Mesothelioma Immunotherapy

Mesothelioma immunotherapy is a treatment that boosts a patient’s immune system in order to better defend against cancerous mesothelioma cells. Immunotherapy for mesothelioma has been proven to be effective in improving prognosis and extending life expectancy. Learn more about mesothelioma immunotherapy.

Fact-Checked and Medically Reviewed By: Dr. Mark Levin

What Is Immunotherapy for Mesothelioma?

Mesothelioma immunotherapy is a type of treatment that uses medications to help the immune system fight this asbestos-caused cancer.

Malignant mesothelioma cells can sometimes hide from the immune system. Mesothelioma immunotherapy treatments work by helping the immune system find cancer cells and destroy them.

Immunotherapy is a newer treatment for mesothelioma. The U.S. Food and Drug Administration (FDA) approved nivolumab (Opdivo®) plus ipilimumab (Yervoy®) as a first-line (initial) mesothelioma treatment in October 2020.

“I think every mesothelioma patient should be able to receive an immunotherapy at some point in their treatment.”

— Dr. Anne Tsao, Mesothelioma Specialist at MD Anderson Cancer Center

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Quick Facts About Mesothelioma Immunotherapy
  • Immunotherapy works by improving how a patient’s immune system fights cancer.
  • currently lists dozens of mesothelioma immunotherapy trials that are available to qualifying mesothelioma patients through clinical trials.
  • In 2018, the Nobel Prize in Physiology or Medicine was awarded to the inventors of immunotherapy for cancer.
  • All mesothelioma cell types (epithelioid, biphasic, and sarcomatoid) may respond to immunotherapy treatments.

How Does Mesothelioma Immunotherapy Work?

The goal of mesothelioma immunotherapy is for the body to better recognize, fight, and destroy cancer cells through various methods.

The goal of many immunotherapies is to target protein receptors on cancer cells and immune cells. The immune system reads antigens (proteins and other substances) on all cells in the body. It can recognize when the cells are healthy or not and produce immune cells to destroy harmful ones.

Mesothelioma cells often escape this immune system response. But, thanks to mesothelioma immunotherapy, the immune system has a better chance of beating the cancer at its own game.

Active vs. Passive Mesothelioma Immunotherapy

There are two main forms of mesothelioma immunotherapy: active and passive. Both have their own benefits and drawbacks.

  • Active immunotherapy: The patient’s own immune system is used to fight the mesothelioma cells. Most treatments covered on this page are active immunotherapies.
  • Passive immunotherapy: Patients receive lab-grown cancer antibodies because their immune system does not generate them on its own.

Each of these two types of immunotherapy has its own benefits and drawbacks. A mesothelioma specialist can tell you if an immunotherapy treatment you’re receiving is active or passive and explain how it will help you.

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Benefits of Immunotherapy for Mesothelioma

Immunotherapy has already helped many cancer patients live longer. Now, the benefits of this innovative mesothelioma treatment are being used to help more patients than ever before.

Here are some of the top benefits of immunotherapy:

  • Mesothelioma immunotherapy may increase the chance of remission (where all visible signs of the cancer disappear). Since the body is recognizing and destroying cancer cells, there is a higher chance the immune system will prevent the cancer from returning after treatment (recurrence).
  • Immunotherapy helps pleural mesothelioma patients that couldn’t get surgery live for four months longer on average compared to those treated with chemotherapy, as noted by the FDA.
  • There are many different immunotherapies being tested in clinical trials, which may give patients more treatment options.

As doctors continue to make immunotherapy advances for mesothelioma treatment, there is hope that more patients may be able to get these treatments and live longer.

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Types of Immunotherapy for Mesothelioma

​​There are several different types of immunotherapy treatments for mesothelioma. Each method targets cancer cells in a different way. It is important to speak with your mesothelioma specialist to learn which type of immunotherapy (if any) is best for you.

Did You Know?

As of 2020, Opdivo and Yervoy are the only immunotherapy drugs for mesothelioma that are FDA-approved. However, you may be able to access other types of immunotherapy through clinical trials.

Learn more about the different types of immunotherapy for malignant mesothelioma below.

Cancer Vaccines

Mesothelioma vaccines work with the immune system to teach the body to destroy cancer cells. These vaccines are usually made by either editing a patient’s immune cells to better respond to cancer cells or by helping their immune cells better identify which cells are cancerous.

Researchers are also working on preventative mesothelioma vaccines. CRS-207 is a listeria-based cancer vaccine that has had some success in clinical trials.

Norwegian biotech firm Targovax has also seen early signs of success in its ONCOS-102 trial. This trial is testing mesothelioma vaccines in combination with standard chemotherapy in several patients. This type of immunotherapy was recently fast-tracked by the FDA for mesothelioma.


Cytokines are proteins that help the body increase the immune response to cancer cells and are sometimes grown in a lab.

Some cytokines help immune system cells grow more quickly, while others help the body resist cancer cell growth.

Immune Checkpoint Inhibitors

Immune system cells called T cells get activated when they detect the cells of diseases through antigens. When this happens, special ‘checkpoint proteins’ on T cells are deactivated. This triggers an immune response, and the T cells destroy the foreign cells.

However, mesothelioma cells prevent these checkpoint proteins from deactivating, so the immune response never happens. Immune checkpoint inhibition corrects this by turning off checkpoint proteins anyway so the cancer can be destroyed. The checkpoints targeted include proteins like CTLA-4, PD-L1, and PD-1.

Some checkpoint inhibitors used to treat mesothelioma include:

  • Atezolizumab (Tecentriq®)
  • Avelomab (Bavencio®)
  • Cemioimab (Libtayo®)
  • Durvalumab (Imfinzi®)
  • Ipilimumab (Yervoy®)
  • Nivolumab (Opdivo®)
  • Pembrolizumab (Keytruda®)

Researchers are studying many of these immunotherapies for use in second-line (follow-up) treatments.

For example, a recent clinical trial published in The Lancet explored how Opdivo could be used as a second-line treatment. In this randomized study, some patients were given Opdivo while others were given a placebo. Those who received Opdivo lived more than 3 months longer.

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Monoclonal Antibodies

Monoclonal antibodies work by targeting a particular site inside of a cancer cell, such as a protein or enzyme. Sometimes antigens on the surface of a mesothelioma cell are also targeted.

Monoclonal antibodies used to treat mesothelioma include tremelimumab and amatuximab.

According to a recent phase II clinical trial, 90% of malignant pleural mesothelioma patients treated with amatuximab plus the chemotherapy drugs pemetrexed and cisplatin showed stable disease (meaning the cancer tumors didn’t grow but also didn’t shrink).

Other Types of Immunotherapy for Mesothelioma

There are several other types of mesothelioma immunotherapies being tested for effectiveness.

Other immunotherapies being studied include:

  • Bacillus Calmette-Guerin: A germ that infects human tissue and activates the immune system. This is usually a liquid treatment for bladder cancer. This is one of the oldest cancer immunotherapies.
  • Imiquimod: A drug typically used for skin cancer. This is usually a cream that promotes a local immune system response where applied.
  • Immunomodulators: Drugs that work with the immune system to increase some types of proteins and decrease others to fight cancer. Types of immunomodulators include lenalidomide, pomalidomide, and thalidomide.

Mesothelioma Immunotherapy in Multimodal Therapy

Doctor consults with a patient about his treatment options

Mesothelioma multimodal therapy is when multiple treatments are combined to help fight this cancer. Mesothelioma specialists will often use immunotherapy alongside other treatments like chemotherapy, virotherapy, and surgery.

Learn more about immunotherapy multimodal treatment combinations below.

Chemotherapy and Immunotherapy

Chemotherapy has been one of the backbones of mesothelioma treatment for decades. These cancer-killing medications can help break up solid tumors growing in a patient’s body.

Many cancer research studies now suggest that combining chemotherapy and immunotherapy may help patients.

One such study from the medical journal Clinical Cancer Research noted that patients treated with a combination of gemcitabine (a chemotherapy drug) and immunotherapy lived longer than those treated with just immunotherapy.

“The immunotherapies take longer to work than chemo. For many of our mesothelioma patients, where we need to bulk reduce their cancer quickly for symptoms, or because it may be in a location where it could potentially be life-threatening where we don’t act, doing chemotherapy with immunotherapy may give us a faster response.”

— Dr. Anne Tsao, Mesothelioma Specialist at MD Anderson Cancer Center

Another trial, the phase III DREAM3R study, is currently accepting patients with advanced pleural mesothelioma to undergo a treatment of durvalumab and chemotherapy.

Surgery and Immunotherapy

Immunotherapy can be used as an additional therapy after a patient has undergone mesothelioma surgery.

Did You Know?

Mesothelioma immunotherapy after surgery reduces the risk of recurrence by enabling the body to recognize and fight off cancer cells that are trying grow back.

A 2022 Baylor College of Medicine study found that treating pleural mesothelioma patients with immunotherapy ahead of surgery — specifically durvalumab plus tremelimumab — resulted in favorable clinical outcomes, including “a provocative signal in increased overall survival.”

Virotherapy and Immunotherapy

In mesothelioma virotherapy, viruses are altered to duplicate themselves better inside tumor cells than in healthy cells. Then, immunotherapy can be used to go where the virus is and target cancer cells.

Find out how immunotherapy and other mesothelioma treatments can help you.

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Arthur Putt

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Still Thriving: 5+ year survivor

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Still Thriving: 17+ year survivor

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Still Thriving: 3+ year survivor

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Immunotherapy and Mesothelioma Prognosis

Cancer immunotherapy may improve a mesothelioma prognosis, which is the general course doctors expect a patient’s cancer to take. Mesothelioma often has a positive response to immunotherapy.

According to the FDA, patients with unresectable (unable to be removed by surgery) malignant pleural mesothelioma who received Opdivo and Yervoy over a two-year period had a median survival time of over 18 months, while patients who were treated with only chemotherapy lived for roughly 14 months.

Further, a July 2021 clinical trial tested atezolizumab (Tecentriq®) plus bevacizumab (Avastin®) in peritoneal mesothelioma patients. The 1-year survival rate in this study was 85%, and 61% of patients didn’t see their cancer spread in this trial.

More immunotherapy treatments may become available as oncology research and clinical trials move forward.

Clinical Trials for Mesothelioma Video Thumbnail

Amy Fair, a nurse with over 20 years of mesothelioma experience, explains what clinical trials are, the types, and how to find them. View Transcript.

Duration: 1 min 31 sec

Besides the standard treatment right now of radiation, surgery, and chemotherapy there are ongoing clinical trials at some facilities that some patients may fit.

Clinical trials are the development of new and novel therapies.

You have to be a candidate and meet certain criterial for clinical trials. Some trials evolve around a certain type of mesothelioma. Some evolve around a certain age group.

There are exciting clinical trials out there now that involved immunotherapy, where they are strengthening and enhancing someone’s immune system to fight the disease. There are target and gene therapies currently in clinical trials that target someone’s DNA make up and molecular studies. These are still currently in several phases of clinical trials.

If you are interested in a clinical trial or your oncologist thinks you’re a candidate for a clinical trial the best way to learn is to start with your oncologist. They should be very knowledgeable about the clinical trials in your area. The National Institute of Health, on their website, has a tremendous amount of knowledge about clinical trials, the different phases that they are in and where these facilities are at that are involved in these clinical trials.

Side Effects of Immunotherapy For Mesothelioma

There are several side effects of immunotherapy for mesothelioma, but most are considered more mild compared to other forms of treatment. The side effects may be different for each person and depend on the specific type of immunotherapy being given.

Mesothelioma immunotherapy side effects can include:

  • Changes in blood pressure
  • Flu-like symptoms such as fever, chills, nausea, and congestion
  • Heart palpitations
  • Inflammation of pleural, peritoneal, or pericardial surfaces or inflammation in other organs due to immune response
  • Pain, itching, burning, or inflammation near the injection site
  • Trouble breathing, tiredness, dizziness, or muscle pains
  • Weight gain due to extra fluid in the body
  • Other health complications

Since some of these treatments are new and you may encounter them while participating in a clinical trial, all side effects will be monitored closely.

Your doctor can tell you which treatment options will best suit you based on possible side effects.

How Much Does Immunotherapy for Mesothelioma Cost?

Mesothelioma immunotherapy costs can vary. According to a 2022 report from the medical journal Frontiers in Oncology, Opdivo plus Yervoy can cost over $292,000 each year.

The news agency Reuters noted that other immune checkpoint inhibitors run around $150,000 per year.

It is important to consult with your doctor to determine your options for mesothelioma immunotherapy and see if your health insurance will cover the cost of care. For example, veterans that get VA health care benefits may be able to access mesothelioma immunotherapy for free or at a reduced cost.

If you’re worried about paying for mesothelioma immunotherapy, we can help. You may be eligible for financial compensation. Call (866) 608-8933 right now to learn if you qualify.

Find Immunotherapy for Mesothelioma Today

Immunotherapies continue to evolve as researchers look for new ways to improve this treatment of mesothelioma.

With the FDA’s approval of Opdivo and Yervoy, more patients may be able to improve their mesothelioma life expectancy. Other immunotherapy options for mesothelioma continue to be studied.

Patients who are looking to use immunotherapy to help treat their cancer should speak with a mesothelioma doctor.

Use our Mesothelioma Doctor Match to connect with a doctor near you today.

FAQs About Mesothelioma Immunotherapy

How effective is immunotherapy for mesothelioma?

Mesothelioma immunotherapy success rates are higher than some other treatments. The median overall survival for patients with sarcomatoid or biphasic mesothelioma treated with immunotherapy was 18.1 months in a 2020 study.

Patients with the same cell types treated with chemotherapy only lived for 8.8 months.

Many types of mesothelioma immunotherapy are still being tested in clinical trials.

How does mesothelioma immunotherapy work?

Your specialist will look for several signs that indicate the body is responding positively to immunotherapy for mesothelioma. It is important to note that this treatment works slower than chemotherapy.

According to Moffitt Cancer Center, doctors will know that the treatment is working if the size of your tumors shrinks or stays the same. Your doctor may conduct laboratory and imaging tests to check on the progress and response rate of the tumor during treatment.

What are the pros and cons of immunotherapy for mesothelioma?

Immunotherapy can be very helpful in improving survival time and quality of life, whether used alone or in combination with other treatments.

However, immunotherapy does have some drawbacks. Patients can experience side effects such as inflammation, flu-like symptoms, and blood pressure changes. Immunotherapy also kills both cancer cells and healthy cells and can be very expensive without insurance or financial aid.

How do you know if immunotherapy is working?

It depends on the circumstances of your case. Immunotherapy patients can sometimes live longer than patients treated with chemotherapy. In a 2020 study, 41% of patients treated with Opdivo and Yervoy were still alive after two years, compared to 27% of patients treated with chemotherapy.

However, only some types of immunotherapy for pleural mesothelioma have been approved by the FDA. This means immunotherapy for peritoneal mesothelioma and other types of this cancer can only be accessed through clinical trials.

Chemotherapy treatments are also significantly cheaper. Before insurance, immunotherapy costs roughly $200,000 or more as of 2022. Thankfully, there is financial support available to help patients cover their treatment expenses.

Reviewed by:Dr. Mark Levin

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 also 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
Written by:

Lead Editor

Laura Wright is a journalist and content strategist with more than 15 years of professional experience. She attended college at the University of Florida, graduating magna cum laude with a bachelor’s degree in journalism in 2008. Her writing has been featured in The Gainesville Sun and other regional publications throughout Florida.

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