Treatment Options for Advanced Malignant Mesothelioma (Stages II, III, and IV)

First-line systemic therapy.

First-line systemic therapy.

Nivolumab and ipilimumab.[1]

First-line systemic therapy.

Cisplatin plus pemetrexed, with or without bevacizumab.[2-4]

First-line systemic therapy.

Durvalumab with platinum plus pemetrexed.[5]

First-line systemic therapy.

Platinum plus pemetrexed, followed by best supportive care, with or without maintenance gemcitabine.[6]

Multimodality clinical trials.[7-10]

Symptomatic treatment to include drainage of effusions, chest tube pleurodesis, or thoracoscopic pleurodesis.[11] For more information, see Cardiopulmonary Syndromes.

Palliative surgical resection in selected patients.[12,13]

Palliative radiation therapy for patients with pain related to their cancer.[14,15]

Intracavitary therapy. Intrapleural or intraperitoneal administration of chemotherapeutic agents (e.g., cisplatin, mitomycin, and cytarabine) has been reported to produce transient reduction in the size of tumor masses and temporary control of effusions in small clinical studies.[16-18] Additional studies are needed to define the role of intracavitary therapy.