Malignant Mesothelioma Biomarkers

Malignant pleural mesothelioma is a highly aggressive tumor associated with asbestos exposure. There are few effective treatment options for mesothelioma, and patients have a very poor prognosis with a median survival of < 12 months from diagnosis. Biomarkers have been proposed as a cost-effective means of cancer management, and the search for a mesothelioma biomarker has been ongoing for the last 30 years. Many traditional soluble (glyco)protein biomarkers have been evaluated over this time, and an ever-increasing list of new biomarkers, including messenger RNA, DNA, microRNA, and antibodies, is being reported from biomarker discovery projects. To date, soluble mesothelin is the only tumor biomarker to receive US Food and Drug Administration approval for clinical use in mesothelioma. Mesothelin is a glycoprotein normally expressed on the surface of mesothelial cells, and in the cancerous state it can be present in circulation. Mesothelin has a limited expression on normal, nonmalignant tissue and is thus an attractive therapeutic target for mesothelin-positive tumors. In this review we will focus on the discovery and clinical usages of mesothelin and provide an update on other mesothelioma biomarkers and show how such biomarker studies might impact on the management of this deadly tumor in the future. CHEST 2017; 152(1):143-149 KEY WORDS: biomarkers; mesothelioma; screening Malignant pleural mesothelioma is a highly aggressive tumor commonly associated with asbestos exposure. There are > 15,000 cases worldwide, and there is real concern that unregulated asbestos use in Asia will see the number of cases significantly increase.1 Clinical management of mesothelioma for most patients is largely palliative and based on combination cisplatin and pemetrexed chemotherapy. Recent randomized trial results suggest that bevacizumab may be considered an alternative first-line treatment option, but as yet this not been routinely clinically adopted.2 A selective subset of patients with good performance indicators may undergo cytoreductive procedures with curative intent as part of a multimodality approach with chemotherapy and radiotherapy; however, debulking pleurectomy is sometimes performed with palliative intent for symptom control.2 New therapies are currently being actively