Peritoneal Mesothelioma Treatment Costs and Prognosis in 2025: What Patients and Families Need to Know

Peritoneal mesothelioma is a rare and aggressive cancer that forms in the lining of the abdominal cavity, known as the peritoneum. It accounts for roughly 10–20% of all mesothelioma diagnoses and is strongly linked to asbestos exposure, though the connection is less direct than in pleural mesothelioma. While many patients have a clear history of occupational or environmental asbestos exposure, others may develop the disease through secondhand exposure or undocumented contact with asbestos-contaminated materials such as cosmetic talc.

Historically, peritoneal mesothelioma carried a grim prognosis, with most patients surviving less than a year after diagnosis. However, treatment advances over the past two decades—particularly the development of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC)—have significantly improved survival for select patients. Today, median survival for patients undergoing CRS-HIPEC can exceed three years, and some long-term survivors are living five years or more.

Despite these improvements, peritoneal mesothelioma remains challenging to treat and difficult to diagnose. Its symptoms are often vague—such as abdominal pain, bloating, or weight loss—and may be mistaken for more common gastrointestinal disorders. As a result, many patients are diagnosed at an advanced stage, when the disease has already spread extensively throughout the abdominal cavity.

This page provides a detailed overview of how peritoneal mesothelioma is diagnosed and staged, the current treatment options available in 2025, and the factors that influence a patient's prognosis. It also covers emerging therapies and the critical role of treatment at specialized, high-volume centers.

Prognosis for Peritoneal Mesothelioma in 2025

Peritoneal mesothelioma remains a rare and challenging cancer to treat, with prognosis varying significantly based on several factors, including histological subtype and treatment approach. While the average life expectancy after diagnosis is often limited, advancements in treatments, particularly cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC), have improved outcomes for selected patients.

Median Survival by Cell Type

Histological subtype is a critical predictor of survival in peritoneal mesothelioma, as different cell types exhibit varying responses to treatment and rates of progression.

• Epithelioid Mesothelioma: This is the most common subtype and is associated with the best prognosis. Median survival for epithelioid peritoneal mesothelioma can range from 9 months to as high as 43.3 months in some studies, particularly when treated with CRS-HIPEC. These tumors tend to grow more slowly and respond better to treatment. ⁸

• Biphasic Mesothelioma: This subtype, which contains both epithelioid and sarcomatoid cells, has an intermediate prognosis. Median survival is generally shorter than that of epithelioid mesothelioma, with reported ranges of 2 to 9.5 months depending on the proportion of sarcomatoid elements and treatment received.⁸ 

• Sarcomatoid Mesothelioma: This is the most aggressive subtype, with a poor prognosis. Median survival is often as low as 1–5.4 months, as these tumors are more resistant to treatment and tend to present at an advanced stage. ⁹

Other Prognostic Factors for Peritoneal Mesothelioma

Survival in peritoneal mesothelioma is influenced by several key factors beyond histological subtype. These include the stage at diagnosis, performance status, access to specialized treatment, and tumor biomarkers.

Stage at Diagnosis

The extent of disease at diagnosis plays a critical role in determining prognosis. While peritoneal mesothelioma lacks a universally accepted staging system, localized disease (analogous to Stages I–II in other cancers) is often amenable to aggressive treatment such as CRS-HIPEC. Median survival for patients with localized disease can range from 30 to 60 months, particularly for those with epithelioid histology and good performance status. In contrast, patients with more advanced disease (analogous to Stages III–IV) typically have shorter survival, often under 12 months, depending on tumor burden, metastasis, and access to treatment. ¹¹

Performance Status (ECOG)

The Eastern Cooperative Oncology Group (ECOG) performance status is a widely used measure of a patient's physical functioning, ranging from 0 (fully active) to 5 (deceased). Patients with lower ECOG scores—indicating better physical activity and independence—are more likely to tolerate aggressive treatments like CRS-HIPEC and systemic therapies, leading to improved survival outcomes. ECOG performance status is a critical factor in determining eligibility for surgery and other intensive treatments. ¹²

Treatment Access and Histology-Tailored Care

Access to specialized cancer centers and multidisciplinary teams significantly improves outcomes for peritoneal mesothelioma patients. Treatments tailored to histology, such as CRS-HIPEC for epithelioid tumors, can substantially extend survival. Patients treated at centers with expertise in mesothelioma are more likely to receive guideline-based, individualized care, which is associated with better survival rates. Clinical trials also provide access to novel therapies that may improve outcomes. ¹¹

Tumor Biomarkers

Emerging research highlights the prognostic and predictive value of tumor biomarkers in peritoneal mesothelioma. For example, the loss of the BAP1 tumor suppressor gene is frequently observed in epithelioid mesothelioma and is associated with longer survival. Conversely, high PD-L1 expression, more common in sarcomatoid and biphasic subtypes, is linked to poorer prognosis but may predict a better response to immunotherapy. These biomarkers are increasingly being used to guide treatment decisions and predict outcomes. ¹²

Long-Term Survival is Possible

Although rare, long-term survival is achievable for some patients with peritoneal mesothelioma. These cases often involve early detection, epithelioid histology, and access to multimodal care, including CRS-HIPEC, systemic chemotherapy, and immunotherapy.

For patients with epithelioid peritoneal mesothelioma, CRS-HIPEC has significantly improved survival, with 5-year survival rates reported between 40% and 70% in selected cases. However, outcomes for biphasic and sarcomatoid subtypes remain limited, underscoring the need for continued research and novel therapies. ¹⁰

This underscores the importance of maintaining hope. Survival statistics reflect population averages and cannot predict individual outcomes. Advances in treatment, combined with each patient’s unique biology and circumstances, may lead to outcomes that defy expectations. Exploring all available options, staying informed, and seeking care from experienced specialists are essential steps in fighting this disease. 

Hospitalization and Inpatient Care Costs for Peritoneal Mesothelioma

For many patients with peritoneal mesothelioma, the most expensive aspect of treatment isn’t always the chemotherapy drugs or the surgical procedure—it’s the hospital stay that follows. Whether recovering from CRS-HIPEC, managing complications, or undergoing palliative interventions, inpatient care can lead to significant financial strain, especially in the absence of strong insurance or legal support.

The data below are drawn from a national study of 1,675 mesothelioma hospital discharges and offer valuable insights into how hospitalization costs and length of stay vary by region and age. ¹³

Regional Differences in Hospitalization Costs

Why the variation? Hospital charges are influenced by many factors, including labor costs, hospital type, and the scope of services provided. The Northeast has the highest average costs—and also some of the nation’s most advanced mesothelioma treatment centers. Institutions like those in Boston and New York helped pioneer the use of HIPEC in mesothelioma and are known for multidisciplinary teams, complex surgical capacity, and cutting-edge clinical trials.

In other words: higher charges often reflect more advanced care.

If you’re pursuing a high-stakes, high-reward treatment like CRS-HIPEC, it’s often worth seeking care from a facility with deep experience—even if the billing rate is higher. And with asbestos trust funds and legal claims available, most patients don’t need to carry those costs alone.

Hospital Costs and Length of Stay by Age

Younger patients (ages 45–64) had the highest costs and longest stays, likely because they’re more often selected for aggressive interventions like CRS-HIPEC and systemic chemotherapy. By contrast, those over age 85 are typically managed more conservatively, with lower treatment intensity and shorter recovery times.

This breakdown also mirrors the latency of asbestos disease. Mesothelioma often develops 20 to 50 years after exposure, which is why most hospitalized patients are between 65 and 84 years old. Only a small fraction—just 3%—are under 45. Age doesn’t just influence survival rates; it shapes which treatments are possible, and how much they cost.

Why Higher Hospital Charges May Reflect Better Survival — Especially for Peritoneal Mesothelioma

Where you receive treatment for peritoneal mesothelioma can make a life-changing difference. Multiple studies—including a major survival analysis focused specifically on this disease—have shown that patients treated at academic medical centers live significantly longer than those treated in community hospitals.¹⁴

That difference didn’t come from the patient population—it came from the treatment approach. Academic centers were:

• Twice as likely to perform life-extending surgery

• Nearly three times more likely to use same-day, guideline-based chemotherapy

And as the table below shows, academic centers offer far more resources than typical hospitals:

Yes, These Hospitals Often Cost More—But They’re Worth It

It’s true that large academic centers typically have higher billed charges due to more intensive services, advanced technologies, and expert staffing. But for peritoneal mesothelioma, those higher costs are often tied directly to better survival outcomes.

And crucially: You don’t have to shoulder those costs alone.

• Asbestos trust funds

• Legal settlements

• Veterans’ benefits

All can help cover travel, lodging, and the cost of care—so you can access the best treatment in the country, not just what’s closest to home or cheapest on paper.

Call 833-4-ASBESTOS to learn how we can help you access top-tier mesothelioma care—without financial barriers.

First-Line Treatment: CRS-HIPEC

For eligible patients, the combination of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is the cornerstone of curative-intent treatment for peritoneal mesothelioma in 2025. This aggressive multimodal approach has fundamentally changed the prognosis for this disease, shifting the median survival from less than one year to three or more years in appropriately selected patients. ¹

What Is CRS-HIPEC?

• Cytoreductive surgery (CRS) involves the meticulous removal of all visible tumors from the peritoneal cavity. This often requires procedures like peritonectomy, omentectomy, and sometimes resection of affected organs (e.g., spleen, segments of bowel, diaphragm).

• HIPEC is performed immediately after surgery. The abdominal cavity is bathed in a heated chemotherapy solution—typically cisplatin, mitomycin-C, or a platinum-based combination—circulated for 60–90 minutes at 41–43°C. The heat increases drug penetration and tumor cell sensitivity while limiting systemic toxicity.

Survival Benefits
Patients undergoing Cytoreductive Surgery (CRS) combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) demonstrate significantly improved survival outcomes compared to those receiving systemic chemotherapy alone. Key findings include:

• Median Overall Survival (OS): CRS-HIPEC achieves a median OS of 44.6 months, a substantial improvement over systemic therapy alone.

• 1-Year OS: Patients who achieve complete cytoreduction (CC-0) can experience 1-year OS rates as high as 93%.

• Systemic Chemotherapy Alone: In contrast, inoperable patients treated with systemic chemotherapy alone typically have a median OS of approximately 11–13 months.

These results underscore the transformative potential of CRS-HIPEC in extending survival for appropriately selected patients.

Patient Selection Matters
The effectiveness of CRS-HIPEC is highly dependent on careful patient selection. The following factors are critical for achieving optimal outcomes:

1. Low Peritoneal Cancer Index (PCI): Patients with a PCI below 20 are more likely to benefit from CRS-HIPEC, as lower tumor burden correlates with better outcomes.

2. Complete or Near-Complete Cytoreduction: Achieving CC-0 (no visible residual disease) or CC-1 (minimal residual disease) is a major prognostic factor for improved survival.

3. Histology: Patients with epithelioid histology respond better to CRS-HIPEC compared to those with sarcomatoid or biphasic subtypes.

4. Performance Status: A good performance status, typically defined as ECOG 0–1, is essential for tolerating the procedure and achieving favorable outcomes.

Challenges in Poor Prognostic Groups:
Outcomes are significantly worse in patients with:

• High tumor burden (e.g., PCI >20).

• Sarcomatoid or biphasic histological subtypes.

• Poor functional status or ECOG scores above 1.

By adhering to stringent selection criteria, CRS-HIPEC can maximize survival benefits while minimizing risks, making it a viable and effective treatment option for well-selected patients.

Risks and Recovery

While CRS-HIPEC is potentially life-extending, it is a complex and demanding treatment:

• Average operative time exceeds 6 hours

• Hospital stays can last 1–2 weeks

• Postoperative complications include infection, bleeding, and, rarely, early mortality

However, in high-volume centers with experienced surgical teams, complication rates are decreasing and outcomes are improving year over year. ⁴

What CRS-HIPEC Costs—and Why It’s Worth Planning For

CRS-HIPEC is one of the most effective treatments for peritoneal mesothelioma—but it’s also one of the most expensive. Between surgery, hospitalization, and follow-up care, total costs often exceed six figures, especially when systemic chemotherapy or immunotherapy is added.

Detailed Cost Breakdown

1. CRS-HIPEC Procedure (Surgery + Perfusion):

   • Estimated charges range from $38,000 to $50,000 for the procedure itself. This includes operating room costs, perfusion equipment, and surgical team fees.

   • In some cases, the cost of the HIPEC device and disposable materials is split across multiple procedures, which can help reduce costs slightly. ¹⁵

2. ICU Stay (1–3 Days):

   • Costs for ICU care can range from $10,000 to $30,000+, depending on the length of stay and the region.

   • Efforts to minimize ICU stays, such as training nurses to handle perfusion tasks, have been shown to reduce costs without compromising patient safety. ¹⁵

3. Total Hospital Stay (7–15 Days):

   • The overall hospital stay, including ward care, diagnostics, and services from other departments, typically costs between $25,000 and $60,000+.

   • The median length of postoperative hospitalization for CRS-HIPEC patients is 9 days, with a range of 1–155 days depending on complications. ¹⁶

4. Systemic Chemotherapy (6 Cycles):

   • Adding systemic chemotherapy to the treatment plan can cost $38,000+ for six cycles.

   • Systemic chemotherapy alone has not shown substantial survival benefits for peritoneal mesothelioma, but it may be used in combination with CRS-HIPEC for certain cases. ¹⁷

5. Immunotherapy (If Added Post-Op):

   • Immunotherapy costs can range from $150,000 to $250,000 per year, depending on the specific drugs and treatment duration.

   • This is often considered for patients with advanced disease or as part of clinical trials.

6. Palliative Care (Fluid Drainage, etc.):

   • Palliative care costs vary widely, from $2,000 to $10,000+ over time, depending on the frequency and type of interventions required.

Regional and Institutional Variations in Cost

• U.S. Hospitals: Self-paying patients in the U.S. may face total charges ranging from $83,000 to $150,000 for CRS-HIPEC. These figures include operating room time, anesthesiology, ICU and recovery care, surgical team fees, and equipment costs.

  • Costs are influenced by the hospital type (academic vs. community), geographic region, and whether complications occur. 

Chemotherapy: The Best Choice for Patients Unable to Undergo HIPEC Treatment and Surgery

For individuals diagnosed with peritoneal mesothelioma who are not eligible for surgery or HIPEC, systemic chemotherapy becomes the primary treatment option. This approach is less invasive and focuses on managing the disease rather than curing it.

Why Some Patients Cannot Undergo Surgery or HIPEC

1. Extensive Tumor Spread
   Peritoneal mesothelioma often spreads throughout the abdominal cavity. In cases where the disease is advanced and the tumor burden is very high, it becomes impossible to remove all visible tumors through surgery. The goal of surgery is to achieve "complete cytoreduction," meaning the removal of as much tumor tissue as possible. However, when the cancer has spread too extensively, surgery may not be effective and could expose the patient to unnecessary risks without significant benefits.

2. Poor Performance Status
   A patient’s overall health and physical ability to handle surgery are critical factors in determining eligibility. Doctors use a scale called the ECOG (Eastern Cooperative Oncology Group) performance status to assess this.

   • A score of 0 means the patient is fully active and able to carry out daily activities.

   • A higher score (e.g., 3 or 4) indicates significant limitations, such as being bedridden or unable to care for oneself.
     Patients with poor performance status are less likely to recover well from the stress of surgery and may face higher risks of complications. For these individuals, systemic chemotherapy is a safer and more manageable option.

3. Sarcomatoid Histology
   Peritoneal mesothelioma has different subtypes, and the sarcomatoid subtype is particularly aggressive. This subtype is associated with a poor prognosis and does not respond well to surgery or other treatments. Because of this, doctors may recommend systemic chemotherapy instead, as it is less invasive and can still help slow the disease's progression.

4. Medical Comorbidities
   Some patients have other serious health conditions, such as heart disease, kidney problems, or diabetes, which make surgery too risky. These conditions increase the likelihood of complications during or after surgery. For these individuals, systemic chemotherapy is often the safer and more practical treatment option.

How Systemic Chemotherapy Helps

Systemic chemotherapy involves the use of drugs that travel through the bloodstream to target cancer cells throughout the body. While it is not a cure for peritoneal mesothelioma, it serves several important purposes:

1. Controlling Disease Progression
   Chemotherapy can slow the growth of cancer cells, preventing the disease from spreading further. This helps to stabilize the condition for as long as possible, even if the cancer cannot be completely eliminated.

2. Alleviating Symptoms
   Peritoneal mesothelioma can cause uncomfortable symptoms such as abdominal pain, swelling, and difficulty eating. Chemotherapy can reduce the size of tumors, which may relieve these symptoms and improve the patient’s comfort.

3. Improving Quality of Life
   By managing symptoms and slowing disease progression, chemotherapy can help patients maintain a better quality of life. This is especially important for those who are not candidates for curative treatments like surgery or HIPEC.

Chemotherapy for Peritoneal Mesothelioma: What It Does — and What It Costs

Chemotherapy is a cornerstone of treatment for peritoneal mesothelioma, particularly for patients with advanced disease or those who are not candidates for surgery or HIPEC (Hyperthermic Intraperitoneal Chemotherapy). While it is not curative, chemotherapy can:

• Slow tumor growth

• Alleviate symptoms such as abdominal pain and swelling

• Extend survival and improve quality of life

The most widely used first-line regimen is a combination of pemetrexed (Alimta) and cisplatin, which has shown promising results in clinical studies and is considered the standard of care for systemic chemotherapy in peritoneal mesothelioma.

Pemetrexed and Cisplatin: The Standard of Care

The combination of pemetrexed (an antifolate) and cisplatin (a platinum-based agent) has been extensively studied and is recommended for patients with peritoneal mesothelioma. These drugs work together to disrupt cancer cell growth and division:

• Pemetrexed interferes with folate-dependent enzymes that are essential for the production of DNA and RNA. By blocking these enzymes, pemetrexed prevents cancer cells from replicating their genetic material, which is necessary for their growth and division. This mechanism helps slow the spread of the disease and can shrink existing tumors.

• Cisplatin damages the DNA within cancer cells, effectively destroying the "blueprint" they need to survive. Mesothelioma cells, unlike healthy cells, often lack the ability to repair this damage, leading to their destruction. This makes cisplatin a highly effective agent in chemotherapy regimens.

Clinical Outcomes with Systemic Chemotherapy
While systemic chemotherapy is not curative, it provides measurable benefits in disease control and survival for non-surgical candidates. Key outcomes include:

• Median Overall Survival (OS): 11–13 months, reflecting the limited but meaningful extension of life expectancy.

• Progression-Free Survival (PFS): 8–13 months, indicating the duration during which the disease remains stable or does not worsen.

• Disease Control Rate (DCR): Approximately 71%, encompassing patients who achieve complete response, partial response, or stable disease.

• Objective Response Rate (ORR): Around 26%, representing the proportion of patients with significant tumor shrinkage.

What to Expect During Treatment

Patients undergoing chemotherapy with pemetrexed and cisplatin typically receive the treatment on an outpatient basis. The regimen includes:

1. Pre-treatment Medications:

   • Dexamethasone to prevent skin rash.

   • Vitamin B12 and folic acid to reduce side effects.

2. Chemotherapy Administration:

   • Pemetrexed is infused intravenously over 10 minutes.

   • Cisplatin is administered over two hours, accompanied by hydration with saline and electrolytes to protect the kidneys.

3. Supportive Care:

   • Antiemetics are provided to manage nausea and vomiting.

This regimen is generally well-tolerated, though side effects such as fatigue, nausea, and low blood counts may occur. Close monitoring by the healthcare team ensures that side effects are managed effectively.

Considerations and Limitations
Despite its benefits, systemic chemotherapy has limitations:

• Side Effects: The platinum-pemetrexed regimen is associated with significant toxicities, including nausea, fatigue, myelosuppression, and nephrotoxicity (with cisplatin).

• Limited Long-Term Survival: While systemic therapy can extend survival, it does not offer the long-term benefits seen with surgical approaches like CRS-HIPEC in eligible patients.

• Variable Response Rates: Sarcomatoid and biphasic histologies are less responsive to chemotherapy, further limiting its effectiveness in these subtypes.

While systemic chemotherapy provides temporary disease control, it is not curative. Most patients will eventually experience progression. The systemic side effects—such as fatigue, nausea, myelosuppression, and nephrotoxicity—must also be weighed, particularly in frail or elderly patients.

Clinical trials are ongoing to evaluate new systemic agents, combinations, and targeted therapies, which may offer expanded options for those not eligible for surgery.

What It Costs: Pemetrexed + Cisplatin for Peritoneal Mesothelioma

Wholesale Drug Cost (6 Cycles):

The estimated wholesale acquisition cost (WAC) for six cycles of pemetrexed and cisplatin is approximately $38,000–$46,225, depending on the source and healthcare setting. Pemetrexed accounts for the majority of this cost, with cisplatin being significantly less expensive. For example, the cost per 100 mg of pemetrexed is $767.49, while the cost per 100 mg of cisplatin is approximately $19.56. ¹⁸

Hospital/Clinic Billing Per Cycle:

The cost billed by hospitals or clinics for administering each cycle of chemotherapy, including infusion services, typically ranges between $30,000 and $40,000. This includes the cost of the drugs, infusion services, and supportive care medications.

Total Billed Cost for a Full Course:

When factoring in infusion services, side-effect management, and supportive care, the total billed cost for a full six-cycle course often exceeds $100,000. This figure can vary based on the healthcare provider, geographic location, and additional supportive care needs.

Out-of-Pocket Burden:

The out-of-pocket expenses for patients can vary significantly based on several factors:

• Insurance Coverage: The extent of coverage for chemotherapy drugs and associated services.

• Copays and Deductibles: These can substantially influence the financial burden.

• Assistance Programs: Availability of financial assistance or patient support programs can help offset costs.

Additionally, the inclusion of newer agents like bevacizumab in combination with pemetrexed and cisplatin can further increase treatment costs by an estimated $8,160 per month. ¹³

Benefits of Pemetrexed + Cisplatin

Improved Survival:

This combination extends median survival by several months compared to monotherapy. While the survival benefit may seem modest, it can provide patients with more time to spend with loved ones, pursue additional treatments, or enjoy meaningful life experiences.

Symptom Relief:

Pemetrexed and cisplatin help reduce symptoms such as abdominal pain, swelling, and discomfort caused by tumor growth. By slowing tumor progression, this regimen can improve patients' day-to-day quality of life.

Quality of Life Gains:

Patients often report improvements in fatigue, appetite, and overall functioning. These gains can enable them to engage in daily activities and maintain a sense of normalcy during treatment.

Evidence-Backed:

This regimen is supported by extensive clinical research and is included in major treatment guidelines for mesothelioma. It remains the most widely studied chemotherapy approach for this disease.

Gemcitabine and Cisplatin: An Alternative Option

For patients who cannot tolerate pemetrexed due to kidney function issues, low blood counts, or prior adverse reactions, the gemcitabine–cisplatin combination offers a valuable alternative. This regimen combines two agents with complementary mechanisms of action:

• Gemcitabine disrupts DNA replication in cancer cells, halting their growth and division.

• Cisplatin damages the DNA structure directly, enhancing the cytotoxic effect.

While not as extensively studied as pemetrexed-based regimens, gemcitabine and cisplatin have shown response rates of 12% to 48% and median survival ranging from 9.4 to 14.7 months in mesothelioma patients. ¹⁸

What It Costs: Gemcitabine-Based Regimens

Drug Costs Per Cycle:

The cost of gemcitabine-based regimens is generally lower than pemetrexed-based regimens. For example:

• The cost per 200 mg of gemcitabine is approximately $4.11.

• The cost per 100 mg of cisplatin is approximately $19.56.
  This results in a total drug cost per cycle of approximately $5,000–$10,000. 

Hospital Billing Per Cycle:

The hospital or clinic billing for administering gemcitabine-based regimens, including infusion services, typically ranges from $20,000 to $30,000 per cycle.

Supportive Care and Side-Effect Medications:

The average monthly cost for supportive care and medications to manage side effects is estimated at $1,000–$2,000.

Overall Financial Commitment:

While gemcitabine-based regimens are slightly less expensive than pemetrexed-based regimens, they still represent a significant financial burden. The cumulative costs of multiple cycles, supportive care, and infusion services can add up quickly, particularly for uninsured or underinsured patients.

Emerging and Experimental Therapies for Peritoneal Mesothelioma

While Cytoreductive Surgery (CRS) combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) and systemic chemotherapy remain the most reliable treatments for peritoneal mesothelioma, researchers are actively exploring new therapies. These emerging approaches aim to improve outcomes, particularly for patients who are not candidates for surgery or whose disease progresses after initial treatment. Below is an expanded overview of these promising therapies:

Immunotherapy for Peritoneal Mesothelioma

Immunotherapy is a cutting-edge treatment that uses the body’s own immune system to fight cancer. For peritoneal mesothelioma—a rare cancer that develops in the lining of the abdomen—immunotherapy is not yet a standard first-line treatment but is becoming an important option, especially for patients who cannot undergo surgery or whose cancer has worsened after chemotherapy.

When It's Used

Immunotherapy is typically considered in the following scenarios for mesothelioma patients:

1. Second-Line or Later Treatment

   • For patients whose cancer has progressed after standard chemotherapy (e.g., platinum-pemetrexed regimens), immunotherapy offers a potential alternative.

   • Drugs like nivolumab and pembrolizumab have shown efficacy in controlling disease progression in this setting. 

2. Unresectable or Advanced Disease

   • Patients with unresectable mesothelioma (tumors that cannot be surgically removed) may benefit from immunotherapy, either alone or in combination with other treatments.

   • For example, the combination of nivolumab + ipilimumab has been approved as a first-line treatment for unresectable pleural mesothelioma and is being explored for peritoneal disease. 

3. Non-Epithelioid Subtypes

   • Non-epithelioid mesothelioma subtypes, which are less responsive to chemotherapy, may derive greater benefit from immunotherapy. Studies have shown improved survival rates in these patients when treated with immunotherapy-based combinations. 

4. Clinical Trials

   • Patients with peritoneal mesothelioma are often encouraged to participate in clinical trials, as these provide access to cutting-edge treatments and help advance research in this rare disease.

How Does Immunotherapy Work?

Cancer cells, including those in mesothelioma, have clever ways of "hiding" from the immune system. Normally, the immune system patrols the body, looking for and destroying abnormal cells. However, mesothelioma tumors can suppress the immune system, allowing the cancer to grow unchecked. Immunotherapy works by "releasing the brakes" on the immune system, enabling it to recognize and attack cancer cells.

Key Mechanism: Immune Checkpoints

The immune system has natural "checkpoints" that act like brakes to prevent it from attacking healthy cells. Unfortunately, cancer cells exploit these checkpoints to avoid being targeted. Immunotherapy drugs, called immune checkpoint inhibitors, block these checkpoints, restoring the immune system’s ability to fight the cancer.

The two main checkpoints targeted in mesothelioma treatment are:

1. PD-1/PD-L1 Pathway: This pathway helps cancer cells avoid detection by the immune system. Blocking it allows immune cells to recognize and attack the tumor.

2. CTLA-4 Pathway: This pathway dampens the immune response. Inhibiting it boosts the immune system’s ability to fight cancer.

Immunotherapy for Peritoneal Mesothelioma: Costs and Coverage

While immunotherapy is FDA-approved for pleural mesothelioma, it is increasingly used off-label—and through clinical trials—for patients with peritoneal mesothelioma, especially when the disease is unresectable or has recurred after HIPEC and chemotherapy. Immune checkpoint inhibitors like nivolumab (Opdivo) and ipilimumab (Yervoy) are showing promise in extending survival, particularly in patients with non-epithelioid histology or limited remaining treatment options.

But this hope comes at a high financial cost.

What Immunotherapy Costs

Cost Per Cycle:

• Nivolumab + Ipilimumab: ~$38,450 per cycle; ~$153,800 for four cycles

• Nivolumab alone: ~$87,000 for four cycles

Additional Costs:

• Infusion center charges, side effect management, and lab monitoring can add thousands of dollars per month.

• Even insured patients often face high co-pays, sometimes requiring manufacturer or charity copay assistance programs.

Immunotherapy vs. Other Treatments

Checkpoint inhibitors are among the most expensive components of peritoneal mesothelioma care—particularly when given over many months. And yet, for some patients, they are the only viable option left. Their use is growing, especially in clinical trials or compassionate-use settings where traditional treatments have failed.

Legal Action Can Help Cover These Costs

Most of our clients don’t file lawsuits for the money—they do it for the medical options. Many forms of insurance won't fully cover immunotherapy unless it's FDA-approved for the specific cancer type. And some patients are simply denied access to clinical trials due to geographic or financial limitations.

But asbestos lawsuits and trust fund claims can help change that:

• Medical expenses are never capped, even in states that limit pain and suffering awards.

• Settlement funds can be used for out-of-pocket expenses, travel to major cancer centers, or cutting-edge treatments like immunotherapy.

• We often advance expenses to help clients access the care they deserve—without delay.

Call 833-4-ASBESTOS to learn how we can help you access immunotherapy and other advanced treatments for peritoneal mesothelioma, without financial roadblocks.

What the Research Shows About Immunotherapy & Mesothelioma

Although research on immunotherapy for peritoneal mesothelioma is still in its early stages, findings from related studies and clinical trials offer promising insights. Immunotherapy appears to be particularly beneficial for patients with non-epithelioid tumors (a more aggressive subtype) or cancers that express high levels of PD-L1, a protein that tumors use to evade the immune system. These factors may help identify patients who are more likely to respond to treatment.

Key Clinical Trials and Findings

1. Keynote 28 Trial

   • This trial evaluated pembrolizumab (Keytruda), a PD-1 inhibitor, in mesothelioma patients whose tumors expressed PD-L1 (≥1%).

   • Results showed that 72% of patients experienced disease stabilization or tumor shrinkage, and 20% had a measurable reduction in tumor size.

   • These findings highlight the potential of pembrolizumab to control disease progression in mesothelioma patients with PD-L1 expression. ⁶

2. CheckMate 743 Trial

   • This study focused on pleural mesothelioma and tested a combination of nivolumab (Opdivo) and ipilimumab (Yervoy), targeting both PD-1 and CTLA-4 pathways.

   • Patients treated with this combination had a median overall survival of 15.9 months, compared to 14.1 months for those receiving standard chemotherapy.

   • While this trial was conducted in pleural mesothelioma, the immune pathways targeted are also relevant to peritoneal mesothelioma, suggesting that similar benefits may be observed in abdominal disease. ⁷

Ongoing Research

Several ongoing clinical trials are now investigating immunotherapy specifically for peritoneal mesothelioma. These studies aim to determine:

• Whether certain tumor types (e.g., epithelioid vs. non-epithelioid) respond better to treatment.

• The role of genetic or molecular markers, such as PD-L1 expression, in predicting treatment success.

• Optimal combinations of immunotherapy drugs to maximize effectiveness while minimizing side effects.

Targeted Therapies for Peritoneal Mesothelioma

Targeted therapies are designed to attack specific genetic or molecular features of cancer cells. Researchers are identifying vulnerabilities in mesothelioma tumors that could be exploited by these drugs. Some of the most promising areas of investigation include:

a. ALK (Anaplastic Lymphoma Kinase) Fusions

• Rare genetic changes, such as STRN-ALK rearrangements, have been identified in some mesothelioma cases.

• Case reports suggest that Alectinib, an ALK inhibitor, may be effective in treating tumors with these mutations.

b. EZH2 Inhibitors

• These drugs target EZH2, an epigenetic regulator that is overexpressed in some mesotheliomas. By inhibiting EZH2, these therapies may slow tumor growth.

c. PARP Inhibitors

• PARP inhibitors are being explored for tumors with DNA repair deficiencies, which make cancer cells more vulnerable to this type of treatment.

d. CDK4/6 Inhibitors

• These drugs may slow tumor proliferation by targeting the cyclin pathway, which is often altered in mesothelioma.

While these therapies are still in the experimental stage, they represent a growing area of research and are being tested in clinical trials for both peritoneal and pleural mesothelioma.

Intraperitoneal Maintenance Therapies

Some institutions are investigating the use of intraperitoneal maintenance therapies to improve outcomes after CRS-HIPEC. These strategies include:

• Early Postoperative Intraperitoneal Chemotherapy (EPIC): Administered shortly after surgery to target any remaining cancer cells.

• Intraperitoneal Maintenance Therapy: Delivered over a longer period to prevent recurrence by eradicating microscopic residual disease.

Although these approaches are not yet standard practice, they aim to delay disease recurrence and improve long-term survival. However, more robust clinical data are needed to establish their effectiveness.

Clinical Trials in 2025

Patients with peritoneal mesothelioma—especially those with relapsed or unresectable disease—are encouraged to consider clinical trials. Access to experimental therapies is often limited outside of these studies, and participation may offer the opportunity to receive cutting-edge treatments not otherwise available.

To find active trials, patients and physicians can consult clinicaltrials.gov or work with major cancer centers and HIPEC programs.

Prognosis by Treatment Type for Peritoneal Mesothelioma in 2025

The prognosis for patients with peritoneal mesothelioma has improved substantially in recent years—particularly for those able to undergo cytoreductive surgery with HIPEC. However, survival outcomes remain closely tied to tumor burden, histologic subtype, treatment strategy, and the quality of care received.

The type of treatment a patient receives is the most important factor in determining how long they might live after being diagnosed with peritoneal mesothelioma. Here’s a breakdown of the main treatment options and their associated survival outcomes:

1. CRS-HIPEC (Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy)

• What it is: This is an aggressive treatment that involves surgically removing as much of the cancer as possible (cytoreduction) and then bathing the abdominal cavity with heated chemotherapy to kill any remaining cancer cells.

• Survival outcomes:

  • Median overall survival (OS): About 44.6 months (nearly 4 years).

  • 1-year survival rate: Up to 93% of patients are alive one year after treatment.

  • 3-year survival rate: Patients with a low tumor burden (measured by the Peritoneal Cancer Index, or PCI) and a specific type of cancer cell (epithelioid histology) tend to do much better.

• Why it works: This approach is most effective when the cancer is caught early and the surgeon can remove nearly all visible tumors (referred to as CC-0 or CC-1 cytoreduction).

2. Systemic Chemotherapy (for Non-Surgical Candidates)

• What it is: This involves using drugs that circulate throughout the body to kill cancer cells. It is typically used for patients who cannot undergo surgery due to the extent of their disease or other health issues.

• Survival outcomes:

  • Median OS: 11–13 months (less than 1.5 years).

  • 1-year survival rate: About 50% of patients survive one year after starting treatment.

• Why it’s less effective: Chemotherapy alone cannot remove large tumors or target cancer cells as precisely as CRS-HIPEC. It is often used to slow the progression of the disease rather than cure it.

3. Untreated Patients

• What it is: Some patients cannot receive any treatment due to severe health problems (comorbidities) or because their cancer is too advanced.

• Survival outcomes:

  • Median OS: Less than 6 months.

• Why survival is so short: Without treatment, the cancer progresses rapidly, causing complications that can lead to death.

Prognostic Scores and Risk Stratification

Doctors use specific scoring systems to predict how well a patient might do with treatment. These scores help guide decisions about whether a patient is a good candidate for CRS-HIPEC or other therapies.

1. Peritoneal Cancer Index (PCI)

• What it is: A score that measures the extent of cancer spread in the abdominal cavity. The higher the score, the more widespread the disease.

• Why it matters:

  • A low PCI (especially <20) is associated with much better survival outcomes.

  • A high PCI often means that surgery is unlikely to remove all the cancer, making CRS-HIPEC less effective.

2. Completeness of Cytoreduction (CC) Score

• What it is: A score that measures how much cancer remains after surgery.

  • CC-0: No visible cancer remains.

  • CC-1: Only tiny cancer deposits remain (less than 2.5 mm).

  • CC-2/3: Larger cancer deposits remain.

• Why it matters:

  • Patients with CC-0 resections have the longest survival because all visible cancer has been removed.

  • Patients with CC-2/3 resections have poor outcomes because the remaining cancer grows back quickly.

3. Performance Status (ECOG Score)

• What it is: A measure of how well a patient can perform daily activities.

  • ECOG 0–1: Patients are fully active or only slightly limited in their activities.

  • ECOG 2 or higher: Patients are more limited and may not tolerate aggressive treatments well.

• Why it matters: Patients with better performance status generally live longer and respond better to treatment.

4. Recurrence-Free Interval

• What it is: The amount of time a patient remains cancer-free after treatment.

• Why it matters:

  • Patients who remain disease-free for 12 months or longer after CRS-HIPEC tend to have better survival if the cancer comes back.

  • A short recurrence-free interval often indicates more aggressive disease.

Factors That Affect Prognosis

Peritoneal mesothelioma affects each person differently, and survival can vary a lot from one patient to another. While the type of treatment plays the biggest role in shaping outcomes, other important factors—like your overall health, tumor type, and access to expert care—also make a difference. Understanding what affects your prognosis can help you and your family make informed decisions, set realistic expectations, and feel more in control of your care.

Histologic Subtype

• Epithelioid mesothelioma is associated with the best prognosis. It is more responsive to surgery and chemotherapy and has a slower progression rate.

• Biphasic tumors contain both epithelioid and sarcomatoid elements and have an intermediate prognosis.

• Sarcomatoid mesothelioma is the most aggressive subtype, often resistant to chemotherapy and considered a contraindication for curative surgery. Patients with this subtype tend to have the shortest survival. ¹

Tumor Burden (PCI Score)

The Peritoneal Cancer Index (PCI) quantifies the extent of disease within the abdomen. Lower scores correlate with:

• A higher likelihood of achieving complete cytoreduction

• Reduced recurrence risk

• Significantly longer survival

A PCI under 20 is generally considered favorable for CRS-HIPEC candidacy

Completeness of Cytoreduction (CC Score)

Even among patients undergoing surgery, the Completeness of Cytoreduction (CC) score is a powerful predictor:

• CC-0 or CC-1 (no visible disease or residual tumor ≤2.5 mm): associated with the longest survival

• CC-2 or CC-3 (larger residual tumors): associated with earlier recurrence and poorer outcomes

Performance Status

A patient's functional capacity—usually measured by the ECOG (Eastern Cooperative Oncology Group) scale—strongly influences prognosis:

• ECOG 0–1: better tolerance of treatment and longer survival

• ECOG 2 or higher: increased risk of complications, poorer response, and often ineligibility for surgery

This is one reason many patients at academic centers—where earlier diagnoses and more aggressive treatment are feasible—have better outcomes. ⁴

Age and Gender

• Younger patients (<65) tend to have better outcomes, likely due to better treatment tolerance.

• Some studies suggest female patients may have slightly better survival, though this may reflect differences in tumor biology or earlier detection rather than gender itself.

Ascites and Nutritional Status

• The presence of ascites (fluid accumulation) often reflects advanced disease and correlates with poorer outcomes.

• Malnutrition and unintentional weight loss reduce a patient’s ability to recover from surgery and tolerate chemotherapy and are associated with shorter survival.

Treatment Setting

As discussed earlier, patients treated at high-volume academic centers benefit from better access to CRS-HIPEC, multidisciplinary care, and emerging therapies. Outcomes are significantly improved in these settings compared to community hospitals. ⁴

Access to Treatment and the Role of High-Volume Centers

Peritoneal mesothelioma is a rare and aggressive cancer that develops in the lining of the abdomen. Because of its rarity and complexity, it requires highly specialized and personalized care, which is best provided by experienced multidisciplinary teams at academic or referral centers. These centers are equipped with the expertise and resources necessary to offer advanced treatments and comprehensive care. Here's a breakdown of what they provide:

1. Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy (CRS-HIPEC):
   This is a highly specialized surgical procedure performed by experienced surgical oncologists. It involves removing visible tumors from the abdominal cavity (cytoreductive surgery) and then delivering heated chemotherapy directly into the abdomen (HIPEC) to target any remaining microscopic cancer cells. This approach has been shown to improve survival in selected patients.

2. Accurate Histologic Diagnosis:
   Specialized pathology services at these centers ensure an accurate diagnosis by analyzing the cancer's specific characteristics under a microscope. This is crucial because treatment decisions often depend on the precise type and subtype of mesothelioma.

3. Tailored Chemotherapy Protocols:
   Chemotherapy regimens are customized to the patient's needs. This may include neoadjuvant chemotherapy (given before surgery to shrink tumors) or intraperitoneal chemotherapy (delivered directly into the abdominal cavity). These tailored approaches maximize effectiveness while minimizing side effects.

4. Access to Clinical Trials and Emerging Treatments:
   Academic and referral centers often participate in cutting-edge research, offering patients access to clinical trials for new therapies. These may include immunotherapy (which boosts the immune system to fight cancer) or targeted agents (which attack specific cancer cells while sparing healthy tissue).

5. Comprehensive Supportive Care:
   These centers provide a holistic approach to care, with teams that include nutritionists, physical therapists, and palliative care specialists. This ensures that patients receive support for their physical, emotional, and nutritional needs throughout their treatment journey.

6. Tumor Boards for Collaborative Decision-Making:
   Complex cases are reviewed in tumor boards—multidisciplinary meetings where experts from various specialties (e.g., surgeons, oncologists, radiologists, and pathologists) collaborate to determine the best treatment plan for each patient. This ensures that all aspects of the patient's condition are considered, leading to a more informed and effective care strategy.

By centralizing care at these specialized centers, patients with peritoneal mesothelioma benefit from a coordinated and expert-driven approach, which can improve outcomes and quality of life. ⁵ 

Survivorship and Follow-Up Care

For patients who undergo successful treatment—especially those who receive CRS-HIPEC and achieve a complete cytoreduction—life after mesothelioma can include years of meaningful survival. However, long-term monitoring and supportive care remain essential. Even patients with excellent initial response face the risk of recurrence, and survivorship brings its own physical, emotional, and logistical challenges.

Monitoring for Recurrence

Peritoneal mesothelioma has a high recurrence rate, even after aggressive treatment. Surveillance typically includes:

• Regular physical exams

• Imaging every 3–6 months during the first 2–3 years (often contrast-enhanced CT or MRI)

• Tumor marker tracking, where applicable (though not always reliable)

• Prompt evaluation of any new abdominal symptoms, especially pain, bloating, weight loss, or ascites

Recurrences are most often local (within the peritoneal cavity), but can occasionally involve distant sites like the chest, lymph nodes, or even the brain..

Post-Recurrence Outcomes

While recurrence is common, it is not always an end-of-options event:

• 75% of patients with recurrence after CRS-HIPEC at one center went on to receive additional treatment

• Median post-recurrence survival: ~14.4 months

• Factors predicting better post-recurrence survival:

  • A disease-free interval >12 months

  • Good performance status (ECOG 0–1)

  • Access to salvage therapies (e.g., second surgery, chemotherapy, immunotherapy)

Patients who initially underwent surgery and had a good response often tolerate recurrence treatment better than those who were inoperable at diagnosis.

Supportive and Rehabilitative Care

Survivorship also means addressing the long-term effects of treatment and the disease itself:

• Digestive issues: Changes in bowel function, adhesions, or nutritional deficiencies

• Fatigue and deconditioning: Especially after major surgery or chemotherapy

• Emotional health: Anxiety around recurrence is common, and survivors often benefit from counseling or peer support

• Financial and legal stress: Especially if income was lost during treatment or if travel was required to reach a specialized center

A structured survivorship plan—developed in collaboration with your oncology team—can help anticipate and manage these issues.

Living With Uncertainty

While some long-term survivors go years without recurrence, mesothelioma is rarely considered “cured.” Still, with careful monitoring, access to experienced specialists, and individualized treatment planning, many patients live far longer—and better—than earlier statistics suggested. Survivorship in 2025 means both vigilance and hope.

How We Help Families Affected by Peritoneal Mesothelioma

A diagnosis of peritoneal mesothelioma can feel overwhelming—but you don’t have to go through it alone. Our firm was founded by an attorney whose own family was deeply affected by asbestos-related cancer. We’ve spent years helping families like yours access the care they need and the compensation they deserve. We understand how devastating this disease can be—physically, emotionally, and financially—and our mission is to lift as much of that burden as we can.

Accessing Expert Care for Peritoneal Mesothelioma

When it comes to peritoneal mesothelioma, where you receive care can make all the difference. The best outcomes are seen at specialized cancer centers with experience in treating this rare disease—especially those that offer cytoreductive surgery (CRS) and HIPEC, the gold-standard treatment for eligible patients.

But getting to one of these centers isn't always simple.

That’s where we come in.

Many of the families we work with live hours—or even states—away from major HIPEC centers. If that’s the case for you, we can help with:

• Advancing the cost of travel and lodging so you can stay near a hospital that performs CRS-HIPEC

• Coordinating medical records and specialist referrals to streamline the intake process

• Helping schedule consultations with top peritoneal mesothelioma surgeons and oncology teams

• Finding clinical trials or new therapies that may be appropriate for your diagnosis

For many of our clients, getting legal help wasn’t about the money—it was about opening the door to better treatment. Financial compensation can help you access care that isn’t covered by insurance or available locally—and that difference can be life-changing.

Using Legal Compensation to Fund Treatment

You may be entitled to compensation from asbestos trust funds, lawsuits, or VA benefits. This support can help cover essential medical costs, such as:

• Travel and lodging for treatment at a specialized hospital

• In-home care, caregiving assistance, or medical equipment

• Copays and deductibles for expensive drugs or procedures

• Off-label or experimental therapies, including immunotherapy or precision-guided chemotherapy

We also help veterans coordinate VA healthcare alongside trust or lawsuit compensation, so they can broaden their treatment options without losing eligibility for their benefits.

You only get one shot at the best possible treatment. Let us help you make it count.

Call 833-4-ASBESTOS for a free consultation and personalized support. There’s no pressure to file—just help, guidance, and answers for you and your family.

Why Families Trust Us with Peritoneal Mesothelioma Cases

We understand what you're going through.
Our founding attorney has felt the impact of asbestos-related cancer personally—losing his grandfather, father, and grandmother to diseases caused by asbestos exposure. That experience drives how we approach every case: with urgency, compassion, and relentless dedication to getting families the answers and justice they deserve.

We bring unmatched resources to the table.
Over the past decade, we’ve built one of the most comprehensive asbestos litigation databases in the country—containing millions of pages of corporate documents, medical studies, jobsite records, and legal filings. We use this deep knowledge to uncover exposure history, identify liable parties, and pursue every available source of compensation for our clients.

We handle the hard stuff—so you don’t have to.
A diagnosis of peritoneal mesothelioma is overwhelming enough without legal paperwork and evidence gathering. That’s why we take care of it all:

• Requesting medical records

• Documenting past job history and military service

• Identifying where and how asbestos exposure occurred

• Working with expert witnesses and investigators to build your claim

You focus on your care—we’ll handle the rest.

We help clients across the U.S.
No matter where you live or where you were exposed—whether in a shipyard, oil refinery, industrial kitchen, or your own home—we can help. We maintain offices in California, Texas, Arizona, and Washington, and we work with clients nationwide through phone, video, and secure online tools. Prefer to meet in person? We’ll come to you, at no cost.

No fees unless we win.
You never pay out-of-pocket. We front all legal costs—including court fees, expert witnesses, and travel. We only get paid if we recover money for you. With over $400 million secured for asbestos victims and their families, we have the experience and resources to fight—and win.

A Path Forward for You and Your Family

Your doctors are focused on your treatment. Let us focus on your financial future.

We’ll help you understand your legal options, identify trust funds or companies responsible for your exposure, and fight to make sure you get the support you need to focus on healing—not medical bills.

Contact us today for a free consultation. There’s no obligation, and every conversation is 100% confidential.

References:

• 1. Yaşar, S., Yılmaz, F., Utkan, G., Algın, E., Bayram, D., Tamam, S., Çakmak Öksüzoğlu, Ö. B., İlhan, A., Erdat, E. C., Ünal, A. E., & Yalçın, Ş. (2024). Analysis of treatment strategies and outcomes in malignant peritoneal mesothelioma: Insights from a multi-center study. Annals of Surgical Oncology, 31(9), 6228–6236. https://doi.org/10.1245/s10434-024-15506-3

• 2. Malekzadeh, P., Good, M., & Hughes, M. S. (2021). Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin in pediatric patients with peritoneal mesothelioma: A single institution experience and long term follow-up. International Journal of Hyperthermia, 38(1), 326–331. https://doi.org/10.1080/02656736.2020.1858194

• 3. Ray, M. D., & Dhall, K. (2021). Hyperthermic intraperitoneal chemotherapy (HIPEC) in the management of peritoneal surface malignancies – An evidence-based review. Current Problems in Cancer, 45(3), 100737. https://doi.org/10.1016/j.currproblcancer.2021.100737

• 4. Welten, V. M., Fields, A. C., Malizia, R. A., Yoo, J., Irani, J. L., Goldberg, J. E., & Melnitchouk, N. (2021). Survival outcomes for malignant peritoneal mesothelioma at academic versus community hospitals. Journal of Gastrointestinal Surgery. https://doi.org/10.1007/s11605-021-05084-0

• 5. Brandl, A., Westbrook, S., Nunn, S., Arbuthnot-Smith, E., Mulsow, J., Youssef, H., Carr, N., Tzivanakis, A., Dayal, S., Mohamed, F., Moran, B. J., & Cecil, T. (2020). Clinical and surgical outcomes of patients with peritoneal mesothelioma discussed at a monthly national multidisciplinary team video-conference meeting. BJS open, 4(2), 260–267. https://doi.org/10.1002/bjs5.50256

• 6. Dumoulin, D. W., Aerts, J. G., & Cornelissen, R. (2017). Is immunotherapy a viable option in treating mesothelioma? Future Oncology, 13(20), 1747–1750. https://doi.org/10.2217/fon-2017-0234

• 7. Cui, W., Popat, S. Immune Checkpoint Inhibition for Unresectable Malignant Pleural Mesothelioma. Drugs 81, 971–984 (2021). https://doi.org/10.1007/s40265-021-01506-0

• 8. Salo, S. A. S., Ilonen, I., Laaksonen, S., Myllärniemi, M., Salo, J. A., & Rantanen, T. (2019). Malignant Peritoneal Mesothelioma: Treatment Options and Survival. Anticancer research, 39(2), 839–845. https://doi.org/10.21873/anticanres.13183

• 9. Brustugun, O. T., Nilssen, Y., & Eide, I. J. Z. (2021). Epidemiology and outcome of peritoneal and pleural mesothelioma subtypes in Norway. A 20 year nation-wide study. Acta oncologica (Stockholm, Sweden), 60(10), 1250–1256. https://doi.org/10.1080/0284186X.2021.1955971

• 10. Kindler H. L. (2013). Peritoneal mesothelioma: the site of origin matters. American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting, 182–188. https://doi.org/10.14694/EdBook_AM.2013.33.182

• 11. Guzmán-Casta, J., Carrasco-CaraChards, S., Guzmán-Huesca, J., Sánchez-Ríos, C. P., Riera-Sala, R., Martínez-Herrera, J. F., Peña-Mirabal, E. S., Bonilla-Molina, D., Alatorre-Alexander, J. A., Martínez-Barrera, L. M., & Rodríguez-Cid, J. R. (2021). Prognostic factors for progression-free and overall survival in malignant pleural mesothelioma. Thoracic cancer, 12(7), 1014–1022. https://doi.org/10.1111/1759-7714.13814

• 12. Kusamura, S., Kepenekian, V., Villeneuve, L., Lurvink, R. J., Govaerts, K., De Hingh, I. H. J. T., Moran, B. J., Van der Speeten, K., Deraco, M., Glehen, O., & PSOGI (2021). Peritoneal mesothelioma: PSOGI/EURACAN clinical practice guidelines for diagnosis, treatment and follow-up. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 47(1), 36–59. https://doi.org/10.1016/j.ejso.2020.02.011

• 13. Borrelli E, Babcock Z, Kogut S. Costs of medical care for mesothelioma. Rare Tumors. 2019;11:2036361319863498. doi:10.1177/2036361319863498

• 14. Welten, V. M., Fields, A. C., Malizia, R. A., Yoo, J., Irani, J. L., Goldberg, J. E., Bleday, R., & Melnitchouk, N. (2022). Survival Outcomes for Malignant Peritoneal Mesothelioma at Academic Versus Community Hospitals. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 26(1), 161–170. https://doi.org/10.1007/s11605-021-05084-0

• 15. Bagnoli, P. F., Cananzi, F. C., Brocchi, A., Ardito, A., Strada, D., Cozzaglio, L., Mussi, C., Brusa, S., Carlino, C., Borrelli, B., Alemanno, F., & Quagliuolo, V. (2015). Peritonectomy and hyperthermic intraperitoneal chemotherapy: cost analysis and sustainability. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 41(3), 386–391. https://doi.org/10.1016/j.ejso.2014.12.004

• 16. Verma, V., Sleightholm, R. L., Rusthoven, C. G., Koshy, M., Sher, D. J., Grover, S., & Simone, C. B., 2nd (2018). Malignant Peritoneal Mesothelioma: National Practice Patterns, Outcomes, and Predictors of Survival. Annals of surgical oncology, 25(7), 2018–2026. https://doi.org/10.1245/s10434-018-6499-1

• 17. Sugarbaker, P. H., Turaga, K. K., Alexander, H. R., Jr, Deraco, M., & Hesdorffer, M. (2016). Management of Malignant Peritoneal Mesothelioma Using Cytoreductive Surgery and Perioperative Chemotherapy. Journal of oncology practice, 12(10), 928–935. https://doi.org/10.1200/JOP.2016.011908

• 18. Borrelli, E. P., & McGladrigan, C. G. (2021). A Review of Pharmacologic Management in the Treatment of Mesothelioma. Current treatment options in oncology, 22(2), 14. https://doi.org/10.1007/s11864-020-00807-y