Author: Lindsey Harle, PhD
A new serum marker for mesothelioma has been approved by the Food and Drug Administration (FDA). MESOMARK, manufactured by Fujirebio Diagnostics, uses antibodies directed against serum-mesothelin related peptide (SMRP) to determine levels of this protein in patient’s blood. SMRP is produced by mesothelial cells, and is present at high levels in patients with malignant mesothelioma, a form of cancer associated with asbestos exposure. In clinical trials, SMRP differentiated patients with mesothelioma from both healthy controls and patients with other cancer diagnoses. The FDA has approved MESOMARK to be used with patients who already have a diagnosis of malignant mesothelioma. Physicians can use the blood test to evaluate patient response to treatment and to assess disease progession or recurrence.
Currently, most physicians monitor patients based on radiographic findings and clinical symptoms. This new, less invasive test will allow physicians to alter treatment protocols for individual patients based on the response, or lack thereof, to treatment. Instead of waiting for patients to develop symptoms associated with tumor growth, physicians can detect increasing levels of SMRP and use this to alter the treatment plan. It will also allow them to screen patients before ordering more expensive testing such as computed tomography (CT).
Fujirebio Diagnostics recently partnered with ARUP Laboratories, a national reference center for laboratory testing, to offer the MESOMARK ELISA assay to physicians. Currently, physicians must become certified, by taking a questionnaire, to order the MESOMARK test. The test is approved for use with patients diagnosed with epitheliod and biphasic malignant mesothelioma.
Malignant mesothelioma is a rare neoplasm of the lining of the body cavities. It can develop in the pleura, peritoneal, or pericardial linings; the majority of cases occur in the pleura. Asbestos exposure is the biggest risk factor for mesothelioma worldwide, and patient’s knowledge of asbestos exposure is frequently inaccurate. The symptoms of mesothelioma are nonspecific and can mimic other conditions. They include cough, shortness of breath, chest pain, difficulty breathing, fatigue and weight loss. Because this is a rare disease with nonspecific clinical findings, patients are usually diagnosed at a late stage, when the disease is incurable. Treatment currently consists of surgical debulking, chemotherapy and radiation. In the majority of cases, these treatments are palliative, and only provide a modest increase in survival time. Most patients die of mesothelioma within a year of diagnosis.
Potential use of the MESOMARK assay as a screening tool for the general population, or in those exposed to asbestosis or other occupational lung diseases, has not been described, but may be addressed in future clinical trials. Use of this or a similar marker as a screen for mesothelioma could lead to diagnosis at an earlier stage. This could lead to increased patient survival time, quality of life, and possibly even cure of the disease.
Elevations in another serum marker, osteopontin, are also linked to mesothelioma, and a trial is currently planned to evaluate its usefulness as a screening tool for at-risk individuals in Turkey.
Currently, a diagnosis of mesothelioma is devastating to patients, but with the use of the MESOMARK serum assay patients and physicians may be able to obtain better disease control, and a prolonged survival time.
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About the Author
Lindsey Harle is a medical doctor who is currently pursuing training in pathology at the University of Hawaii. She has written and published several scientific articles on the subjects of cancer cachexia and androgen deprivation therapy, and has performed original research on the diagnosis of myelodyspastic syndromes.
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