Abstract
BackgroundRadiological monitoring of malignant pleural mesothelioma (MPM) using modified RECIST criteria is limited by low sensitivity and inter-observer variability. Serial serum mesothelin measurement has shown utility in the assessment of treatment response during chemotherapy but has never been assessed in the longer term follow up of patients.MethodsThis is a single centre study of consecutive patients diagnosed with MPM who received chemotherapy or best supportive care (BSC). Serum mesothelin measurements with paired 6 monthly CT scans were performed following the completion of chemotherapy, or from baseline in the BSC group. Changes in mesothelin were correlated with radiological progression and overall survival.ResultsForty-one patients with MPM were recruited and followed up for a minimum of 12 months (range 12–21 months). The majority of patients (n = 23) received chemotherapy with pemetrexed and cisplatin. Across the cohort a 10% rise in serum mesothelin could predict radiological progression with a sensitivity of 96% (IQR; 79–100) and specificity of 74% (IQR; 50–91). Sensitivity fell to 80% in sarcomatoid only disease. Patients with a rising mesothelin at 6 months had significantly worse overall survival (175 days) compared to stable/falling levels (448 days) (p = 0.003).ConclusionsThis is the first study to assess serum mesothelin’s ability to detect progression of MPM following chemotherapy or during BSC. A 10% rise in serum mesothelin level showed excellent sensitivity at predicting progressive disease. Mesothelin measurement has several advantages over serial CT imaging including reducing hospital visits and cost.
Highlights
Radiological monitoring of malignant pleural mesothelioma (MPM) using modified Response Evaluation Criteria in Solid Tumours (RECIST) criteria is limited by low sensitivity and inter-observer variability
Participants In total, 41 patients with malignant pleural mesothelioma were recruited to this study and had a mesothelin taken at baseline alongside usual care
Twenty-three patients received chemotherapy in the form of Pemetrexed and Cisplatin, with no patients being referred for surgical intervention
Summary
Radiological monitoring of malignant pleural mesothelioma (MPM) using modified RECIST criteria is limited by low sensitivity and inter-observer variability. Serial serum mesothelin measurement has shown utility in the assessment of treatment response during chemotherapy but has never been assessed in the longer term follow up of patients. Chemotherapy is the only treatment modality that has shown to improve survival following the results of a large randomised control de Fonseka et al BMC Cancer (2018) 18:199. Studies have shown that serial FDG-PET (Fludeoxyglucose positron emission tomography) scanning can be used to predict response [14] but is significantly limited by false positive uptake in inflamed tissue from surgical intervention or pleurodesis, as well as restricted availability or limited reimbursement from insurers [15]
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