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 Missouri and Illinois institutions, including Siteman Cancer Center (Washington University/Barnes-Jewish) and University of Illinois Cancer Center. 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.