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NCCN Guidelines for Patients



Malignant Pleural Mesothelioma, Version 1.2016

Stage I–III sarcomatoid or stage IV mesothelioma

Treatment with chemotherapy

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.

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.

The PS (




taus) is also considered for

people with stage IV mesothelioma, sarcomatoid

type, or disease that can’t be removed by surgery.

For a PS 0–2, your doctors may recommend to wait

and watch the cancer or start chemotherapy. For a

PS 3–4, your doctors may recommend supportive

care and, possibly, hospice for end-of-life care.

Hospice includes both physical and emotional care

for people who are close to the end-of-life.

The chemotherapy treatments recommended for

mesothelioma are listed in

Guide 8

. All of the

chemotherapy drugs listed in

Guide 8

are liquids

that are slowly injected into your vein.

First-line treatment is the first set of treatments.

Second-line treatment is given when the first-line

treatment doesn’t work or stops working. Cisplatin

with pemetrexed is recommended 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

can’t take cisplatin. Pemetrexed with cisplatin and

bevacizumab is only given as a first-line treatment

when surgery is not an option.

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 alone.

Guide 8. Treatment with chemotherapy

First-line treatment

Second-line treatment

Pemetrexed + cisplatin (preferred)



Pemetrexed + cisplatin + bevacizumab


Pemetrexed + carboplatin


Gemcitabine + cisplatin




Treatment guide

Stage I–III sarcomatoid or stage IV mesothelioma