Mesothelioma Drugs: Chemotherapy, Immunotherapy and Other Medicines

What drugs are used for mesothelioma?

Mesothelioma drugs include chemotherapy, immune checkpoint inhibitors, and selected targeted medicines. They may be used to slow cancer growth, reduce symptoms, or support other treatments. The choice depends on whether cancer arises in the pleura (lining around the lungs) or peritoneum (abdominal lining), whether surgery is feasible, previous treatment, overall health, and patient goals. No drug works for everyone, and drug therapy is not a guaranteed cure.

For an overview of the broader care plan, see mesothelioma treatments and your mesothelioma care team.

Chemotherapy medicines and combinations

Pemetrexed (Alimta) with cisplatin is an established first-line chemotherapy regimen for certain patients with unresectable pleural mesothelioma. Carboplatin may be substituted for cisplatin in selected circumstances, such as when kidney function, hearing, or other health factors affect tolerability. A clinician chooses the actual regimen and dose.

For patients receiving pemetrexed, the team ordinarily prescribes specific folic acid and vitamin B12 supplementation and may prescribe a corticosteroid to reduce certain toxicities. Do not independently choose doses or replace prescribed supplements with over-the-counter megadoses. Blood counts, kidney function, and other measures are monitored.

Other chemotherapy drugs, including gemcitabine or vinorelbine, may be considered in particular later-line settings; their role differs from standard first-line combinations. Read the dedicated chemotherapy overview and what to expect during chemotherapy.

Immunotherapy drugs: approved combinations

Nivolumab (Opdivo) plus ipilimumab (Yervoy) is an FDA-approved first-line immunotherapy combination for adults with unresectable malignant pleural mesothelioma. These medicines block different immune checkpoints; they are not conventional chemotherapy.

In September 2024, the FDA approved pembrolizumab (Keytruda) with pemetrexed and platinum chemotherapy as first-line treatment for adults with unresectable advanced or metastatic malignant pleural mesothelioma. This is a combination regimen—not an approval of pembrolizumab alone for every mesothelioma patient. Some patients are better suited to chemotherapy alone or another approach.

Immune-related adverse effects can affect lungs, bowel, liver, thyroid and other organs, sometimes seriously or after treatment has stopped. New diarrhea, cough, breathlessness, rash, severe fatigue, or other unexplained symptoms warrant prompt reporting. See immunotherapy for mesothelioma and how immunotherapy is changing treatment.

Targeted medicines and investigational drugs

Bevacizumab blocks vascular endothelial growth factor (VEGF), a signal involved in blood-vessel growth. Some clinicians may consider adding it to cisplatin and pemetrexed for selected patients with pleural mesothelioma. It is not appropriate for everyone; blood pressure, bleeding, clotting, wound-healing and other risks matter. Its use and regulatory status should be confirmed for the individual regimen.

Other agents, including ramucirumab and experimental targeted or immune therapies, have been studied in clinical trials. A promising study is not the same as FDA approval for a specific mesothelioma indication. Ask whether an option is approved, off-label, or available only through a trial.

How drug treatment differs for peritoneal mesothelioma

Evidence from major pleural mesothelioma drug trials should not automatically be applied to peritoneal mesothelioma. Some patients with peritoneal disease may be candidates for cytoreductive surgery and heated intraperitoneal chemotherapy (HIPEC); others receive systemic drug treatment based on disease extent, fitness, and specialist assessment.

HIPEC delivers heated chemotherapy into the abdominal cavity during a specialized surgical procedure. It is not the same as taking a systemic chemotherapy drug or an immunotherapy infusion. For more detail, see HIPEC for mesothelioma and cytoreductive surgery.

How doctors choose and monitor a drug plan

Before starting, the oncology team reviews pathology, disease location and extent, treatment history, functional status, kidney and liver function, blood counts, autoimmune conditions, other medications, and the patient’s preferences. The team may recommend a second opinion at a center experienced with mesothelioma.

During treatment, clinicians monitor symptoms, blood tests and imaging. A change in scan appearance alone does not tell the whole story: the team also evaluates how the patient feels, adverse effects and whether the treatment goal remains realistic. Patients should ask about the planned number of cycles, when scans will occur, and what would prompt a change.

Drug side effects and when to call for help

Chemotherapy can cause low blood counts, nausea, fatigue, mouth sores and nerve or kidney problems depending on the drug. Immunotherapy can cause inflammatory reactions in organs; bevacizumab may increase certain bleeding, clotting and blood-pressure risks. Side effects vary widely, and many can be managed when reported early.

Call the oncology team immediately for fever during chemotherapy, new or worsening shortness of breath, significant diarrhea, inability to keep fluids down, unusual bleeding, or rapidly worsening symptoms. Severe breathing difficulty, chest pain, confusion or other life-threatening symptoms require emergency services. Use the team’s individualized fever threshold and emergency instructions.

Supportive measures may include prescribed anti-nausea drugs, nutrition support, symptom-directed medicines and palliative care alongside active treatment. See palliative care and hydration and electrolytes.

Questions to ask about costs, trials and next steps

Before agreeing to a regimen, request the generic and brand names, treatment goal, expected schedule, major risks, alternatives and a written plan for after-hours concerns. Ask the financial navigator about insurance authorization, infusion charges, supportive medications and travel. Assistance programs have different eligibility rules and should never be assumed to cover the full bill.

Clinical trials may offer access to investigational treatments, but participation can involve additional visits and uncertain benefits. The oncology team can identify studies appropriate to the exact diagnosis and prior treatment. A second opinion can help clarify the tradeoffs without requiring a patient to commit to a specific therapy.

Frequently asked questions

What is the most common chemotherapy drug for mesothelioma?

Pemetrexed combined with a platinum drug, often cisplatin, is an established regimen for certain patients with unresectable pleural mesothelioma. The best option is individualized.

Are immunotherapy drugs chemotherapy?

No. Immune checkpoint inhibitors act on immune signaling, while chemotherapy directly affects rapidly dividing cells. Some regimens combine both.

Is pembrolizumab approved by itself for all mesothelioma cases?

No. The FDA approval described here is pembrolizumab with pemetrexed and platinum chemotherapy for specified first-line unresectable advanced or metastatic pleural mesothelioma.

Can drugs cure mesothelioma?

No drug offers a guaranteed cure. Treatment may control disease or relieve symptoms, and outcomes vary by person and disease characteristics.

Is HIPEC the same as intravenous chemotherapy?

No. HIPEC is heated chemotherapy delivered into the abdominal cavity during a specialized procedure, usually after cytoreductive surgery.

Why might a doctor choose carboplatin instead of cisplatin?

A doctor may select carboplatin when particular health or tolerability factors make cisplatin less suitable. Both require monitoring.

Can supplements replace prescribed cancer medicines?

No. Supplements do not replace cancer treatment. Pemetrexed requires a clinician-directed folic acid and vitamin B12 schedule; other supplements should be reviewed for interactions.

When should I call about side effects?

Follow the written care plan and report fever during chemotherapy, new breathing problems, severe diarrhea, bleeding, or inability to drink promptly. Seek emergency help for life-threatening symptoms.

Confirmed Medical Sources

These primary medical and regulatory resources explain the approved indications and treatment evidence. Review dates and drug labels with your oncology team, because approvals can change.

• National Cancer Institute: Malignant Mesothelioma Treatment (PDQ), Health Professional Version
• National Cancer Institute: Treatment for Mesothelioma
• FDA: Pembrolizumab with chemotherapy approval (September 17, 2024)
• NCI: Nivolumab drug information
• NCI: Pemetrexed drug information