ANNALS EXPRESS: Biomarkers in mesothelioma

Annals of Clinical Biochemistry 2017 January [Epub ahead of print] [Link]

Arnold DT, Maskell N


Mesothelioma is an aggressive cancer of pleural and peritoneal cells that is difficult to diagnose and monitor. Numerous studies have attempted to identify a blood- or pleural fluid-based biomarker that could be used in the diagnostic pathway. More recently there has been interest in the ability of serum/plasma biomarkers to monitor mesothelioma, given development of newer treatments, and limitations of radiological assessment. The majority of research has focused on soluble mesothelin (SM), a soluble glycoprotein expressed by mesothelial cells. Although SM lacks the sensitivity to be used as a stand-alone diagnostic marker, serial measurements may be informative, with rising levels indicating disease progression and poor survival. High levels of other soluble glycoproteins, such as osteopontin, fibulin-3 and vascular endothelial growth factor (VEGF) are independently associated with poor prognosis at baseline, although further research is required to ascertain any role outside of clinical trials. More recent literature has focused on the development of novel biomarkers from discovery cohorts. Although many DNA and mRNA biomarkers show promise in the diagnosis or screening of mesothelioma, none have been prospectively evaluated for use in clinical practice. In this review article we highlight the potential utility of biomarkers and evaluate the existing literature.