Mesothelioma is a cancer of the thin lining that surrounds the lungs, called the pleura, or, less often, the lining of the abdomen, called the peritoneum. Most cases are caused by asbestos exposure, often 20 to 50 years earlier, through work in construction, shipyards, insulation or the military, or by living with someone who brought asbestos dust home. Shortness of breath, chest pain and fluid around the lung are common first signs. This article explains the tests, the treatments, and the integrative research.
The Tests That Guide Treatment
The subtype. A biopsy shows whether the mesothelioma is epithelioid, the most common and slower-growing type, or sarcomatoid or biphasic, called non-epithelioid. The subtype strongly affects which treatment works best.
BAP1. Many mesotheliomas have lost a protein called BAP1, and a small share of people carry an inherited BAP1 mutation, which also raises the risk of melanoma of the eye and skin and kidney cancer. Genetic testing is especially important for people diagnosed young or with a family history. See our article on tumor DNA and RNA sequencing.
Immunotherapy: The Dutch-Led CheckMate 743 Trial
In the CheckMate 743 trial, led by Paul Baas of the Netherlands Cancer Institute in Amsterdam, the immunotherapy combination nivolumab and ipilimumab extended median survival to 18.1 months, compared with 14.1 months with chemotherapy. The benefit was greatest in non-epithelioid mesothelioma, where survival doubled, to 18.1 months from 8.8 months.1 In a Canadian, Italian and French trial, adding pembrolizumab to chemotherapy also improved survival.2 Newer combinations tested in 2025, including the European BEAT-meso trial, gave mixed results.3 See our article on how immunotherapy works.
Surgery: What the UK MARS2 Trial Showed
For years, many patients with pleural mesothelioma were offered major surgery to remove the lining of the lung. In the UK MARS2 trial, people who had this extended surgery with chemotherapy did not live longer than those who had chemotherapy alone and had more complications.4 Surgery is now reserved for carefully selected patients at expert centers.
Peritoneal Mesothelioma
Mesothelioma of the abdomen is treated very differently. In selected patients, surgery to remove all visible tumor combined with heated chemotherapy bathed through the abdomen, called HIPEC, produced a median survival of about four and a half years in a large international study.5 See our article on hyperthermia.
Integrative Research in Mesothelioma
Because mesothelioma is rare, few natural substances have been studied in people with it. The two integrative approaches with the most human evidence are:
Tumor Treating Fields, from Italy. Low-intensity electric fields delivered through patches on the chest disrupt dividing cancer cells. In the Italian STELLAR trial, people with pleural mesothelioma who used the device with chemotherapy lived a median of 18.2 months, longer than expected with chemotherapy alone, and it was approved in the United States for this use (Ceresoli and colleagues, The Lancet Oncology, 2019). See our article on electromagnetic field therapy.
Heated chemotherapy in the chest, from Germany. German surgical centers, including Regensburg, have combined surgery for pleural mesothelioma with heated chemotherapy rinsed through the chest, called HITHOC. A German multicenter study found it safe and suggested it may help control the cancer locally (Ried and colleagues, Cancers, 2021). Randomized trials are needed.
These are some of the natural and integrative options studied in mesothelioma, and others have promising research as well. Which may fit your situation depends on your tumor testing, your current treatment and possible drug interactions. In a consultation, Dr. Silver, MD, educates you on these options and the research behind them. Request a consultation.
How Cancer Expert MD Helps
Cancer Expert MD provides education and consultation for people with every type and stage of cancer, and specializes in Stage IV and metastatic cancer. Our guide to what to do when treatment stops working explains re-testing and the next steps, and our book, The New Reality of Cancer, covers testing and treatment across all cancers.
Frequently Asked Questions
What causes mesothelioma?
Most cases are caused by asbestos exposure, often decades earlier. A small share of people carry an inherited BAP1 mutation that raises the risk.
Does immunotherapy work for mesothelioma?
Yes. In the CheckMate 743 trial, nivolumab and ipilimumab extended survival compared with chemotherapy, especially in non-epithelioid mesothelioma, where survival doubled.
Is surgery recommended for pleural mesothelioma?
Only for carefully selected patients at expert centers. The UK MARS2 trial found that major surgery did not help most patients live longer.
How is peritoneal mesothelioma treated?
In selected patients, with surgery to remove all visible tumor and heated chemotherapy bathed through the abdomen, called HIPEC.
About the author. Dr. Silver, MD, graduated from Temple University School of Medicine, trained as an interventional cardiologist, and has practiced medicine for nearly fifty years. A lymphoma survivor of about twenty-five years, he is co-author, with Dr. Lindmeier, DHSc, of The New Reality of Cancer: The Science of Recovery. Read more about Dr. Silver, MD.
Research by Dr. Lindmeier, DHSc, cancer educator and co-author of The New Reality of Cancer.
This article is for general education only and is not individual medical advice. Always consult your own doctor before making any changes to your care.
© 2026 Lovely LYF LLC. All rights reserved. This article draws on the research in The New Reality of Cancer and may not be copied, republished or distributed without written permission.
For more in-depth information on this topic and many others, get our book, The New Reality of Cancer: The Science of Recovery.
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References
- Baas P, Scherpereel A, Nowak AK, et al. First-line nivolumab plus ipilimumab in unresectable malignant pleural mesothelioma (CheckMate 743): a multicentre, randomised, open-label, phase 3 trial. The Lancet. 2021;397(10272):375–386.
- Chu Q, Perrone F, Greillier L, et al. Pembrolizumab plus chemotherapy versus chemotherapy in untreated advanced pleural mesothelioma in Canada, Italy, and France (CCTG IND.227/KEYNOTE-483). The Lancet. 2023;402(10419):2295–2306.
- Felip E, Popat S, Dafni U, et al. A randomised phase III study of bevacizumab and carboplatin–pemetrexed chemotherapy with or without atezolizumab as first-line treatment for advanced pleural mesothelioma (ETOP 13-18 BEAT-meso). Annals of Oncology. 2025;36(5):548–560.
- Lim E, Waller D, Lau K, et al. Extended pleurectomy decortication and chemotherapy versus chemotherapy alone for pleural mesothelioma (MARS 2). The Lancet Respiratory Medicine. 2024.
- Yan TD, Deraco M, Baratti D, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma: multi-institutional experience. Journal of Clinical Oncology. 2009;27(36):6237–6242.
This article is for education only. It is not medical advice and does not diagnose or treat any condition. Cancer Expert MD has no financial relationship with any laboratory, drug maker, supplement company, clinic or hospital.
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