If the patient is fit enough and the tumour is resectable I would go for an extended pleurectomy decortication preceded by neo adjuvant pemetrexed as my oncologist tells me as the best evidence treatment for sarcomatoid mesothelioma.
Patients with sarcomatoid mesothelioma do not benefit from surgery. However, patients may benefit from immunotherapy treatment. Various new immunotherapy drugs are currently tested in clinical trials (CRS-207, Tremelimumab, Anti-PD-1/Anti-PD-L1). The trial staff may help with information regarding the effect in sarcomatous mesothelioma.