- Email: [email protected]
Malignant Pleural Mesothelioma: The Need to Move from Research to Clinical Practice
Archives of Medical Research 47 (2016) 407
LETTER TO THE EDITOR
Malignant Pleural Mesothelioma: The Need to Move from Research to Clinical Practice To the Editor,
Malignant pleural mesothelioma (MPM) is an aggressive and lethal cancer and remains as a significant worldwide health problem due to its non-specific symptoms that often result in a delayed diagnosis and poor survival (1). The major known risk factor for MPM is inhalation of asbestos or asbestiform fibers (2). The World Health Organization (WHO) estimated that |100,000 persons worldwide die each year of asbestos-related disease resulting from occupational exposures (3). Moreover, asbestos and asbestiform fibers are naturally found and become environmental pollutants for the overall population with an excess of MPM deaths among residents in many areas of the world (2). In industrialized countries, a mortality rate peak of MPM is expected within 2025 (3). Occupationally exposed patients are usually older than 60 years and are more likely to be men, whereas environmental exposure involves younger median ages (!40 years) of both genders (3). Recent studies on MPM have pointed out that early diagnosis and targeted treatment strategies may improve overall survival. In order to assess the likelihood of MPM development in asbestos-exposed subjects, it would be advisable to include of a panel of biomarkers with high sensitivity and specificity that may help carry out differentiated diagnoses, monitor treatment response and formulate prognosis. To date, several MPM biomarkers have been analyzed in tissues and/or body fluids of exposed subjects, but few result in being reliable, namely, mesothelin and fibulin-3 (4,5). Recent advances in cancer molecular biology include the identification of microRNAs (miRs) involved in several physiological and pathological processes such as cell growth, differentiation, proliferation and metabolism, angiogenesis, stress response and tissue remodeling (5). Thus, new frontiers are opening up in the study of miRs as far as MPM screening, diagnosis and follow-up are concerned. Presently, literature reports propose the stratification of high-risk subjects and early diagnosis of MPM through the perusal of the following pool of blood analysis: miR-126-3p, miR625-3p and miR103a-3p in pairing with mesothelin and fibulin-3 (4,5).
Instead, for MPM patients, the analysis of miR-16-5p, miR-126-3p, miR-143-3p, miR-145-5p, miR-192-5p, miR-193a-3p, miR-200b-3p, miR-203a-3p and miR-6523p may be useful to monitor sensitivity to therapy and for prognostic scope (4,5). Scientific studies on these biomarkers have to be finalized in order to recognize those with the highest sensitivity and specificity. This must be followed by validation through the implementation on the at-risk population in order to produce results that will then have to be transferred to clinical practice. Such an approach should also include developing highly specialized centers in areas at risk, awareness raising, capacity building, institutional framework and a national/ international plan of action to reduce the MPM mortality rate.
References 1. Robinson BW, Musk AW, Lake RA. Malignant mesothelioma. Lancet 2005;366:397e408. 2. Stayner L, Welch LS, Lemen R. The worldwide pandemic of asbestosrelated diseases. Annu Rev Public Health 2013;34:205e216. 3. World Health Organization (WHO). Asbestos: Elimination of asbestos-related diseases. Available at: http://www.who.int/media centre/factsheets/fs343/en/index.html. August 25, 2016. 4. Robinson BW, Creaney J, Lake R, et al. Mesothelin-family proteins and diagnosis of mesothelioma. Lancet 2003;362:1612e1616. 5. Micolucci L, Akhtar MM, Olivieri F, et al. Diagnostic value of microRNAs in asbestos exposure and malignant mesothelioma: systematic review and qualitative meta-analysis. Oncotarget 2016; [Epub ahead of print].
CATERINA LEDDA VENERANDO RAPISARDA Occupational Medicine Department of Clinical and Experimental Medicine University of Catania Catania, Italy Address reprint requests to: Dr. Caterina Ledda, Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; Phone: þ39953782366; FAX: þ39953782366; E-mail: [email protected] Received for publication August 8, 2016; accepted August 25, 2016 (ARCMED-D-16-00472). The authors declare no conflict of interest.
0188-4409/$ - see front matter. Copyright Ó 2016 IMSS. Published by Elsevier Inc. http://dx.doi.org/10.1016/j.arcmed.2016.08.009
LETTER TO THE EDITOR
Malignant Pleural Mesothelioma: The Need to Move from Research to Clinical Practice To the Editor,
Malignant pleural mesothelioma (MPM) is an aggressive and lethal cancer and remains as a significant worldwide health problem due to its non-specific symptoms that often result in a delayed diagnosis and poor survival (1). The major known risk factor for MPM is inhalation of asbestos or asbestiform fibers (2). The World Health Organization (WHO) estimated that |100,000 persons worldwide die each year of asbestos-related disease resulting from occupational exposures (3). Moreover, asbestos and asbestiform fibers are naturally found and become environmental pollutants for the overall population with an excess of MPM deaths among residents in many areas of the world (2). In industrialized countries, a mortality rate peak of MPM is expected within 2025 (3). Occupationally exposed patients are usually older than 60 years and are more likely to be men, whereas environmental exposure involves younger median ages (!40 years) of both genders (3). Recent studies on MPM have pointed out that early diagnosis and targeted treatment strategies may improve overall survival. In order to assess the likelihood of MPM development in asbestos-exposed subjects, it would be advisable to include of a panel of biomarkers with high sensitivity and specificity that may help carry out differentiated diagnoses, monitor treatment response and formulate prognosis. To date, several MPM biomarkers have been analyzed in tissues and/or body fluids of exposed subjects, but few result in being reliable, namely, mesothelin and fibulin-3 (4,5). Recent advances in cancer molecular biology include the identification of microRNAs (miRs) involved in several physiological and pathological processes such as cell growth, differentiation, proliferation and metabolism, angiogenesis, stress response and tissue remodeling (5). Thus, new frontiers are opening up in the study of miRs as far as MPM screening, diagnosis and follow-up are concerned. Presently, literature reports propose the stratification of high-risk subjects and early diagnosis of MPM through the perusal of the following pool of blood analysis: miR-126-3p, miR625-3p and miR103a-3p in pairing with mesothelin and fibulin-3 (4,5).
Instead, for MPM patients, the analysis of miR-16-5p, miR-126-3p, miR-143-3p, miR-145-5p, miR-192-5p, miR-193a-3p, miR-200b-3p, miR-203a-3p and miR-6523p may be useful to monitor sensitivity to therapy and for prognostic scope (4,5). Scientific studies on these biomarkers have to be finalized in order to recognize those with the highest sensitivity and specificity. This must be followed by validation through the implementation on the at-risk population in order to produce results that will then have to be transferred to clinical practice. Such an approach should also include developing highly specialized centers in areas at risk, awareness raising, capacity building, institutional framework and a national/ international plan of action to reduce the MPM mortality rate.
References 1. Robinson BW, Musk AW, Lake RA. Malignant mesothelioma. Lancet 2005;366:397e408. 2. Stayner L, Welch LS, Lemen R. The worldwide pandemic of asbestosrelated diseases. Annu Rev Public Health 2013;34:205e216. 3. World Health Organization (WHO). Asbestos: Elimination of asbestos-related diseases. Available at: http://www.who.int/media centre/factsheets/fs343/en/index.html. August 25, 2016. 4. Robinson BW, Creaney J, Lake R, et al. Mesothelin-family proteins and diagnosis of mesothelioma. Lancet 2003;362:1612e1616. 5. Micolucci L, Akhtar MM, Olivieri F, et al. Diagnostic value of microRNAs in asbestos exposure and malignant mesothelioma: systematic review and qualitative meta-analysis. Oncotarget 2016; [Epub ahead of print].
CATERINA LEDDA VENERANDO RAPISARDA Occupational Medicine Department of Clinical and Experimental Medicine University of Catania Catania, Italy Address reprint requests to: Dr. Caterina Ledda, Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; Phone: þ39953782366; FAX: þ39953782366; E-mail: [email protected] Received for publication August 8, 2016; accepted August 25, 2016 (ARCMED-D-16-00472). The authors declare no conflict of interest.
0188-4409/$ - see front matter. Copyright Ó 2016 IMSS. Published by Elsevier Inc. http://dx.doi.org/10.1016/j.arcmed.2016.08.009