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Mesothelioma Treatment Effectiveness by Type, Stage, and Modality

Malignant mesothelioma (pleural > peritoneal > pericardial/testicular) is aggressive; median survival 12–21 months. Treatment effectiveness varies:

By Modality

Prognostic Factors

Histology: Epithelioid > biphasic > sarcomatoid.
Stage: I–II resectable; III–IV systemic.
Performance status, age, biomarkers (BAP1, CDKN2A).

Multidisciplinary tumor board essential. Clinical trials encouraged at all stages.

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Treatment	Role	Effectiveness
Surgery (EPP, P/D)	Macroscopic complete resection	Best chance for long-term survival in early stage (I–II), epithelioid, good PS; median OS 18–35 mo. High morbidity (EPP > P/D).
Chemotherapy (Cisplatin/Pemetrexed)	Systemic; neoadjuvant, adjuvant, palliative	Response ~40%; median OS 12–16 mo; improves symptoms, modest survival benefit.
Radiation	Adjuvant (post-EPP), palliative	Reduces local recurrence; hemithorax RT after EPP standard; palliative for pain.
Immunotherapy (Nivo/Ipi)	First-line unresectable (CheckMate 743)	OS 18.1 vs 14.1 mo (chemo); approved for unresectable.
Targeted (Bevacizumab, etc.)	Investigational/combination	Modest benefit in trials; not standard.
TTFields	Adjuvant to chemo	LUNAR trial: OS 18.2 vs 14.1 mo; FDA approved.
Palliative Care	Symptom control, QoL	Early integration improves mood, survival.