Treatments for pleural mesothelioma

The most important factor that your healthcare team will consider when planning treatment for pleural mesothelioma is if the cancer is resectable or unresectable. Resectable means that most or all of it can be removed with surgery. Unresectable means that it can’t be removed with surgery. Whether the cancer is resectable or unresectable usually depends on the stage of pleural mesothelioma. Your healthcare team will also consider your needs and work with you to develop a treatment plan.

The following are treatment options for resectable and unresectable pleural mesothelioma, as well as for recurrent pleural mesothelioma (which means it has come back after treatment).

Resectable pleural mesothelioma means that most or all of the cancer that the healthcare team can see can be removed with surgery. Most stage 1 tumours are resectable. Some stage 2 and 3 tumours can be removed with surgery.

Before you are offered surgery to treat pleural mesothelioma, your healthcare team will do different tests to make sure you are healthy enough to have and recover from surgery.

The types of surgery used will depend on where pleural mesothelioma started and if it has spread.

Pleurectomy and decortication removes the pleura but not the lung on the side of the chest where the mesothelioma started.

Extrapleural pneumonectomy removes the pleura, the lung on the side of the chest where the cancer is, part of the diaphragm and lymph nodes in the chest. The membrane surrounding the heart (called the pericardium) may also be removed.

Find out more about surgery for mesothelioma.

Chemotherapy uses drugs to destroy cancer cells. It is offered after surgery for resectable pleural mesothelioma.

The most common chemotherapy drug combinations used are:

• cisplatin and pemetrexed
• cisplatin and raltitrexed
• pemetrexed and carboplatin

Find out more about chemotherapy for mesothelioma.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. It isn’t used very often to treat pleural mesothelioma because there is usually more than 1 tumour and there is a risk that radiation could damage healthy cells and nearby organs in the area. But radiation therapy may be used to relieve pain or control symptoms (called palliative radiation therapy).

If radiation therapy is offered for pleural mesothelioma, intensity-modulated radiation therapy (IMRT) is directed to the side of the chest where the cancer developed.

Find out more about radiation therapy for mesothelioma.

Unresectable pleural mesothelioma means that the cancer has spread too far to be completely removed with surgery. Stage 4 tumours are unresectable. Some stage 2 and stage 3 tumours are also unresectable. The sarcomatoid subtype of pleural mesothelioma is also considered unresectable. This is because it grows quickly and often comes back (recurs) after it is removed. So surgery isn’t a very effective treatment for this subtype.

The same treatments used for unresectable disease may be offered to people who aren’t well enough to have surgery or who choose not to have surgery.

Palliative surgery is used to relieve symptoms rather than to treat the cancer itself. The palliative surgeries that may be offered for unresectable pleural mesothelioma include:

• thoracentesis to drain fluid from around the lungs
• pleurodesis to stop fluid from building up around the lungs again after it has been drained
• image-guided thermal ablation to relieve pain caused by the cancer

Find out more about surgery for mesothelioma.

The chemotherapy drugs that can be used alone to treat unresectable pleural mesothelioma are:

• pemetrexed
• gemcitabine
• vinorelbine

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

• cisplatin and pemetrexed
• cisplatin and raltitrexed
• pemetrexed and carboplatin
• cisplatin and gemcitabine

Find out more about chemotherapy for mesothelioma.

Immunotherapy helps to strengthen or restore the immune system’s ability to fight cancer. Immunotherapy is a standard treatment for unresectable pleural mesothelioma.

The most common immunotherapy drug combination given is nivolumab (Opdivo) and ipilimumab (Yervoy).

The immunotherapy drug pembrolizumab (Keytruda) may be used with the chemotherapy drugs cisplatin and pemetrexed.

Find out more about immunotherapy for mesothelioma.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. External radiation therapy can be used to relieve pain or control the symptoms of unresectable pleural mesothelioma (called palliative radiation therapy).

Find out more about radiation therapy for mesothelioma.

Recurrent pleural mesothelioma means that the cancer has come back after it has been treated.

Currently, there are no standard treatments for recurrent pleural mesothelioma. Your healthcare team will suggest treatments and work with you to develop a treatment plan based on:

• where the cancer has come back
• what treatments you've already had
• your overall health
• your needs and what is important to you

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

Talk to your doctor about clinical trials open to people with pleural mesothelioma. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

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.