NCCN Guidelines for Patients
Malignant Pleural Mesothelioma, Version 1.2014
Stage I–III sarcomatoid or stage IV mesothelioma
Stage I–III sarcomatoid or stage IV mesothelioma:
Treatment with chemotherapy
Treatment with chemotherapy alone is recommended
for stage I–III sarcomatoid mesothelioma and stage
IV mesothelioma. Chemotherapy alone is also
recommended for stage I–III epithelioid or mixed
mesothelioma that can’t be removed by surgery.
Chemotherapy drugs kill fast-growing cells. Cancer
cells grow fast, so chemotherapy works well to stop
new cancer cells from being made. However, it also
kills normal cells and can cause side effects. Ask your
doctor for a list of all the side effects caused by the
chemotherapy drugs you will have.
The chemotherapy treatments recommended for
mesothelioma are listed in
below. All of the
chemotherapy drugs listed in
are liquids that
are slowly injected into your vein.
First-line treatment is the first set of treatments given
to treat a disease. Second-line treatment is the next
treatment(s) given when first-line treatment fails.
Cisplatin with pemetrexed is preferred for first-
line treatment. But, gemcitabine with cisplatin is a
good option if you cannot take pemetrexed. And
pemetrexed with carboplatin is a good option if
you have poor overall health, difficulty doing daily
activities, or other serious health conditions.
Chemotherapy is given in cycles of treatment days
followed by days of rest. Cycles give the body a
chance to recover before the next treatment. The
length of 1 cycle of pemetrexed and cisplatin is 21
days. Pemetrexed and cisplatin are given on Day 1 of
the cycle. Other treatments that also follow this cycle
include pemetrexed with carboplatin and pemetrexed
The length of 1 cycle of gemcitabine and cisplatin is
21 to 28 days. For each cycle, gemcitabine is given
on Days 1, 8, and 15, and cisplatin is given only on
Day 1. Vinorelbine is given 1 time every 7 days.
If the cancer grows or spreads after first-line
treatment, then you may receive second-line
treatment. However, there is little research to provide
guidelines for second-line treatment. If given as first-
line treatment, pemetrexed should only be given as
second-line treatment if a good, lasting response was
achieved with it the first time.
Chart 7. Treatment with chemotherapy
Pemetrexed + cisplatin