Liquid Biopsy in Malignant Pleural Mesothelioma: State of the Art, Pitfalls, and Perspectives

Abstract

Malignant pleural mesothelioma (MPM) is an aggressive tumor linked to asbestos exposure. Although the risk factors for MPM are well-known, the majority of MPM patients are diagnosed at an advanced stage and have a very poor prognosis. Circulating biomarkers for early diagnosis remain to be identified, and the current standard for MPM diagnosis relies on pleural biopsies. Robust non-invasive tests for the screening of asbestos-exposed subjects are therefore an important unmet clinical need. This review provides a critical summary of recent liquid biopsy-based studies aimed at discovering novel blood-based circulating biomarkers for the early diagnosis and prognostic stratification of MPM patients.

Potential role of serum mesothelin in predicting survival of patients with malignant pleural mesothelioma

“…Previous studies have focused on identifying novel markers measurable in biological fluids, including serum and PE (6,13,14). Serum is easily obtainable with minimal stress for patients, while PE is present in the majority of MPM patients at diagnosis and routinely withdrawn for diagnosis and therapeutic purposes.…”

“…The ideal prognostic biomarker to be determined in serum or PE has not yet been identified. Several biomarkers have been proposed but, to date, none of them can be considered adequate to evaluate the prognosis of MPM because of heterogeneous clinical results in various published studies (6,13,14). By contrast, SMRP may be a prognostic marker for MPM as reported for other malignancies, including ovarian, lung, breast and esophageal cancers (19,21).…”

“…In recent years, other biomarkers have been proposed in body fluids, including osteopontin, fibulin-3 and vascular endothelial growth factor evaluated in plasma, serum and pleural effusion, in addition to hyaluronic acid evaluated in serum and pleural effusion and the high mobility group box 1 detected only in serum (6,13,14). They showed a low prognostic significance.…”

“…However, due to the small number of samples and the heterogeneity of patients analyzed in the individual studies, the clinical application of all the markers mentioned above, in MPM, requires further confirmation (6,13,14).…”

Predictive and Prognosis Factors of Clinical Utility in Mesothelioma

“…Given the aforementioned, liquid biopsy has gained interest from oncologists and basic researchers [145]. Although liquid biopsy is still far from replacing tissue biopsy for mesothelioma, plasma and serum samples represent minimally invasive, low-risk, and easily obtained biological fluids that many studies have indicated as potentially interesting prognosis biomarkers as mentioned in the section "Biological factors" [146].…”