous tissue. This heated chemotherapy kills cancer cells left behind that are invisible to the naked eye.

According to one study, the median survival rates for malignant peritoneal mesothelioma patients who received cytoreduction with HIPEC were 81% at 1 year, 60% at 3 years, and 47% at 5 years.

New Chemotherapy Treatments

Mesothelioma specialists and researchers are constantly looking for new types of chemotherapy and for ways to improve existing treatments.

Learn about new and emerging chemotherapy treatments below.

Targeted Chemotherapy

Targeted chemotherapy is already being used to treat many types of cancer, and has recently been receiving attention from top mesothelioma doctors as well.

Targeted chemotherapy is a newer kind of “smart” therapy that focuses on changes in cells that are unique to cancer. In this way, targeted therapy is able to destroy cancer cells without damaging healthy cells.

By sparing healthy cells, targeted therapy can reduce common chemotherapy side effects like hair loss, nausea, diarrhea, and anemia.

Cancer research has discovered gene and protein changes in patients with mesothelioma. Targeted chemo drugs work by directly addressing those changes caused by the disease.

For example, a protein called VEGF (vascular endothelial growth factor) aids cancerous tumors by forming new blood vessels so the tumors can access the nutrients they need to continue growing.

A newer drug called bevacizumab (Avastin®) stops VEGF from working and helps starve the tumor. When given alongside pemetrexed and cisplatin, it has been shown to help people with mesothelioma live longer.

Mesothelioma Chemotherapy Clinical Trials

Specialists often recommend that their patients join mesothelioma clinical trials where new drugs and treatments are constantly being developed and tested to improve patient outcomes.

As of January 2024, there are more than 50 active trials for mesothelioma involving chemotherapy listed on, a clinical trial database.

For example, one clinical trial is testing whether adding an immunotherapy drug called durvalumab (Imfinzi®) will help patients with advanced pleural mesothelioma when added to chemotherapy treatment.

Other researchers are assessing whether the immunotherapy medication nivolumab (Opdivo®) combined with chemotherapy can benefit pleural mesothelioma patients after tumor-removing surgery.

If you’re interested in emerging treatments or clinical trials, talk to your doctor about your options. Get help preparing for your appointment with our Free Questions to Ask Your Doctor checklist.

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  • Preparing for treatment
  • Finding clinical trials
  • Getting a second opinion

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We Can Help You Get Mesothelioma Chemotherapy

Chemotherapy is a common treatment for all types of mesothelioma, and may be worth pursuing if you or your loved one has been diagnosed with this rare cancer.

Whether your doctor has already recommended chemo or you’re still exploring your treatment options, Mesothelioma Hope can make the process of getting the right medical care less overwhelming.

Our in-house nurses and Patient Advocates can answer your questions about chemotherapy, help you find a doctor for treatment, and prepare you for your first appointment.

Call our team at (866) 608-8933 or fill out our contact form to get started.

Mesothelioma Chemotherapy FAQs

Can mesothelioma be treated with chemotherapy?

Yes. Chemotherapy is the most commonly recommended treatment for all types of mesothelioma.

Chemotherapy may be used throughout the patient’s entire body or locally to destroy cancer cells left behind from surgery. Mesothelioma chemotherapy can help treat the cancer or reduce its symptoms.

How many rounds of chemo for mesothelioma is standard?

Typically, mesothelioma patients get systemic chemo in 3-4 week cycles with a rest period in between. A single chemotherapy session might last anywhere from a few minutes to 2 or more hours.

Most patients receive 2-4 cycles of chemotherapy treatment.

A medical oncologist can help you determine the mesothelioma chemotherapy regimen that works best for your specific situation. Call our team at (866) 608-8933 to get help connecting with top oncologists near you.

Does chemotherapy work for mesothelioma?

Yes, chemotherapy can work for mesothelioma.

The American Cancer Society says chemotherapy drugs can shrink or slow tumor growth.

Researchers are also studying new chemotherapy drugs alone and in combination with other mesothelioma treatments to see how they can better help patients.

What is the most common treatment for mesothelioma?

Chemotherapy is the most common systemic (whole-body) treatment for mesothelioma.

It is often recommended as the first line of treatment for pleural and peritoneal mesothelioma patients.

How effective is chemotherapy for mesothelioma?

A clinical trial testing chemotherapy against immunotherapy found that:

  • 58% of pleural mesothelioma patients were alive at 1 year
  • 27% of pleural mesothelioma patients were alive at 2 years

However, keep in mind that these rates are just an average, and your experience may be different.

How much does chemotherapy for mesothelioma cost?

A 2022 report published in Frontiers in Public Health found that the average cost of chemotherapy for mesothelioma is $95,715.26. This number may vary based on your insurance coverage, cancer center, the number of cycles you receive, and other factors.

For help understanding your insurance and other financial options to pay for chemo, call our caring team at (866) 608-8933.

Dr. Mark LevinReviewed by:Mark Levin, MD

Certified Oncologist and Hematologist

  • Fact-Checked
  • Editor

Mark Levin, MD, has over 30 years of experience in academic and community hematology and oncology. In addition to serving as Chief or Director at four different teaching institutions throughout his life, he is still a practicing clinician, has taught and designed formal education programs, and has authored numerous publications in various fields related to hematology and oncology.

Dr. Mark Levin is an independently paid medical reviewer.

  • Board Certified Oncologist
  • 30+ Years Experience
  • Published Medical Author
Jenna TozziWritten by:

Director of Patient Advocacy

Jenna Tozzi, RN, is the Director of Patient Advocacy at Mesothelioma Hope. With more than 15 years of experience as an adult and pediatric oncology nurse navigator, Jenna provides exceptional guidance and support to mesothelioma patients and their loved ones. Jenna has been featured in Oncology Nursing News and is a member of the Academy of Oncology Nurse & Patient Navigators & the American Nurses Association.

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  1. American Cancer Society. “Chemotherapy for Malignant Mesothelioma.” Retrieved from: Accessed on May 15, 2024.
  2. American Cancer Society. “What’s New in Malignant Mesothelioma Research?” Retrieved from: Accessed on May 15, 2024.
  3. American Society of Clinical Oncology. “Mesothelioma: Types of Treatment.” Retrieved from: Accessed on May 15, 2024.
  4. Bou-Samra, P., et al. (2023). Epidemiological, therapeutic, and survival trends in malignant pleural mesothelioma: A review of the National Cancer Database. Cancer medicine, 12(11), 12208–12220. Retrieved from: Accessed on May 15, 2024.
  5. Cancer Research UK. “Chemotherapy for mesothelioma.” Retrieved from: Accessed on May 15, 2024.
  6. Cancer Research UK. “Chemotherapy for pleural mesothelioma.” Retrieved from: Accessed on May 15, 2024.
  7. Darlison, L., Taylor, B., Harrison, M., Gardiner, C., & Ejegi-Memeh, S. (2021). Understanding the palliative care needs and experiences of people with mesothelioma and their family carers: An integrative systematic review. Retrieved from: Accessed on May 15, 2024.
  8. Enomoto, L., Shen, P., Levine, E., & Votanopoulos, K. (2019) “Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal mesothelioma: patient selection and special considerations.” Cancer Manag Res. 2019 May 7;11:4231-4241. doi: 10.2147/CMAR.S170300. PMID: 31190990; PMCID: PMC6511620. Retrieved from: Accessed on May 15, 2024.
  9. The Guardian. (2024, February 15). Drug offers ‘wonderful’ breakthrough in treatment of asbestos-linked cancer. Retrieved from: Accessed on May 15, 2024.
  10. NYU Langone Health (n.d.). “Chemotherapy for Malignant Mesothelioma.” Retrieved from: Accessed on May 15, 2024.
  11. Queen Mary University of London. (2023, April 16). Clinical trial shows tumour-starving drug improves survival of mesothelioma. Retrieved from: Accessed on May 15, 2024.
  12. Szlosarek, Peter; Creelan, Benjamin; Sarkodie, Thomas. JAMA Oncology. (2024, February 15). Pegargiminase Plus First-Line Chemotherapy in Patients With Nonepithelioid Pleural Mesothelioma. Retrieved from: Accessed on May 15, 2024.
  13. Ye Zhuo-miao, Tang Zi-Qing, Xu Zhe, Zhou Qin, Li Huan (2022). “Cost-effectiveness of nivolumab plus ipilimumab as first-line treatment for American patients with unresectable malignant pleural mesothelioma.” Retrieved from: Accessed on May 15, 2024.


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