Peritoneal Mesothelioma Treatments and Prognosis

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.

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

Systemic Chemotherapy for Non-Surgical Candidates

For patients with peritoneal mesothelioma who are not candidates for surgery, systemic chemotherapy remains the cornerstone of treatment. Several factors may render patients ineligible for surgical intervention, including:

• Extensive Tumor Spread: Advanced disease with high tumor burden often precludes complete cytoreduction.

• Poor Performance Status: Patients with low functional capacity or high ECOG scores are less likely to tolerate aggressive surgical procedures.

• Sarcomatoid Histology: This subtype is associated with poor prognosis and limited response to surgical approaches.

• Medical Comorbidities: Conditions such as severe cardiovascular or renal disease may increase surgical risks, making systemic therapy the safer option.

For these patients, systemic chemotherapy is primarily palliative, aiming to control disease progression, alleviate symptoms, and improve quality of life.

Standard Chemotherapy Regimen
The first-line systemic chemotherapy regimen for peritoneal mesothelioma typically includes a combination of:

• Pemetrexed: This drug works by interfering with the building blocks that cells need to make DNA. DNA is like the instruction manual for cells, and without it, cells can’t grow or divide properly. Cancer cells, which grow and divide much faster than normal cells, are especially affected by this disruption.

• Cisplatin: This is a powerful drug made from platinum. It works by attaching itself to the DNA inside cancer cells, creating "crosslinks" that tangle up the DNA. This damage prevents the cancer cells from copying their DNA and dividing, which eventually causes them to die.

  • Carboplatin: This drug is similar to cisplatin but is gentler on the kidneys. It’s often used instead of cisplatin for patients who have kidney problems, as it causes less damage to the kidneys while still being effective at targeting cancer cells.

This platinum-pemetrexed combination, originally established for pleural mesothelioma, has shown consistent efficacy across mesothelioma subtypes, including peritoneal mesothelioma.

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.

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.

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.

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.

Common Immunotherapy Drugs for Mesothelioma

Several drugs have been developed to target these pathways, and they are showing promise in treating mesothelioma. Here are the most commonly used ones:

1. Nivolumab (Opdivo):

   • A drug that blocks the PD-1 pathway, helping immune cells detect and destroy cancer cells.

2. Pembrolizumab (Keytruda):

   • Another PD-1 inhibitor, similar to nivolumab, that enhances the immune system’s ability to fight cancer.

3. Ipilimumab (Yervoy):

   • A drug that targets the CTLA-4 pathway, boosting the immune system’s activity against cancer.

Combination Therapies

In some cases, these drugs are used together for a stronger effect. For example, the combination of nivolumab + ipilimumab has shown improved survival in patients with pleural mesothelioma (a related type of mesothelioma affecting the lungs) and is now being tested for peritoneal mesothelioma in clinical trials.

What the Research Shows

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.

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.

Summary of Benefits and Challenges of Immunotherapy

Benefits:

• Immunotherapy offers a new avenue of treatment for patients with limited options, particularly those with advanced or recurrent disease.

• It has shown the potential to improve survival and control disease progression, especially in patients with high PD-L1 expression or non-epithelioid tumors.

Challenges:

• Not all patients respond to immunotherapy, and identifying predictive biomarkers remains a key area of research.

• Side effects, such as immune-related toxicities, can occur but are generally manageable with supportive care.

As research progresses, immunotherapy is expected to play an increasingly important role in the treatment of peritoneal mesothelioma, offering hope to patients with this challenging disease.

Targeted Therapies

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 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.

Survival by Treatment Type

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.

Medical Treatment Center Experience Matters

The expertise and resources of the treating facility play a major role in peritoneal mesothelioma outcomes. Studies have shown a clear survival advantage for patients treated at high-volume academic centers compared to those treated in community settings.

• 5-year overall survival (OS) at academic centers: 29.7%

• 5-year OS at community hospitals: 18.3% ⁴

Academic centers are more likely to offer specialized procedures like cytoreductive surgery with HIPEC, as well as same-day chemotherapy delivery, which may represent intraperitoneal HIPEC administration during surgery. These therapies have been shown to improve survival, particularly when performed by experienced teams. Patients at academic facilities are also more likely to undergo tumor debulking or radical resections—procedures that significantly impact long-term prognosis.

Beyond surgical expertise, academic centers typically have access to:

• Dedicated mesothelioma care teams

• Advanced imaging and pathology support

• Access to clinical trials and experimental treatments

• Multidisciplinary tumor boards that guide care planning

This disparity in access and survival has important implications not only for clinical outcomes, but also for legal and financial matters. Many individuals with peritoneal mesothelioma were exposed to asbestos through no fault of their own—and if they lack access to high-quality care due to cost or location, the legal system may be one of the only avenues to secure compensation and afford treatment at leading institutions.

Factors That Affect Outcome

Peritoneal mesothelioma is a heterogeneous disease, and survival varies widely between individuals. While treatment modality is the most significant predictor of prognosis, multiple biological, clinical, and logistical factors also influence the course of the disease. Understanding these variables is crucial for guiding treatment decisions and setting expectations for patients and families.

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 

The Data on Survival

The survival outcomes for patients with malignant peritoneal mesothelioma (MPM) differ significantly depending on whether they are treated at academic centers or community hospitals. This disparity highlights the importance of specialized care and access to advanced treatment options. Below is a detailed explanation of the survival data and contributing factors:

1. 5-Year Overall Survival (OS):

   • At academic centers, the 5-year overall survival rate is 29.7%

   • At community hospitals, the 5-year overall survival rate is significantly lower at 18.3%

     • This stark difference underscores the critical role that academic centers play in improving long-term outcomes for patients with MPM. ¹

2. Access to CRS-HIPEC:
   Patients treated at academic centers are more than twice as likely to undergo Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy (CRS-HIPEC) compared to those treated at community hospitals. CRS-HIPEC is considered the best treatment for MPeM, offering a significant survival benefit by combining tumor removal with targeted chemotherapy delivery directly into the abdominal cavity. The higher rates of CRS-HIPEC at academic centers are likely due to the availability of experienced surgical oncologists and specialized facilities. 

3. Integrated Chemotherapy Delivery:
   Patients at academic centers are also significantly more likely to receive chemotherapy on the same day as surgery, which serves as a proxy indicator for integrated HIPEC delivery. This integrated approach ensures that chemotherapy is administered in a timely and effective manner, maximizing its impact on residual cancer cells. In contrast, community hospitals often lack the infrastructure or expertise to provide such coordinated care. ¹

4. Multidisciplinary Expertise:
   The improved survival outcomes at academic centers can also be attributed to the presence of multidisciplinary teams, including surgical oncologists, medical oncologists, pathologists, and supportive care specialists. These teams collaborate to develop personalized treatment plans, ensuring that patients receive the most effective and comprehensive care possible. Additionally, academic centers are more likely to have access to clinical trials and emerging therapies, further enhancing survival prospects.

5. Histologic Subtypes and Prognosis:
   The type of mesothelioma histology also plays a role in survival outcomes. Academic centers are more likely to have specialized pathology services capable of accurately diagnosing histologic subtypes, such as epithelioid mesothelioma, which is associated with a better prognosis. In contrast, community hospitals may have a higher proportion of patients with mesothelioma NOS (not otherwise specified), making it difficult to tailor treatment effectively.

The data clearly demonstrate that patients with malignant peritoneal mesothelioma have significantly better survival outcomes when treated at academic centers compared to community hospitals. This is largely due to the availability of advanced treatments like CRS-HIPEC, integrated chemotherapy delivery, and the expertise of multidisciplinary teams. For patients with this rare and aggressive cancer, seeking care at an experienced academic or referral center can make a substantial difference in both survival and quality of life.

Barriers to Access

Unfortunately, not every patient can easily access this level of care. Barriers may include:

• Geographic distance from specialty centers

• Insurance restrictions or out-of-network treatment costs

• Lack of financial resources for travel, lodging, or time off work

• Physician referral gaps, especially in areas where mesothelioma is less well understood

These disparities can directly affect survival, and they disproportionately affect patients in rural areas, those without strong support systems, and individuals from lower-income backgrounds.

How Legal Compensation Can Help

Many patients developed peritoneal mesothelioma as a result of occupational asbestos exposure—often decades earlier. As a result, they may be entitled to financial compensation from asbestos trust funds or through litigation. This compensation can be a critical lifeline, covering:

• Travel and lodging to reach a high-volume center

• Treatment not covered by insurance

• Lost wages and long-term care expenses

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.

Cost of Care and Financial Considerations for Peritoneal Mesothelioma

The financial burden of treating peritoneal mesothelioma can be significant. Even with health insurance, many patients face steep out-of-pocket costs for hospitalization, surgery, chemotherapy, imaging, and long-term follow-up. Because peritoneal mesothelioma is so rare, effective treatment often means traveling to a specialized cancer center for procedures like CRS-HIPEC. These complex, lifesaving therapies are expensive—and frequently out of reach for patients without financial assistance.

Hospitalization and Treatment Costs

Peritoneal mesothelioma typically requires a combination of intensive surgery and heated chemotherapy. The average hospital stay for CRS-HIPEC often exceeds a week, and the total bill—including surgery, ICU care, and inpatient chemotherapy—can easily reach $100,000 or more.

Treatment costs vary depending on the specifics of care:

• Chemotherapy agents like pemetrexed and cisplatin may cost over $38,000 for a standard multi-cycle course.

• Adding newer or experimental agents—such as immunotherapies or targeted drugs—can raise drug-related costs to $100,000 or more annually.

• CRS-HIPEC, while often performed as a single hospitalization, is a highly specialized procedure with operating room and oncologic pharmacy costs far above average.

Most insurance plans cover standard chemotherapy and inpatient surgery, but may not fully cover travel, advanced imaging, or the full cost of extended hospitalization.

Hidden Costs That Add Up

In addition to direct treatment expenses, patients and caregivers face a range of indirect financial burdens:

• Maintenance therapy: Some patients continue systemic or intraperitoneal chemotherapy after initial treatment, often at their own expense.

• Post-op recovery support: Nutritional supplements, physical therapy, and ostomy supplies may not be fully covered.

• Travel and lodging: CRS-HIPEC is typically performed at a limited number of academic centers. Patients often need to travel—and stay—far from home for surgery and follow-up.

• Lost wages: Patients and caregivers frequently miss weeks or months of work during treatment and recovery.

These costs can easily add up to tens of thousands of dollars—and for many families, they arrive just as income is reduced.

Legal and Financial Support Options

Fortunately, patients with peritoneal mesothelioma often qualify for financial compensation due to asbestos exposure—even if that exposure occurred decades ago.

Asbestos Trust Funds

Many companies that used or sold asbestos-containing products filed for bankruptcy in the 1990s and 2000s. As part of their reorganization, they were required to establish trust funds to compensate victims. These trusts are still active today and have collectively paid out billions of dollars in claims.

If your peritoneal mesothelioma was caused by exposure to asbestos—whether through industrial work, household contact, or contaminated consumer products—you may be eligible to file claims with one or more trusts. These funds can help cover treatment, travel, lost income, and long-term care expenses.

Lawsuits Against Responsible Companies

In addition to trust funds, some patients may be able to file lawsuits against companies that are still operating today. These legal claims often result in confidential settlements and can be pursued even if the exposure happened 30–50 years ago. Many cases resolve without ever going to court.

Government Benefits and Private Support

• Veterans who were exposed to asbestos during military service may be eligible for VA benefits, including monthly compensation and free or low-cost treatment at VA facilities.

• The Social Security Administration recognizes peritoneal mesothelioma as a qualifying condition for fast-tracked disability benefits through its Compassionate Allowances program. These benefits may include monthly income and early access to Medicare.

• Some pharmaceutical companies offer copay assistance programs or patient assistance funds, particularly for high-cost drugs like immunotherapy agents.

How We Help Families Affected by Peritoneal Mesothelioma

A diagnosis of peritoneal mesothelioma can feel like an insurmountable challenge, but you’re not in this alone. Our law firm, founded by someone who lost loved ones to asbestos-related cancer, is dedicated to helping families secure the compensation and care they need. We know the toll this disease takes—emotionally, physically, and financially—and we’re here to ease that burden with compassion and expertise.

Helping You Access the Care You Deserve

We assist clients in pursuing compensation from:

• Asbestos Trust Funds – Companies responsible for asbestos exposure often established trust funds during bankruptcy to compensate victims. These funds continue to pay claims, and if your peritoneal mesothelioma is linked to asbestos exposure—even from years past—you may be eligible. We streamline the process to maximize your claim.

• Lawsuits Against Operating Companies – If the companies that exposed you to asbestos are still in business, you may be able to file a lawsuit. These cases frequently settle privately, often without a court appearance. We build robust cases to hold these companies accountable.

• Social Security Disability Benefits – Peritoneal mesothelioma qualifies for expedited Social Security Disability benefits under the Compassionate Allowances program. This fast-track process can deliver monthly income and, in some cases, early Medicare eligibility in just weeks. Our team ensures your application is thorough, minimizing delays and helping with appeals if necessary.

• VA Claims for Veterans – Veterans exposed to asbestos during military service may qualify for Department of Veterans Affairs benefits, including monthly compensation and access to specialized treatment. We assist in navigating the VA claims process to secure the support you’ve earned.

Why Families Trust Us

We understand the personal impact. Our founding attorney’s family was devastated by asbestos-related cancer, losing his grandfather, father, and grandmother. This drives our commitment to treat every client with empathy, urgency, and respect. Our firm has amassed one of the nation’s most extensive asbestos litigation resources, including millions of pages of corporate records, scientific research, court documents, and exposure data. We leverage this expertise to fight for every family we represent.

We handle the details. Facing a cancer diagnosis is overwhelming enough without the added stress of paperwork. Our team manages everything—from collecting medical records to tracing decades-old asbestos exposure. We collaborate with medical specialists, investigators, and industrial experts to build airtight cases. You focus on your health; we focus on your claim.

We serve clients nationwide. Whether your exposure occurred in a factory, on a military base, or at a construction site, we can help, no matter where you live. With offices in California, Texas, Arizona, and Washington, and advanced virtual tools, we make communication seamless via phone or video. If you prefer an in-person meeting, we’ll come to you at no cost. Our priority is making the process as accessible and stress-free as possible.

No upfront fees. We cover all legal expenses, from expert consultations to filing fees, so you pay nothing out-of-pocket. You only pay us if we secure compensation for you. With over $400 million recovered for asbestos-related disease victims, we’re confident in our ability to deliver results while you focus on healing.

Nationwide Service, No Upfront Costs

We represent clients in all 50 states. Whether you were exposed at a petrochemical plant, in a textile mill, or through contaminated home repairs, we’ll build your case and fight for the compensation you’re owed. There are no upfront fees—we only get paid if we recover money for you.

A Way Forward

Your medical team is fighting for your life—let us fight for your financial security and your family’s future. We’ll guide you through your options, identify responsible parties or trust funds, and act quickly to alleviate financial stress, so you can prioritize your treatment.

Contact us today for a free, no-obligation consultation. Every discussion is completely confidential, and we’re here to help you take the next step.ntial.

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