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Mesothelioma Management: Different Biomarkers Serve Different Functions

29115435_lab techAustralian researchers have attempted to settle the debate about the value of the newly proposed mesothelioma biomarker fibulin-3 compared with the gold standard biomarker mesothelin.  According to their new report in the journal Thorax, mesothelin is still the best marker for diagnosing mesothelioma but fibulin-3 is better at predicting mesothelioma outcomes.

The multi-center study included 153 patients – 82 with pleural mesothelioma, 36 with other types of malignancies causing pleural effusions (excess lung fluid), and 35 with benign effusions. For comparison, the team also measured biomarker levels in the blood plasma of 49 people with non-mesothelioma asbestos-related diseases.

Researchers measured mesothelin and fibulin-3 levels in both pleural effusions and blood plasma and determined that mesothelin provides the best diagnostic accuracy, regardless of where it comes from. At the same time, fibulin-3 was revealed to be an important prognostic indicator in mesothelioma – especially when measured in pleural effusions.

“Malignant mesothelioma patients with effusion fibulin-3 levels below the median survived significantly longer than those with levels above the median,” reports lead author Jenette Creaney, PhD, of the National Centre for Asbestos Related Diseases at the University of Western Australia. Neither mesothelin nor a measure of white blood cell function called the neutrophil to lymphocyte ratio was found to be a significant prognostic marker.

“Soluble mesothelin is a superior diagnostic biomarker for malignant mesothelioma compared with fibulin-3, whereas fibulin-3 provides superior prognostic information compared with mesothelin,” concludes Dr. Creaney.

The news is potentially important for clinicians because mesothelioma is one of the most difficult cancers to diagnose. As with many cancers, delayed diagnosis of mesothelioma can lead to a grim prognosis. Researchers around the world continue to focus heavily on diagnostic markers for earlier mesothelioma diagnosis and prognostic markers to help guide treatment planning.


Creaney, J, “Comparison of fibulin-3 and mesothelin as markers in malignant mesothelioma”, July 18, 2014, Thorax, Epub ahead of print

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