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
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