Mesothelioma

Why choose UCLA Health for mesothelioma care? 

At UCLA Health, we offer innovative, advanced mesothelioma treatment. We approach each patient with malignant pleural mesothelioma individually. Our treatment strategies often combine several leading-edge approaches to attack the tumor including lung-sparing surgery, unique targeted radiation, systemic therapies such as immunotherapy, chemotherapy, biologic therapy, cryoablation therapy, and electric field-based Tumor Treating Fields (TT Fields; Optune Lua). One of our unique approaches includes combining lung-sparing surgery with post-operative pleural-based (targeted) radiation therapy and continuous, low-toxicity immunotherapy. Together, these therapies are designed to prolong life with good quality. We are a busy international referral center for patients with mesothelioma.  

Highlights of our program include: 

Established experts: Our team includes doctors at the forefront of mesothelioma care. We have decades of experience studying and providing effective mesothelioma treatment and we care for patients from around the globe. Our providers are highly experienced and care for patients with mesothelioma on a daily basis. 

Collaborative care: Your care team includes medical oncologists, radiation oncologists, thoracic surgical oncologists, radiologists, interventional radiologists, pathologists, anesthesiologists and a dedicated mesothelioma nurse practitioner. Our weekly mesothelioma tumor board attended by providers from each of these specialties reviews our patients’ needs and formulates a personalized care plan for every patient.

Novel therapies: UCLA Health doctors are familiar with several effective treatment approaches for mesothelioma, including cryoablation, lung-sparing surgery, targeted pleural radiation and a unique type of immunotherapy called maintenance interferon-alpha therapy. Our experts also help lead phase 1 through phase 3 clinical trials to identify new and promising mesothelioma therapies and our laboratories investigate novel treatment strategies for this disease.

Extra support: Our dedicated mesothelioma nurse practitioner (NP) can answer all your questions and discuss your care plan. This NP connects with you soon upon contacting us to provide education and support and answer your many questions. Many of our patients tell us that this important resource is one of the most helpful aspects of the care we provide.  

Access to care: After surgery, our patients commonly undergo a highly specialized form of targeted radiation therapy called whole pleural radiation. Our program includes radiation oncologists who practice in Los Angeles, in Orange County and at the West Los Angeles Veterans Affairs Medical Center, to provide easy access to advanced care. 

What is malignant pleural mesothelioma?

Malignant pleural mesothelioma is a cancer that forms in the pleura, the tissue that lines the chest cavity. It is not lung cancer. Rather, the pleural lining covers everything inside your chest, including your heart, diaphragm, spine, ribs, lungs, blood vessels and nerves. It is the source of cancer cells and allows a tumor to quickly spread throughout the chest.

Malignant pleural mesothelioma is a rare and aggressive cancer that is associated with exposure to asbestos in the majority of cases. Getting a diagnosis can be overwhelming, and patients are often told that the prognosis is bleak. However, there are effective mesothelioma treatments. At UCLA Health, we use advanced techniques to simultaneously help prolong survival and increase your quality of life.

Types of malignant pleural mesothelioma

There are several types of mesothelioma, including:

Epithelioid mesothelioma: This is the most common type of malignant pleural mesothelioma. We can typically treat this type of mesothelioma with surgery, radiation, cryoablation, chemotherapy and/or immunotherapy.

Sarcomatoid mesothelioma: This type accounts for approximately 15% of malignant pleural mesothelioma tumors and this type can be more aggressive and spread to areas outside of the chest. Treatment mostly consists of medication therapies, particularly immunotherapy with or without chemotherapy.

Biphasic mesothelioma: This type is a mix of epithelioid and sarcomatoid mesothelioma.

Other rare types: Lymphohistiocytoid and other rare types of mesothelioma require specific treatment based on their characteristics. Most often, we treat these types with a combination of surgery, radiation, chemotherapy and/or immunotherapy.

Who is at risk of developing mesothelioma?

The main risk factor for mesothelioma is asbestos exposure. The use of asbestos has been limited for more than 30 years but is still imported into and used in the Unites States and other countries, and remains present in older structures, insulation, and has been reported in cosmetics/talc powder.

People who work in certain occupations have a higher risk of asbestos exposure and mesothelioma, including those who are: 

• Aircraft or auto mechanics
• Construction workers
• Electricians
• Firefighters
• Insulators 
• Mine workers
• Pipefitters
• Shipyard workers and ship crew
• Many others

Diagnosis and staging malignant pleural mesothelioma

The diagnosis of malignant pleural mesothelioma requires a biopsy that can be performed in a variety of ways. To determine the extent of possible spread of mesothelioma, a variety of scans and procedures may be recommended. Typically, surgery is offered when the tumor is confined to one side of the chest.  Diagnosis and staging include:

CT guided needle biopsy: This is a procedure when a needle is inserted into the tumor to sample it, under guidance of a CT scan. 

Thoracoscopy with biopsy: This is a minimally invasive surgical procedure in which a camera is inserted through a small incision in the chest, and which has high accuracy for the diagnosis of mesothelioma. 

Integrated PET-CT scan: In one setting, our patients undergo a high-quality CT of the entire body and an integrated PET scan which shows the metabolic activity of the tumor. Together, the spread of mesothelioma is identified. 

Cervical mediastinoscopy or endobronchial ultrasound (EBUS): Sometimes it is necessary to biopsy lymph nodes in the chest to understand if mesothelioma has spread to these locations. Cervical mediastinoscopy and endobronchial ultrasound (EBUS) are minimally invasive procedures that sample these lymph nodes for microscopic evaluation. 

Diagnostic laparoscopy: Malignant pleural mesothelioma can spread from the chest to the abdominal cavity. Sometimes it is necessary to evaluate this potential spread with a minimally invasive surgical procedure in which a small camera is inserted through a small incision in the abdominal wall.

Treatments we offer

At UCLA Health, we use treatment approaches that have been pioneered by our experts and that are tailored for each individual patient. This personalized approach is designed to give people the best chance for a positive outcome. Our mesothelioma care plans involve a series of consecutive treatments that often include:

Surgery: Pleurectomy and decortication is our frontline surgical treatment for mesothelioma. During this procedure, our thoracic surgeons remove the lining of the chest cavity (pleura) where the tumor is located, without removing the lung. This is a major operation that has a goal to have no visible tumor within the chest. 

Radiation therapy: UCLA Health offers highly specialized whole pleura targeted radiation using tomotherapy machines. This advanced technique, most often delivered once a patient recovers from surgery, allows us to deliver radiation specifically to the area that was affected by the tumor while minimizing harm to normal tissues such as the lung. 

Maintenance interferon-alpha therapy: Mesothelioma is a type of cancer that even after surgery and radiation therapy, some tumor cells may be left behind. To address this issue, UCLA Health experts pioneered the use of maintenance interferon-alpha therapy, a type of immunotherapy which stimulates the immune system to find and destroy cancer cells. We use the lowest effective dose, allowing people to remain on immunotherapy for as long as possible.

Chemotherapy: Some people may have chemotherapy with or without bevacizumab, a blood vessel inhibitor. This treatment has been FDA-approved since 2004. The combination of medications has been shown to be effective, particularly in epithelioid mesothelioma tumors.

Immunotherapy: Immunotherapy for mesothelioma typically includes ipilimumab and nivolumab, two common medications used to treat many cancer types by stimulating the body to produce immune responses against the cancer. This combination can be successful in treating mesothelioma, particularly the sarcomatoid type.

Chemoimmunotherapy: This is a combination of chemotherapy and immunotherapy for mesothelioma.

Cryoablation: In some people, individual cancerous nodules (growths) develop in the chest cavity after treatment. Our interventional radiologists often use a freezing technique called cryoablation to destroy these nodules during a straightforward outpatient needle procedure.

Tumor treating (TTF | Optune Lua): This treatment uses electrical fields to prevent tumor cells from dividing and growing. TTFields is delivered through ceramic discs arrays that we apply to the outside of your chest to disrupt tumor growth. This treatment is most effective when used alongside with chemotherapy.

Meet our team

Our team has vast experience and expertise in treatment of mesothelioma. We offer advanced therapies and continually study new approaches to work toward an eventual cure.

Contact us

Call 310-267-4612 to request an appointment with the mesothelioma care team at UCLA Health. To reach our nurse practitioner, please call 310-818-1304.