Treatment Approach
Treatment for mesothelioma depends on disease stage, cell type (epithelioid, sarcomatoid, biphasic), patient health, and extent of spread. A multidisciplinary team — including thoracic surgeons, oncologists, pulmonologists, and palliative care specialists — guides treatment planning.
Surgery
Extrapleural pneumonectomy (EPP) removes the affected lung, pleura, pericardium, and diaphragm. Reserved for patients with early-stage disease and adequate lung function.
Pleurectomy/decortication (P/D) removes the pleura while preserving the lung. Generally better tolerated with lower mortality than EPP.
Chemotherapy
First-line chemotherapy for pleural mesothelioma is pemetrexed + cisplatin (or carboplatin for patients who cannot tolerate cisplatin). This combination has been the standard of care since 2003.
Immunotherapy
Nivolumab + ipilimumab (Opdivo + Yervoy) received FDA approval in 2020 for first-line treatment of unresectable pleural mesothelioma, showing improved survival over chemotherapy alone in a Phase 3 trial.
Clinical Trials
Several trials are enrolling patients at Minnesota institutions, including the University of Minnesota Masonic Cancer Center and Mayo Clinic in Rochester. ClinicalTrials.gov lists current enrollment. ClinicalTrials.gov lists current enrollment.
Palliative Care
Palliative interventions — including thoracentesis (fluid drainage), pleurodesis, and pain management — significantly improve quality of life at all disease stages and are not mutually exclusive with disease-directed treatment.