Mesothelioma Multimodal Therapy

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Dr. David Sugarbaker: The Importance of Multimodal Therapy for Mesothelioma Treatment

What Is Multimodal Therapy for Mesothelioma?

Multimodal therapy for mesothelioma combines different treatments to attack the cancer from multiple angles. “Bimodal therapy” combines 2 therapies. “Trimodal therapy” combines 3 therapies. Each therapy does something different and works together to target different aspects of the disease. 

The best multimodal treatment plans can extend patient survival for 2 to 5 years or more. Some long-term survivors have lived 10+ years from the time of their diagnosis. 

Key Facts About Mesothelioma Multimodal Therapy

1. A multimodal approach is best for people with pleural mesothelioma in stages 1 to 3. 
2. It’s also best for people with no coexisting diseases to help prevent complications.
3. The median survival is 18–24 months with multimodal vs. 12 months with single therapy. 
4. Potential long-term survivors of more than 5 years can occur in some cases.

Your multimodal team will include different types of mesothelioma doctors and care experts who work together. This may include a surgeon, cancer doctor (oncologist), radiation doctor, nurses and a licensed dietitian. A multimodal approach for mesothelioma usually focuses on tumor-removing surgery with chemo and radiation therapy given before, after or during surgery. 

How Multimodal Therapy Treats Mesothelioma

A multimodal approach harnesses the power of multiple mesothelioma treatments. Each adds a key strength, creating a more complete and effective way to fight disease. Combining mesothelioma drugs, procedures, physical therapy and localized therapy can better control tumor growth, stop cancer from coming back, extend survival and offer greater quality of life.  

Your doctor will recommend the exact combination best for you. Which therapies are chosen depends on which type of mesothelioma you have and your overall health.

Mesothelioma Multimodal Treatments

• Chemo: Powerful drugs like Alimta (pemetrexed) and cisplatin kill fast-growing cancer cells. This treatment is often used before or after surgery.
• Heated intraperitoneal chemo: The heated chemotherapy solution in HIPEC washes the belly during surgery for peritoneal mesothelioma.
• Immunotherapy: Drugs like Keytruda (pembrolizumab) help the immune system recognize and attack cancer cells, especially in later stages of cancer.
• Radiation therapy: High-energy beams target tumors to reduce pain and prevent regrowth after surgery.
• Surgery: Lung-saving procedures (like pleurectomy/decortication or P/D) and lung-removing procedures (like extrapleural pneumonectomy or EPP) aim to remove visible tumors. 
• Targeted therapy: These drugs target specific proteins, genetic mutations or even processes to stop or kill cancer cells.
• Tumor treating fields: TTFields is a wearable device that sends electrical pulse waves to interrupt cancer cell division. This treatment is often used with chemo for pleural mesothelioma.

For pleural patients a multimodal treatment with immunotherapy, chemo, surgery and radiation is most common. For peritoneal patients, a bimodal approach using tumor-removing (cytoreductive) surgery and HIPEC has shown 5+ year survival in many people. In advanced cases, immunotherapy with chemo or TTF added may help control cancer cell growth and symptoms.

Multimodal therapy continues to be used more often. Research in 2024 and 2025 shows improved survival with multimodal therapy for mesothelioma. While not an immediate cure, these combination treatments offer hope of extended survival. 

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Multimodal Therapy Breakthroughs for Mesothelioma

Cutting-edge approaches are improving outlooks for people with mesothelioma. Once new therapy combinations like immunotherapy with chemo or TTFields and chemo were significant breakthroughs and are now FDA-approved. Clinical trials are ongoing for emerging treatment combinations. 

Emerging Mesothelioma Multimodal Therapies

• Imfinzi with chemo: A clinical trial is now underway to study this combination for pleural mesothelioma. Imfinzi (durvalumab) is a monoclonal antibody FDA-approved for lung, bile duct, and bladder cancers. Other studies have shown promise for mesothelioma.
• Keytruda with chemo and surgery: Currently recruiting participants, a new study is looking at Keytruda paired with chemo and image-guided surgery. Keytruda and chemo show promise when used before and after mesothelioma surgery.
• Surgery with photodynamic therapy: A randomized Phase II trial is underway, testing photofrin-mediated photodynamic therapy, which uses porfimer sodium and light to destroy cancer, with pleurectomy and post-operative chemo for pleural mesothelioma.

New mesothelioma treatments, such as CAR T-cell therapy and targeted gene-blocking drugs, show promise, and doctors hope these will become part of multimodal treatments. But they’re still under investigation. 

Accessing new therapies and new combinations often requires trial participation, highlighting the need for expanded treatment options and further research. A Patient Advocate can help find clinical trials recruiting patients and the top cancer centers offering them.

Mesothelioma Survivor

Carla Fasolo: What treatment options did you pursue for pleural mesothelioma?

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Doctor DaSilva sent me to doctor George Simon, and he’s very, very good. I ended up having, chemo, and I think it’s called immunotherapy.
And, you know, the first few times was kinda hard because I would be sleeping a lot and, you know, it it does have its effect on you, the medications that they give you and everything. But had positive outcome. They had told me that my tumor was the size of a softball when I it started, fracturing my ribs and then damaging ribs.
And then, after my third, therapy, the tumor had shrunk quite a bit. And that was amazing. To me, that was awesome, you know. And, it has had continued to do so in my therapy.

I was scheduled to have surgery but it got postponed twice, and I decided that it was kind of a sign not to have the surgery done. So I talked to doctor DaSilva about it, and, he said that was fine. And that it came to that point where I needed surgery, He’d take care of it. He’s very good.

He’s, when he found out that my daughter was a doctor, he he wanted to call her. He called her right away and talked to her and told her, you know, what I was going through, what I had.

Yeah.

Multimodal Treatment Strategies

Timing plays a critical role in the effectiveness of multimodal treatments for mesothelioma. These treatments fall into 3 key categories based on when they’re given. 

Categories of Mesothelioma Multimodal Treatment

1. Neoadjuvant therapy: This is given in the weeks or months before surgery. Neoadjuvant therapy (typically chemo) helps shrink tumors to improve surgical outcomes. This pretreatment increases the likelihood of complete tumor removal during the main procedure. 
2. Primary therapy: Surgery aims to remove as much of the tumor as possible. Some patients receive additional targeted therapies like HIPEC or photodynamic therapy during the operation to enhance effectiveness.
3. Adjuvant therapy: This is given in the weeks or months after primary therapy. The treatment (chemo or radiation) targets the remaining cancer cells to prevent recurrence. Radiation is focused on surgical sites or the chest cavity to eliminate remaining disease.   

This structured, phased approach maximizes the potential for long-term survival. It also includes tumor removal and prevention of cancer recurrence. Strategically timing treatments, taking a comprehensive approach, and tailoring treatment to your health represent the gold standard for improving mesothelioma prognosis. 

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Dr. Jeffrey Velotta: Benefits of Surgery With Multimodal Care

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When you add surgery in a multimodal fashion, Again, we’re never saying surgery alone is what we recommend. We always recommend surgery with something else systemically.

That has always been shown to be the best. Patients live Longer. You live longer and you feel better because you got the disease out and it doesn’t cause buildup of fluid, It doesn’t cause pain anymore. So symptomatically patients feel better.

Yes. It’s kind of like a no pain, no gain, meaning the first three months could be rough, and I explain that to patients. But over time, They recover. They all feel better.

I haven’t had patients that have said, wish I never had the surgery, or other clinicians coming to me, or other referring providers coming to me, or others saying, You should have never done the surgery, things like that. It tells me at least from the patient satisfaction out of how they’re feeling and how they’re recovering that they’re feeling better than what they did when they did have the mesothelioma.

Who Is Eligible for Multimodal Treatment?

Multimodal therapy for mesothelioma is a strong, aggressive approach that works best when the cancer is caught early. It’s also important that you are healthy enough to handle intense treatments. Your doctor will look at several factors to decide if combined treatments are right for you.

Factors That Influence Multimodal Therapy Eligibility

• Cell type: Epithelioid mesothelioma often responds better to surgery and chemo, giving patients with this type a better chance of survival using multimodal therapy.
• Overall health: You need to be well enough to recover from major surgery and manage side effects from chemo and radiation.
• Stage: Your mesothelioma stage, or how far the cancer has spread, matters. Early-stage mesothelioma is easier to treat because it is more localized.
• Type of mesothelioma: Pleural mesothelioma, which affects the lung lining, is more often treated with multimodal therapy than peritoneal mesothelioma or other rare types.

Your doctors will determine if you can safely tolerate the treatment and if your mesothelioma cells are likely to respond well. An early diagnosis and good overall health improve your chances of benefiting from multimodal therapy.

Life Expectancy and Prognosis After Mesothelioma Multimodal Therapy

Multimodal therapy for mesothelioma has greatly improved life expectancy, especially for those diagnosed at earlier stages. A 2024 study in the Annals of Surgical Oncology found that patients who had P/D combined with chemo and immunotherapy lived a median of nearly 3 years. This is much longer than the 12 to 18 months survival seen with single treatments.

Personal stories reflect this progress. Jennifer Lucarelli, a pleural mesothelioma survivor, credits multimodal therapy for her recovery. Jennifer shares with us, “Surgery, chemo and radiation gave me a fighting chance. Five years later, I’m still here. Living, traveling and enjoying life.”

Outcomes vary depending on cancer stage, cell type and overall health. However, new treatments, including immunotherapy, TTFields and improved ways to combine therapies, offer people with mesothelioma even more hope. Regular follow-ups and participation in new clinical trials are continuously pushing survival rates higher.

Asbestos.com Expert Takeaway

Expert Takeaways on Multimodal Treatment

• A 2023 study of some Medicare patients diagnosed with mesothelioma reports: 8% to 11% had chemo; 1% had radiation; 14% to 27% had surgery; and 5% to 11% had all 3 therapies.
• A mesothelioma specialist can work with you to develop a personalized treatment plan. Factors like cancer stage, type and overall health will affect your treatment options.

“A very effective treatment for mesothelioma is a multimodal approach consisting of a combination of surgery, chemo, radiation and/or immunotherapy. It removes the visible tumor to help alleviate symptoms and provide reduction of tumor burden. This ensures patients are in a better position to potentially live longer.”

Dr. Jeffrey Velotta, thoracic surgeon at Kaiser Permanente

Common Questions About Multimodal Therapy for Mesothelioma

What are the benefits and risks of multimodal therapy for mesothelioma?

Benefits:

• Combining treatments (surgery, chemotherapy, and radiation) can be more effective than single therapies. 
• Different approaches targeting cancer cells in various ways, could reduce the risk of cancer returning. 
• The therapies for each patient can be tailored based on cancer stage, location, and patient health.

Risks:

• Multiple treatments may lead to increased side effects (e.g., fatigue, nausea, or weakened immunity). 
• Aggressive treatments require more healing time. 
• Ultimately, the treatments aren’t suitable for everyone. 
• Those with advanced cancer or poor health may not qualify.

What can I expect during multimodal therapy?

Your doctors assess your cancer stage and overall health to create a customized plan. If eligible, surgical procedures like P/D (lung-saving) or EPP (lung-removing) may be used to remove tumors. 

Chemo drugs shrink remaining cancer cells before or after surgery. High-energy radiation beams target residual cancer cells to prevent regrowth. Regular scans and follow-ups track recovery progress and manage side effects.

How long does treatment take?

Multimodal treatment for mesothelioma typically takes 3 to 6 months for the initial treatment (surgery, chemotherapy and radiation). Some people continue maintenance of their disease through immunotherapy or clinical trials for months or years. Lifelong monitoring is needed to detect recurrence early.