Treatments for pleural mesothelioma

Treatment options for pleural mesothelioma are based on whether the cancer can be removed with surgery (is resectable) or can’t be removed with surgery (is unresectable). Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

People with the sarcomatoid subtype of pleural mesothelioma are not usually offered surgery. This is because it is an aggressive tumour that comes back (recurs) quickly after treatment.

The following are treatment options for the different stages of pleural mesothelioma.

Resectable pleural mesothelioma

Resectable pleural mesothelioma includes most stage 1 tumours and may include some stage 2 and 3 tumours.

Radiation therapy

External beam radiation therapy is now given before surgery for resectable pleural mesothelioma, as studies have shown that this significantly improves survival.

External beam radiation therapy may be given after an extrapleural pneumonectomy for resectable pleural mesothelioma, if it wasn’t done before surgery.

Radiation is directed to the side of the chest where the mesothelioma has been found.

Radiation therapy is usually not given after a pleurectomy and decortication because of the risk it could damage the lung.

Surgery

Surgery is more helpful when all or most of the cancer can be removed. You must be healthy enough to have surgery and recover from it.

The types of surgery offered are:

  • extrapleural pneumonectomy
  • pleurectomy and decortication

Chemotherapy

Chemotherapy is offered after surgery for resectable pleural mesothelioma.

The most common chemotherapy drug combinations used to treat pleural mesothelioma are:

  • cisplatin and pemetrexed (Alimta)
  • cisplatin and raltitrexed (Tomudex)
  • pemetrexed and carboplatin (Paraplatin, Paraplatin AQ) – may be offered to people who have other health problems and can’t be given cisplatin

Unresectable pleural mesothelioma

Unresectable pleural mesothelioma includes stage 4 tumours as well as some stage 2 and stage 3 tumours. The cancer has spread too far for surgery to remove it completely.

The same treatments used for unresectable disease may also be offered to people who are not well enough to have surgery to remove the mesothelioma and to others who may choose not to have surgery.

Palliative surgeries

Palliative surgeries relieve symptoms, such as pain or difficulty breathing, but they do not treat the cancer itself. The palliative surgeries that may be offered for unresectable pleural mesothelioma include:

  • debulking surgery
  • thoracentesis
  • pleurodesis

Chemotherapy

The most common chemotherapy drug combinations used to treat pleural mesothelioma are:

  • cisplatin and pemetrexed (Alimta)
  • cisplatin and raltitrexed (Tomudex)
  • pemetrexed and carboplatin (Paraplatin, Paraplatin AQ) – may be offered to people who have other health problems and can’t be given cisplatin
  • cisplatin and gemcitabine (Gemzar)

Chemotherapy drugs that are used alone to treat mesothelioma are:

  • pemetrexed
  • gemcitabine
  • vinorelbine (Navelbine)

Radiation therapy

External beam radiation therapy is given to relieve pain or control the symptoms of unresectable pleural mesothelioma.

Recurrent pleural mesothelioma

Recurrent pleural mesothelioma means that the cancer has come back after it has been treated. There are no standard treatments for recurrent pleural mesothelioma. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Treatment decisions are based on:

  • where the cancer has come back
  • what treatments have already been given
  • your overall health

Treatment options may include palliative surgery, chemotherapy or radiation therapy.

If you can’t have or don’t want cancer treatment

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Clinical trials

There may be a clinical trial in Canada open to people with pleural mesothelioma. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

Expert review and references

  • American Cancer Society. Malignant mesothelioma. 2016.
  • Cancer Care Ontario. Evidence-Based Series 7-14-1: The Use of Chemotherapy in Patients with Advanced Malignant Pleural Mesothelioma. Version 2 ed. 2012.
  • Cancer Care Ontario. Evidence-Based Series 7-14-2:Surgical Management of Malignant Pleural Mesothelioma. Version 2 ed. 2012.
  • Cho BC, Feld R, Leighl O, Anraku M, Tsao MS, Hwang DM, Hope A, de Perrot M . A feasibility study evaluating Surgery for Mesothelioma After Radiation Therapy: the "SMART" approach for resectable malignant pleural mesothelioma. Journal of Thoracic Oncology. 2014: http://www.jto.org/article/S1556-0864(15)30223-9/pdf.
  • de Perrot M, Feld R, Leighl NB, Hope A, Waddell TK, Keshavjee S, Cho BC . Accelerated hemithoracic radiation followed by extrapleural pneumonectomy for malignant pleural mesothelioma. Journal of Thoracic Cardiovascular Surgery. 2016.
  • Kondola S, Manners D, Nowak AK . Malignant pleural mesothelioma: an update on diagnosis and treatment options. Therapeutic Advances in Respiratory Disease. 2016.
  • National Cancer Institute. Malignant Mesothelioma Treatment for Health Professionals (PDQ®). 2015.
  • National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Malignant Pleural Mesothelioma (Version 1.2016).
  • Opitz I . Management of malignant pleural mesothelioma - the European experience. Journal of Thoracic Disease. 2014.
  • Pass HI, Carbone M, King LM, Rosenzweig KE . Benign and malignant mesothelioma. DeVita VT Jr, Lawrence TS, & Rosenberg SA. Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015: 114: 1738-1760.
  • Shukla A, Shukla A . Current therapies for malignant mesothelioma. Journal of Cancer Science and Therapy. 2014.
  • Stahel RA, Weder W, Lievens Y, Felip E . Malignant pleural mesothelioma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2010.