Japanese researchers believe they have found a way to diagnose a rare form of mesothelioma earlier using a simple blood test. Diffuse malignant peritoneal mesothelioma (DMPM), which represents about a fourth of all mesothelioma cases, is an aggressive malignancy that spreads across the lining of the abdomen. In most cases, DMPM is lethal within a year.
The standard treatment for diffuse malignant peritoneal mesothelioma is cytoreductive surgery to remove as much of the mesothelioma as possible, followed by intraperitoneal chemotherapy to destroy residual cancer cells. In some studies, this approach has resulted in 5-year survival rates of 30 to 60 percent. However, it is most successful when it is performed early, while the primary mesothelioma tumor is more easily removed.
Like all forms of mesothelioma, DMPM can be a diagnostic challenge. Its symptoms, which can include abdominal pain, buildup of abdominal fluid, fever, diarrhea, anorexia and weight loss, are also seen in a number of other disease processes. The mesothelioma researchers in Japan say focusing on a protein found in high levels indiffuse malignant peritoneal mesothelioma patients may offer a way to diagnose and treat it earlier, when the odds of survival are higher.
“High-mobility group box 1” or HMGB1 is a protein already known to be associated with another disease called pulmonary fibrosis. The cells from which diffuse malignant peritoneal mesothelioma arises, called mesenchymal cells, are similar to the lung fibroblasts which give rise to pulmonary fibrosis. Because of that similarity, the researchers hypothesized that DMPM cells might also produce high levels of HMGB1. To test the theory, they measured the HMGB1 levels in 13 mesothelioma patients and 45 patients with benign asbestos-related diseases.
Writing on their findings in the Journal of Clinical Gastroenterology, the team reports, “We demonstrated that the patients with DMPM had significantly higher serum levels of HMGB1 compared with the population who had been exposed to asbestos but did not develop DMPM.” They conclude that HMGB1 could be a useful serum biomarker for DMPM, helping clinicians to find and treat this type of mesothelioma disease earlier.
Tabata, C, et al, “Serum HMGB1 as a Diagnostic Marker for Malignant Peritoneal Mesothelioma”, May 16, 2013, Journal of Clinical Gastroenterology, Epub head of print.
Mirarabshahii, P, et al, “Diffuse malignant peritoneal mesothelioma – an update on treatment:, October 2012, Cancer Treatment Review, pp. 605-612.