Biomarkers for Malignant Pleural Mesothelioma-A Novel View on Inflammation

Our plain-English summary of Biomarkers for Malignant Pleural Mesothelioma-A Novel View on Inflammation, by M. Vogl, A. Rosenmayr, T. Bohanes, et al (Cancers, 2021).

The study

• Authors: M. Vogl, A. Rosenmayr, T. Bohanes, A. Scheed, M. Brndiar, E. Stubenberger, B. Ghanim
• Journal: Cancers
• Published: 2021;13(4)
• Type of article: Review
• Cited by: 31 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is an aggressive disease with limited treatment response and devastating prognosis. Exposure to asbestos and chronic inflammation are acknowledged as main risk factors. Since immune therapy evolved as a promising novel treatment modality, we want to reevaluate and summarize the role of the inflammatory system in MPM. This review focuses on local tumor associated inflammation on the one hand and systemic inflammatory markers, and their impact on MPM outcome, on the other hand. Identification of new biomarkers helps to select optimal patient tailored therapy, avoid ineffective treatment with its related side effects and consequently improves patient's outcome in this rare disease. Additionally, a better understanding of the tumor promoting and tumor suppressing inflammatory processes, influencing MPM pathogenesis and progression, might also reveal possible new targets for MPM treatment. After reviewing the currently available literature and according to our own research, it is concluded that the suppression of the specific immune system and the activation of its innate counterpart are crucial drivers of MPM aggressiveness translating to poor patient outcome.

In plain English

This article was a review, not a new study. The authors searched PubMed for English-language literature on inflammation-related biomarkers in malignant pleural mesothelioma (MPM). They included all available biomarker studies except case reports, ending with 194 references dating from 1960 to early 2021. They described asbestos exposure as the main risk factor for MPM, but exposure was not the subject of the review. The review covered immune cells and signaling molecules in and around the tumor, and blood inflammation markers such as white cell counts, cell ratios, C-reactive protein, fibrinogen and albumin. It asked whether these markers help predict survival or treatment response. The authors noted that current European guidelines recommend no biomarkers for MPM in daily practice. Across the studies reviewed, low numbers of specific immune cells and high levels of unspecific inflammatory markers seemed unfavorable. IL-6 did not seem usable for predicting survival or treatment response in MPM. The authors concluded that the specific immune system is the "friend" and its unspecific counterpart the "foe". They noted that much of the data came from retrospective studies.

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: narrative review of published literature (PubMed search, English only, case reports excluded)
• Who was studied: Published studies on inflammatory biomarkers in malignant pleural mesothelioma, from Wagner et al. 1960 to early 2021; 194 references included
• Exposure: Not an exposure study. It reviewed local (tumor-associated) and systemic (blood) inflammatory markers. Asbestos is described only as background, as the main risk factor for MPM.
• Main results:
  • In the studies reviewed on local inflammation, low numbers of specific immune cells and high numbers of unspecific immune cells generally seemed unfavorable.
  • In the studies reviewed on systemic (blood) markers, high unspecific inflammatory markers seemed adverse.
  • The authors reported that current European guidelines recommend no biomarkers for MPM in daily practice.
  • IL-6 did not appear usable as a prognostic or predictive marker for MPM, although the authors assumed it plays a major role in promoting systemic inflammation.
• The authors' conclusion: The authors concluded that in MPM the specific (adaptive) immune system acts as a 'friend' and the unspecific (innate) immune system as a 'foe'. They added that this is reflected in the prognostic value of the corresponding biomarkers.
• Limitations the authors state:
  • Much of the data reviewed came from retrospective studies, which the authors attribute to how rare MPM is.
  • Research on inflammatory biomarkers in mesothelioma is limited.
  • For some markers, such as myeloid-derived suppressor cells, the authors know of no data on prognostic or predictive value in MPM.

Topics

Medical terms in this study, explained in our Lexicon: Biomarker, Pleural Mesothelioma, Inflammation, Prognosis, Chronic Inflammation.

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