PUBLICATION- Serum mesothelin as a response biomarker in pleural mesothelioma
07/30/2025

University of Bristol PhD researcher Dr Geraldine Lynch and the ASSESS-meso team have published results of their serum mesothelin (SM) research in the journal Lung Cancer.

‘Serum mesothelin as a response biomarker in pleural mesothelioma’

Free link to Access: https://www.lungcancerjournal.info/article/S0169-5002(25)00562-8/fulltext

Highlights

  • CT scans are the gold standard for disease monitoring in pleural mesothelioma.
  • A blood biomarker could offer a more accessible alternative.
  • Serial mesothelin is a reliable response biomarker in PM regardless of subtype.
  • Serial mesothelin predicts disease status regardless of treatment or baseline value.
  • This supports the use of mesothelin as an adjunct to CT scans.

Abstract

Background

CT scans are the current gold standard for disease monitoring for Pleural mesothelioma (PM), with radiology reported using the modified RECIST criteria. While mRECIST has its own challenges, attending for CT scans adds time and expense. A blood-based biomarker which tracks disease status could enable more responsive, community-based disease monitoring. This study evaluated the relationship between serial serum mesothelin (SM) levels and disease status.

Methods

Patients with PM were recruited from Assess-Meso, a multi-centre prospective cohort study of patients with mesothelioma, between 28/2/2019 and 31/12/2023. Logistic regression, adjusted for sex, age, histology, performance status, eGFR and treatment, was used to assess the relationship between serial SM and radiological disease status. Prespecified sub-group analyses stratified participants by initial SM and treatment status.

Results

156 patients had ≥ 2 SM measurements with paired CT scans. Rising SM was associated with disease progression in the coincident time period (Adj OR 1.11, 95 % CI 1.03–1.19) and the subsequent 6 months (Adj OR 1.13, 1.03–1.23), regardless of initial SM. A 25 % change in SM was the optimal threshold, with a 25 % rise associated with disease progression (Adj OR 2.68 (1.52–4.73)) with sensitivity and specificity of 48.7 % (43.1 %-54.4 %) and 75.7 % (70.8 %-80.5 %) respectively. For patients receiving treatment, falling SM predicted subsequent disease response (Adj OR 1.37, 1.16–1.61).

Conclusions

Serial SM is a reliable response biomarker in PM, regardless of initial value and treatment status. These results support the use of SM in routine clinical care as an adjunct to CT scans, with several benefits over radiological monitoring.