Biomarkers for early diagnosis of malignant mesothelioma: Do we need another moonshot?

Our plain-English summary of Biomarkers for early diagnosis of malignant mesothelioma: Do we need another moonshot?, by S. Lagniau, K. Lamote, J.P. van Meerbeeck, et al (Oncotarget, 2017).

The study

• Authors: S. Lagniau, K. Lamote, J.P. van Meerbeeck, K.Y. Vermaelen
• Journal: Oncotarget
• Published: 2017;8(32):53751-53762
• Type of article: Review
• Cited by: 38 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Early diagnosis of malignant pleural mesothelioma (MPM) is a challenge for clinicians. The disease is usually detected in an advanced stage which precludes curative treatment. We assume that only new and non-invasive biomarkers allowing earlier detection will result in better patient management and outcome. Many efforts have already been made to find suitable biomarkers in blood and pleural effusions, but have not yet resulted in a valid and reproducible diagnostic one. In this review, we will highlight the strengths and shortcomings of blood and fluid based biomarkers and highlight the potential of breath analysis as a non-invasive screening tool for MPM. This method seems very promising in the early detection of diverse malignancies, because exhaled breath contains valuable information on cell and tissue metabolism. Research that focuses on breath biomarkers in MPM is in its early days, but the few studies that have been performed show promising results. We believe a breathomics-based biomarker approach should be further explored to improve the follow-up and management of asbestos exposed individuals.

In plain English

This article is a review of biomarkers that might detect malignant pleural mesothelioma (MPM) earlier. The authors searched MEDLINE (PubMed) and Web of Science. They tabulated results from 14 articles that compared MPM patients with asbestos-exposed people who were either healthy or had benign asbestos-related conditions such as pleural plaques or asbestosis. They reviewed blood and pleural fluid markers, including soluble mesothelin (SMRP), osteopontin, fibulin-3 and HMGB-1, along with circulating RNAs and analysis of exhaled breath. The authors reported that most blood and pleural fluid markers lacked enough sensitivity and/or specificity to separate MPM patients from asbestos-exposed people without MPM, and that there was still no validated 'gold standard'. They described breath research in MPM as being in its early days, with promising results. They noted, however, that those studies were small and none had been externally validated. The authors concluded that breath-based testing should be explored further. They recommended that future studies focus on people occupationally exposed to asbestos at least 20 years earlier.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Review of published studies, based on a literature search (no date range or formal inclusion criteria stated)
• Who was studied: Published studies on mesothelioma biomarkers. The summary table drew on 14 articles and included only data comparing MPM patients with asbestos-exposed people, either healthy or with benign asbestos-related conditions such as asbestosis, pleural plaques and fibrosis
• Exposure: Not an exposure study. The review concerned candidate diagnostic biomarkers in blood, pleural effusions, circulating RNA and exhaled breath, in people with MPM or at risk from asbestos exposure. No fiber types or doses were analysed
• Main results:
  • The authors judged that most blood and pleural fluid biomarkers reviewed lacked sufficient sensitivity and/or specificity to distinguish MPM patients from healthy asbestos-exposed people and people with benign asbestos-related diseases
  • For serum soluble mesothelin (SMRP), the reviewed literature showed high specificity but a lack of sensitivity
  • The authors stated that no validated 'gold standard' biomarker for early MPM detection yet existed
  • The authors described research on breath biomarkers in MPM as at an early stage, with the few studies done showing promising results
  • The review cited an earlier, separately published breath study by the authors' group using ion mobility spectrometry. It was not performed in this review. In that study, MPM patients were distinguished from healthy non-exposed people and asymptomatic asbestos-exposed people with a sensitivity of 87% and a specificity of 70%
  • The authors recommended that future studies focus on people occupationally exposed to asbestos with a latency of at least 20 years since exposure
• The authors' conclusion: The authors concluded that a breath-based (breathomics) biomarker approach should be explored further to improve follow-up and management of asbestos-exposed people
• Limitations the authors state:
  • Limitation the authors identified in the breath studies they reviewed: conclusions cannot be generalized because each study included a limited number of people
  • Limitation the authors identified in the breath studies they reviewed: none had externally validated their findings
  • Limitation the authors identified in the reviewed HMGB-1 study: the sample was small and the groups were not matched for age, sex and smoking status
  • Limitation the authors identified across breath-analysis studies: lack of standardization in analytical technology makes it difficult to compare results between studies

Topics

Medical terms in this study, explained in our Lexicon: Biomarker, Mesothelioma, Pleural Mesothelioma, Pleural Effusion.

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