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Blyth KG, Adusumilli PS, Astoul P, Darlison L, Lee YCG, Mansfield AS, Marciniak SJ, Maskell N, Panou V, Peikert T, Rahman NM, Zauderer MG, Sterman D, Fennell DA. Leveraging the pleural space for anticancer therapies in pleural mesothelioma. THE LANCET. RESPIRATORY MEDICINE 2024; 12:476-483. [PMID: 38740045 DOI: 10.1016/s2213-2600(24)00111-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/19/2024] [Accepted: 03/21/2024] [Indexed: 05/16/2024]
Abstract
Most patients with pleural mesothelioma (PM) present with symptomatic pleural effusion. In some patients, PM is only detectable on the pleural surfaces, providing a strong rationale for intrapleural anticancer therapy. In modern prospective studies involving expert radiological staging and specialist multidisciplinary teams, the population incidence of stage I PM (an approximate surrogate of pleura-only PM) is higher than in historical retrospective series. In this Viewpoint, we advocate for the expansion of intrapleural trials to serve these patients, given the paucity of data supporting licensed systemic therapies in this setting and the uncertainties involved in surgical therapy. We begin by reviewing the unique anatomical and physiological features of the PM-bearing pleural space, before critically appraising the evidence for systemic therapies in stage I PM and previous intrapleural PM trials. We conclude with a summary of key challenges and potential solutions, including optimal trial designs, repurposing of indwelling pleural catheters, and new technologies.
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Affiliation(s)
- Kevin G Blyth
- School of Cancer Sciences, University of Glasgow, Glasgow, UK; Queen Elizabeth University Hospital, Glasgow, UK; Cancer Research UK Scotland Centre, Glasgow, UK.
| | - Prasad S Adusumilli
- Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Cellular Therapeutics Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Philippe Astoul
- Thoracic Oncology Department, Hôpital NORD, Aix-Marseille University, Marseille, France
| | | | - Y C Gary Lee
- University of Western Australia, Perth, WA, Australia; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | | | - Stefan J Marciniak
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
| | - Nick Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK; Department of Respiratory Medicine, Southmead Hospital, Bristol, UK
| | - Vasiliki Panou
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark; Odense Respiratory Research Unit, University of Southern Denmark, Odense, Denmark; Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Tobias Peikert
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK; Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Marjorie G Zauderer
- Cellular Therapeutics Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel Sterman
- New York University School of Medicine, New York, NY, USA
| | - Dean A Fennell
- University of Leicester, Leicester, UK; University Hospitals of Leicester NHS Trust, Leicester, UK
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Rigon M, Mutti L, Campanella M. Pleural mesothelioma (PMe): The evolving molecular knowledge of a rare and aggressive cancer. Mol Oncol 2024; 18:797-814. [PMID: 38459714 PMCID: PMC10994233 DOI: 10.1002/1878-0261.13591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/22/2023] [Accepted: 01/15/2024] [Indexed: 03/10/2024] Open
Abstract
Mesothelioma is a type of late-onset cancer that develops in cells covering the outer surface of organs. Although it can affect the peritoneum, heart, or testicles, it mainly targets the lining of the lungs, making pleural mesothelioma (PMe) the most common and widely studied mesothelioma type. PMe is caused by exposure to fibres of asbestos, which when inhaled leads to inflammation and scarring of the pleura. Despite the ban on asbestos by most Western countries, the incidence of PMe is on the rise, also facilitated by a lack of specific symptomatology and diagnostic methods. Therapeutic options are also limited to mainly palliative care, making this disease untreatable. Here we present an overview of biological aspects underlying PMe by listing genetic and molecular mechanisms behind its onset, aggressive nature, and fast-paced progression. To this end, we report on the role of deubiquitinase BRCA1-associated protein-1 (BAP1), a tumour suppressor gene with a widely acknowledged role in the corrupted signalling and metabolism of PMe. This review aims to enhance our understanding of this devastating malignancy and propel efforts for its investigation.
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Affiliation(s)
- Manuel Rigon
- Centre for Clinical Pharmacology and Precision Medicine William Harvey Research InstituteQueen Mary University of LondonUK
- Department of BiologyUniversity of Rome Tor VergataRomeItaly
| | - Luciano Mutti
- Department of Biotechnological and Applied Clinical SciencesDISCAB, L'Aquila UniversityL'AquilaItaly
- Temple University Sbarro Institute for Cancer Research and Molecular MedicinePhiladelphiaPAUSA
| | - Michelangelo Campanella
- Centre for Clinical Pharmacology and Precision Medicine William Harvey Research InstituteQueen Mary University of LondonUK
- Department of Biomedical SciencesUniversity of PaduaPaduaItaly
- Institute Gustave RoussyVillejuifFrance
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Sorino C, Mondoni M, Marchetti G, Agati S, Inchingolo R, Mei F, Flamini S, Lococo F, Feller-Kopman D. Pleural Mesothelioma: Advances in Blood and Pleural Biomarkers. J Clin Med 2023; 12:7006. [PMID: 38002620 PMCID: PMC10672377 DOI: 10.3390/jcm12227006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/30/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Pleural mesothelioma (PM) is a type of cancer that is highly related to exposure to asbestos fibers. It shows aggressive behavior, and the current therapeutic approaches are usually insufficient to change the poor prognosis. Moreover, apart from staging and histological classification, there are no validated predictors of its response to treatment or its long-term outcomes. Numerous studies have investigated minimally invasive biomarkers in pleural fluid or blood to aid in earlier diagnosis and prognostic assessment of PM. The most studied marker in pleural effusion is mesothelin, which exhibits good specificity but low sensitivity, especially for non-epithelioid PM. Other biomarkers found in pleural fluid include fibulin-3, hyaluronan, microRNAs, and CYFRA-21.1, which have lower diagnostic capabilities but provide prognostic information and have potential roles as therapeutic targets. Serum is the most investigated matrix for biomarkers of PM. Several serum biomarkers in PM have been studied, with mesothelin, osteopontin, and fibulin-3 being the most often tested. A soluble mesothelin-related peptide (SMRP) is the only FDA-approved biomarker in patients with suspected mesothelioma. With different serum and pleural fluid cut-offs, it provides useful information on the diagnosis, prognosis, follow-up, and response to therapy in epithelioid PM. Panels combining different markers and proteomics technologies show promise in terms of improving clinical performance in the diagnosis and monitoring of mesothelioma patients. However, there is still no evidence that early detection can improve the treatment outcomes of PM patients.
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Affiliation(s)
- Claudio Sorino
- Division of Pulmonology, Sant’Anna Hospital of Como, University of Insubria, 21100 Varese, Italy; (C.S.); (S.A.)
| | - Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, 20122 Milan, Italy
| | | | - Sergio Agati
- Division of Pulmonology, Sant’Anna Hospital of Como, University of Insubria, 21100 Varese, Italy; (C.S.); (S.A.)
| | - Riccardo Inchingolo
- Pulmonary Medicine Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Federico Mei
- Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy;
| | - Sara Flamini
- Departement of Thoracic Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (S.F.); (F.L.)
- Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Filippo Lococo
- Departement of Thoracic Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (S.F.); (F.L.)
- Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - David Feller-Kopman
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA;
- Division of Pulmonary and Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, USA
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Ferguson K, Neilson M, Mercer R, King J, Marshall K, Welch H, Tsim S, Maskell NA, Rahman NM, Evison M, Blyth KG. Results of the Meso-ORIGINS feasibility study regarding collection of matched benign-mesothelioma tissue pairs by longitudinal surveillance. BMJ Open 2023; 13:e067780. [PMID: 37553196 PMCID: PMC10414089 DOI: 10.1136/bmjopen-2022-067780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 06/13/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVES To assess key elements of the design for Meso-ORIGINS (Mesothelioma Observational study of RIsk prediction and Generation of paired benign-meso tissue samples, Including a Nested MRI Substudy), an ambitious, UK-wide, prospective study that will collect ≥63 matched benign-mesothelioma tissue pairs through longitudinal surveillance and repeat biopsy of patients with asbestos-associated pleural inflammation (AAPI). DESIGN A multicentre, mixed-methods feasibility study, comprising a prospective observational element, evaluating recruitment feasibility, technical feasibility of repeat local anaesthetic thoracoscopy (LAT) and patient acceptability, and a retrospective cohort study focused on AAPI-mesothelioma evolution rate, informing sample size. SETTING 4 UK pleural disease centres (February 2019-January 2020). PARTICIPANTS Patients with AAPI (history or typical imaging plus appropriate pleural histology) were eligible for both elements. In August 2019, eligibility for the prospective element was broadened, including addition of radiological AAPI for technical feasibility and patient acceptability endpoints only. Retrospective cases required ≥2 years follow-up. OUTCOME MEASURES A prospective recruitment target was set a priori at 27 histological AAPI cases (or 14 in any 6 months). Technical feasibility and patient acceptability were determined at 6-month follow-up by thoracic ultrasound surrogates and questionnaires, respectively. Retrospective malignant pleural mesothelioma evolution rate was defined by proportion (95% CI). Baseline predictors of evolution were identified using logistic regression. RESULTS 296 patients with AAPI (39 prospective, 257 retrospective) were recruited/selected. 21/39 prospective recruits were histologically diagnosed (target n=27). Repeat LAT was technically feasible and acceptable in 13/28 (46%) and 24/36 (67%) cases with complete follow-up data. Mesothelioma evolution was confirmed histologically in 36/257 retrospective cases (14% (95% CI 10.3% to 18.8%)) and associated with malignant CT features (OR 4.78 (95% CI 2.36 to 9.86)) and age (OR 1.06 (95% CI 1.02 to 1.12)). CONCLUSIONS Our initial eligibility criteria were too narrow. Meso-ORIGINS will recruit a broader cohort, including prevalent cases, any biopsy type and patients with malignant CT features. A range of rebiopsy techniques will be allowed, accounting for technical and patient factors. The sample size has been reduced to 500. TRIAL REGISTRATION NUMBER ISRCTN12840870.
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Affiliation(s)
- Katie Ferguson
- Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital Campus, Glasgow, UK
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | - Rachel Mercer
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK
| | - Jenny King
- Department of Respiratory Medicine, University Hospital of South Manchester, Manchester, UK
| | - Kelly Marshall
- Department of Respiratory Medicine, University Hospital of South Manchester, Manchester, UK
| | - Hugh Welch
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Selina Tsim
- Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital Campus, Glasgow, UK
| | - Nick A Maskell
- University of Bristol Academic Respiratory Unit, Westbury on Trym, UK
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK
| | - Matthew Evison
- Department of Respiratory Medicine, University Hospital of South Manchester, Manchester, UK
| | - Kevin G Blyth
- Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital Campus, Glasgow, UK
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
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Barnett SE, Kenyani J, Tripari M, Butt Z, Grosman R, Querques F, Shaw L, Silva LC, Goate Z, Marciniak SJ, Rassl DM, Jackson R, Lian LY, Szlosarek PW, Sacco JJ, Coulson JM. BAP1 Loss Is Associated with Higher ASS1 Expression in Epithelioid Mesothelioma: Implications for Therapeutic Stratification. Mol Cancer Res 2023; 21:411-427. [PMID: 36669126 PMCID: PMC10150242 DOI: 10.1158/1541-7786.mcr-22-0635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/20/2022] [Accepted: 01/19/2023] [Indexed: 01/21/2023]
Abstract
The nuclear deubiquitylase BRCA1-associated protein 1 (BAP1) is frequently inactivated in malignant pleural mesothelioma (MPM) and germline BAP1 mutation predisposes to cancers including MPM. To explore the influence on cell physiology and drug sensitivity, we sequentially edited a predisposition mutation (w-) and a promoter trap (KO) into human mesothelial cells. BAP1w-/KO MeT5A cells express less BAP1 protein and phenocopy key aspects of BAP1 loss in MPM. Stable isotope labeling with amino acids in cell culture-mass spectrometry revealed evidence of metabolic adaptation, with concomitant alteration of cellular metabolites. In MeT5A, BAP1 deficiency reduces glycolytic enzyme levels but increases enzymes involved in the tricarboxylic acid cycle and anaplerotic pathways. Notably both argininosuccinate synthase 1 (ASS1), essential for cellular synthesis of arginine, and its substrate aspartate, are elevated in BAP1w-/KO MeT5A cells. Likewise, ASS1 expression is higher in BAP1-altered MPM cell lines, and inversely correlates with BAP1 in The Cancer Genome Atlas MESO dataset. Elevated ASS1 is also evident by IHC staining in epithelioid MPM lacking nuclear BAP1 expression, with improved survival among patients with BAP1-negative/ASS1-expressing tumors. Alterations in arginine metabolism may sensitize cells to metabolic drugs and we find that BAP1-negative/ASS1-expressing MPM cell lines are more sensitive to ASS1 inhibition, although not to inhibition of purine synthesis by mizoribine. Importantly, BAP1w-/KO MeT5A become desensitized to arginine deprivation by pegylated arginine deiminase (ADI-PEG20), phenocopying BAP1-negative/ASS1-expressing MPM cell lines. IMPLICATIONS Our data reveal an interrelationship between BAP1 and arginine metabolism, providing a potential means of identifying patients with epithelioid MPM likely to benefit from ADI-PEG20.
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Affiliation(s)
- Sarah E. Barnett
- Molecular Physiology and Cell Signalling, University of Liverpool, Liverpool, United Kingdom
| | - Jenna Kenyani
- Molecular Physiology and Cell Signalling, University of Liverpool, Liverpool, United Kingdom
| | - Martina Tripari
- Molecular Physiology and Cell Signalling, University of Liverpool, Liverpool, United Kingdom
| | - Zohra Butt
- Molecular Physiology and Cell Signalling, University of Liverpool, Liverpool, United Kingdom
| | - Rudi Grosman
- Biochemistry and Systems Biology, University of Liverpool, Liverpool, United Kingdom
| | - Francesca Querques
- Molecular Physiology and Cell Signalling, University of Liverpool, Liverpool, United Kingdom
| | - Liam Shaw
- Molecular Physiology and Cell Signalling, University of Liverpool, Liverpool, United Kingdom
| | - Luisa C. Silva
- Molecular Physiology and Cell Signalling, University of Liverpool, Liverpool, United Kingdom
| | - Zoe Goate
- Molecular Physiology and Cell Signalling, University of Liverpool, Liverpool, United Kingdom
| | - Stefan J. Marciniak
- Cambridge Institute for Medical Research, Cambridge, United Kingdom
- Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Doris M. Rassl
- Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Richard Jackson
- Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, United Kingdom
| | - Lu-Yun Lian
- Biochemistry and Systems Biology, University of Liverpool, Liverpool, United Kingdom
| | - Peter W. Szlosarek
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Joseph J. Sacco
- Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Judy M. Coulson
- Molecular Physiology and Cell Signalling, University of Liverpool, Liverpool, United Kingdom
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6
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Wang JJ, Yan L. Serum diagnostic markers for malignant pleural mesothelioma: a narrative review. Transl Cancer Res 2022; 11:4434-4440. [PMID: 36644178 PMCID: PMC9834602 DOI: 10.21037/tcr-22-2873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/24/2022] [Indexed: 12/29/2022]
Abstract
Background and Objective The prognosis of patients with malignant pleural mesothelioma (MPM) is poor, and early diagnosis is key to improving the prognosis. Pleural biopsy is the gold reference for diagnosing MPM, but it is an invasive method that can cause operation-related complications such as bleeding and infection. Serum biomarkers, with the advantages of mini-invasiveness, short turnaround time and objectiveness, represent a promising diagnostic tool for MPM. Methods We searched the PubMed database to identify clinical studies published between 1990 to July 2022 that investigated the diagnostic accuracy of serum biomarkers for MPM. The major findings of the verified studies were summarized. Key Content and Findings Currently, there are many available serum markers for MPM, including mesothelin, soluble mesothelin-related peptides, osteopontin, fibulin-3, high mobility group box 1, and microRNA. Systematic review and meta-analysis evidence indicates that the sensitivity and specificity of these serum markers are less than 0.90. In addition, a large portion of previous studies have limitations, especially the representativeness of the study cohort. Conclusions The diagnostic accuracy of currently available serum biomarkers is unsatisfactory, and further studies are needed to investigate novel serum biomarkers.
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Affiliation(s)
- Jing-Jing Wang
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Li Yan
- Department of Respiratory and Critical Care Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
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7
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Kidd AC, Anderson O, Cowell GW, Weir AJ, Voisey JP, Evison M, Tsim S, Goatman KA, Blyth KG. Fully automated volumetric measurement of malignant pleural mesothelioma by deep learning AI: validation and comparison with modified RECIST response criteria. Thorax 2022; 77:1251-1259. [PMID: 35110367 PMCID: PMC9685726 DOI: 10.1136/thoraxjnl-2021-217808] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/20/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND In malignant pleural mesothelioma (MPM), complex tumour morphology results in inconsistent radiological response assessment. Promising volumetric methods require automation to be practical. We developed a fully automated Convolutional Neural Network (CNN) for this purpose, performed blinded validation and compared CNN and human response classification and survival prediction in patients treated with chemotherapy. METHODS In a multicentre retrospective cohort study; 183 CT datasets were split into training and internal validation (123 datasets (80 fully annotated); 108 patients; 1 centre) and external validation (60 datasets (all fully annotated); 30 patients; 3 centres). Detailed manual annotations were used to train the CNN, which used two-dimensional U-Net architecture. CNN performance was evaluated using correlation, Bland-Altman and Dice agreement. Volumetric response/progression were defined as ≤30%/≥20% change and compared with modified Response Evaluation Criteria In Solid Tumours (mRECIST) by Cohen's kappa. Survival was assessed using Kaplan-Meier methodology. RESULTS Human and artificial intelligence (AI) volumes were strongly correlated (validation set r=0.851, p<0.0001). Agreement was strong (validation set mean bias +31 cm3 (p=0.182), 95% limits 345 to +407 cm3). Infrequent AI segmentation errors (4/60 validation cases) were associated with fissural tumour, contralateral pleural thickening and adjacent atelectasis. Human and AI volumetric responses agreed in 20/30 (67%) validation cases κ=0.439 (0.178 to 0.700). AI and mRECIST agreed in 16/30 (55%) validation cases κ=0.284 (0.026 to 0.543). Higher baseline tumour volume was associated with shorter survival. CONCLUSION We have developed and validated the first fully automated CNN for volumetric MPM segmentation. CNN performance may be further improved by enriching future training sets with morphologically challenging features. Volumetric response thresholds require further calibration in future studies.
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Affiliation(s)
- Andrew C Kidd
- Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Owen Anderson
- School of Computing Science, University of Glasgow, Glasgow, UK
- Canon Medical Research Europe Ltd, Edinburgh, UK
| | - Gordon W Cowell
- Department of Imaging, Queen Elizabeth University Hospital, Glasgow, UK
| | | | | | - Matthew Evison
- Department of Respiratory Medicine, University Hospital of South Manchester, Manchester, UK
| | - Selina Tsim
- Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | - Kevin G Blyth
- Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
- Beatson Institute for Cancer Research, Glasgow, UK
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8
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Conway RJH, Symonds J, Walton D, Probets J, Comins C, Stadon L, Harvey JE, Blyth KG, Maskell NA, Bibby AC. Protocol for a prospective observational cohort study collecting data on demographics, symptoms and biomarkers in people with mesothelioma (ASSESS-meso). BMJ Open 2022; 12:e060850. [PMID: 36357003 PMCID: PMC9660577 DOI: 10.1136/bmjopen-2022-060850] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 10/05/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Mesothelioma is a heterogeneous disease that can be challenging to monitor and prognosticate. ASSESS-meso is a multicentre, prospective, longitudinal observational cohort study of patients with mesothelioma. The primary aim is to describe different clinical phenotypes and investigate predictive and prognostic factors, including biomarkers from blood and pleural fluid. The secondary aim is to provide a resource for future trials and substudies. METHODS AND ANALYSIS We aim to recruit 700 patients with a histological, cytological or clinicopathological diagnosis of mesothelioma, at any anatomical site (pleural, peritoneal, pericardial, etc). Longitudinal data will be collected, including clinical information, radiological investigations, blood tests and patient-reported outcome measures for breathlessness, chest pain and sweats. Preplanned analyses will use Cox proportional hazards method to evaluate factors associated with survival, linear and logistic regression models to investigate associations with symptoms, and analysis of variance modelling to explore changes in symptoms over time. ETHICS AND DISSEMINATION Ethical approval has been granted by the Research Ethics Committee South West-Central Bristol (17-SW-0019) and Health Research Authority (IRAS ID 220360). A study steering committee has been established and results will be published OpenAccess in peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN: 61861764.
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Affiliation(s)
- Ruairi J H Conway
- Department of Medicine, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Jenny Symonds
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- Department of Respiratory Medicine, North Bristol NHS Trust, Westbury on Trym, UK
| | - Deborah Walton
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- Department of Respiratory Medicine, North Bristol NHS Trust, Westbury on Trym, UK
| | - Janet Probets
- Department of Respiratory Medicine, North Bristol NHS Trust, Westbury on Trym, UK
| | - Charles Comins
- Bristol Haematology and Oncology Centre, Bristol Royal Infirmary, Bristol, UK
| | - Louise Stadon
- Department of Respiratory Medicine, North Bristol NHS Trust, Westbury on Trym, UK
| | - John E Harvey
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- Department of Respiratory Medicine, North Bristol NHS Trust, Westbury on Trym, UK
| | - Kevin G Blyth
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
- Beatson Institute, Cancer Research UK Beatson Institute, Glasgow, UK
| | - Nick A Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- Department of Respiratory Medicine, North Bristol NHS Trust, Westbury on Trym, UK
| | - Anna C Bibby
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- Department of Respiratory Medicine, North Bristol NHS Trust, Westbury on Trym, UK
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9
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Roshini A, Goparaju C, Kundu S, Nandhu MS, Longo SL, Longo JA, Chou J, Middleton FA, Pass HI, Viapiano MS. The extracellular matrix protein fibulin-3/EFEMP1 promotes pleural mesothelioma growth by activation of PI3K/Akt signaling. Front Oncol 2022; 12:1014749. [PMID: 36303838 PMCID: PMC9593058 DOI: 10.3389/fonc.2022.1014749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is an aggressive tumor with poor prognosis and limited therapeutic options. The extracellular matrix protein fibulin-3/EFEMP1 accumulates in the pleural effusions of MPM patients and has been proposed as a prognostic biomarker of these tumors. However, it is entirely unknown whether fibulin-3 plays a functional role on MPM growth and progression. Here, we demonstrate that fibulin-3 is upregulated in MPM tissue, promotes the malignant behavior of MPM cells, and can be targeted to reduce tumor progression. Overexpression of fibulin-3 increased the viability, clonogenic capacity and invasion of mesothelial cells, whereas fibulin-3 knockdown decreased these phenotypic traits as well as chemoresistance in MPM cells. At the molecular level, fibulin-3 activated PI3K/Akt signaling and increased the expression of a PI3K-dependent gene signature associated with cell adhesion, motility, and invasion. These pro-tumoral effects of fibulin-3 on MPM cells were disrupted by PI3K inhibition as well as by a novel, function-blocking, anti-fibulin-3 chimeric antibody. Anti-fibulin-3 antibody therapy tested in two orthotopic models of MPM inhibited fibulin-3 signaling, resulting in decreased tumor cell proliferation, reduced tumor growth, and extended animal survival. Taken together, these results demonstrate for the first time that fibulin-3 is not only a prognostic factor of MPM but also a relevant molecular target in these tumors. Further development of anti-fibulin-3 approaches are proposed to increase early detection and therapeutic impact against MPM.
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Affiliation(s)
- Arivazhagan Roshini
- Department of Neuroscience and Physiology, State University of New York - Upstate Medical University, Syracuse, NY, United States
| | - Chandra Goparaju
- Department of Cardiothoracic Surgery, Langone Medical Center, New York University School of Medicine, New York, NY, United States
| | - Somanath Kundu
- Department of Neuroscience and Physiology, State University of New York - Upstate Medical University, Syracuse, NY, United States
| | - Mohan S. Nandhu
- Department of Neuroscience and Physiology, State University of New York - Upstate Medical University, Syracuse, NY, United States
| | - Sharon L. Longo
- Department of Neurosurgery, State University of New York - Upstate Medical University, Syracuse, NY, United States
| | - John A. Longo
- Department of Neuroscience and Physiology, State University of New York - Upstate Medical University, Syracuse, NY, United States
| | - Joan Chou
- Department of Neuroscience and Physiology, State University of New York - Upstate Medical University, Syracuse, NY, United States
- Department of Neurosurgery, State University of New York - Upstate Medical University, Syracuse, NY, United States
| | - Frank A. Middleton
- Department of Neuroscience and Physiology, State University of New York - Upstate Medical University, Syracuse, NY, United States
| | - Harvey I. Pass
- Department of Cardiothoracic Surgery, Langone Medical Center, New York University School of Medicine, New York, NY, United States
| | - Mariano S. Viapiano
- Department of Neuroscience and Physiology, State University of New York - Upstate Medical University, Syracuse, NY, United States
- Department of Neurosurgery, State University of New York - Upstate Medical University, Syracuse, NY, United States
- *Correspondence: Mariano S. Viapiano,
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10
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Ferrari L, Iodice S, Cantone L, Dallari B, Dioni L, Bordini L, Palleschi A, Mensi C, Pesatori AC. Identification of a new potential plasmatic biomarker panel for the diagnosis of malignant pleural mesothelioma. LA MEDICINA DEL LAVORO 2022; 113:e2022052. [PMID: 36475505 PMCID: PMC9766837 DOI: 10.23749/mdl.v113i6.13522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/26/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Malignant pleural mesothelioma (MPM) is a rare highly aggressive tumor strongly associated with asbestos exposure and characterized by poor prognosis. Currently, diagnosis is based on invasive techniques, thus there is a need of identifying non-invasive biomarkers for early detection of the disease among asbestos-exposed subjects. In the present study, we measured the plasmatic concentrations of Mesothelin, Fibulin-3, and HMGB1 protein biomarkers, and of hsa-miR-30e-3p and hsa-miR-103a-3p Extracellular-Vesicles- embedded micro RNAs (EV-miRNAs). We tested the ability of these biomarkers to discriminate between MPM and PAE subjects alone and in combination. METHODS the study was conducted on a population of 26 patients with MPM and 54 healthy subjects with previous asbestos exposure (PAE). Mesothelin, Fibulin-3, and HMGB1 protein biomarkers were measured by the enzyme-linked immunosorbent assay (ELISA) technique; the levels of hsa-miR-30e-3p and hsa-miR-103a-3p EV-miRNAs was assessed by quantitative real-time PCR (qPCR). RESULTS the most discriminating single biomarker resulted to be Fibulin-3 (AUC 0.94 CI 95% 0.88-1.0; Sensitivity 88%; Specificity 87%). After investigating the different possible combinations, the best performance was obtained by the three protein biomarkers Mesothelin, Fibulin-3, and HMGB1 (AUC 0.99 CI 95% 0.97-1.0; Sensitivity 96%; Specificity 93%). CONCLUSIONS the results obtained contribute to identifying new potential non-invasive biomarkers for the early diagnosis of MPM in high-risk asbestos-exposed subjects. Further studies are needed to validate the evidence obtained, in order to assess the reliability of the proposed biomarker panel.
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Affiliation(s)
- Luca Ferrari
- EPIGET Lab, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy,Occupational Health Unit, Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Simona Iodice
- EPIGET Lab, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Laura Cantone
- EPIGET Lab, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Barbara Dallari
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Dioni
- EPIGET Lab, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Lorenzo Bordini
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Palleschi
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Carolina Mensi
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Angela Cecilia Pesatori
- EPIGET Lab, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy,Occupational Health Unit, Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, Milan, Italy
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11
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Armato SG, Nowak AK, Francis RJ, Katz SI, Kholmatov M, Blyth KG, Gudmundsson E, Kidd AC, Gill RR. Imaging in pleural mesothelioma: A review of the 15th International Conference of the International Mesothelioma Interest Group. Lung Cancer 2021; 164:76-83. [PMID: 35042132 DOI: 10.1016/j.lungcan.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 12/11/2021] [Indexed: 11/16/2022]
Abstract
Imaging of mesothelioma plays a role in all aspects of patient management, including disease detection, staging, evaluation of treatment options, response assessment, pre-surgical evaluation, and surveillance. Imaging in this disease impacts a wide range of disciplines throughout the healthcare enterprise. Researchers and clinician-scientists are developing state-of-the-art techniques to extract more of the information contained within these medical images and to utilize it for more sophisticated tasks; moreover, image-acquisition technology is advancing the inherent capabilities of these images. This paper summarizes the imaging-based topics presented orally at the 2021 International Conference of the International Mesothelioma Interest Group (iMig), which was held virtually from May 7-9, 2021. These topics include an update on the mesothelioma staging system, novel molecular targets to guide therapy in mesothelioma, special considerations and potential pitfalls in imaging mesothelioma in the immunotherapy setting, tumor measurement strategies and their correlation with patient survival, tumor volume measurement in MRI and CT, CT-based texture analysis for differentiation of histologic subtype, diffusion-weighted MRI for the assessment of biphasic mesothelioma, and the prognostic significance of skeletal muscle loss with chemotherapy.
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Affiliation(s)
- Samuel G Armato
- Department of Radiology, The University of Chicago, Chicago, IL, USA.
| | - Anna K Nowak
- Medical School and National Centre for Asbestos Related Diseases, University of Western Australia, Perth, Western Australia, Australia; Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Institute for Respiratory Health, Perth, Western Australia, Australia
| | - Roslyn J Francis
- Medical School and National Centre for Asbestos Related Diseases, University of Western Australia, Perth, Western Australia, Australia; Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Sharyn I Katz
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Manizha Kholmatov
- Department of Radiology, The University of Chicago, Chicago, IL, USA
| | - Kevin G Blyth
- Institute of Cancer Sciences, University of Glasgow, UK; Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | | | - Andrew C Kidd
- Institute of Cancer Sciences, University of Glasgow, UK; Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Ritu R Gill
- Department of Radiology, Beth Israel Lahey Health, Harvard Medical School, Boston, MA, USA
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