New Mesothelioma Test Effective at Predicting Which Patients Will Benefit from Surgery
Researchers at the Brigham and Womens Hospital in Boston, Massachusetts have developed and tested a gene ratio test that helps predict which pleural mesothelioma patients will benefit from surgical procedures and trimodality therapy (multiple modes of therapy).
The test, which analyzes relative expression levels of four genes involved in malignant mesothelioma, has shown in multiple studies to be effective at foretelling postsurgical outcome in pleural mesothelioma patients. The researchers were motivated to develop a molecular test that could predict surgical outcome because current staging methods and other means of assessing prognosis are insufficient at determining which mesothelioma patients will benefit from surgery or trimodality therapy.
The report states that “Trimodality treatment consisting of surgical resection with chemotherapy and radiation leads to longer survival than nonsurgical therapy in patients with malignant pleural mesothelioma (MPM).” However, this aggressive approach is only beneficial to about 50 percent of MPM patients and involves high medical costs and side effects. With only half of patients benefitting from this aggressive treatment approach, there is clearly a need for a way to determine which individuals will see an improved prognosis.
The current median survival of patients that undergo the aggressive trimodality therapy is one to two years, but approximately 20 percent of patients may be disease-free for three to 15 years. Considering the potential of improving survival so significantly, taking an aggressive treatment approach is certainly warranted among the patients who may be more genetically apt to benefit. This further supports the need for an accurate test to asses which patients should take on the medical costs and side effects of aggressive treatment.
The researchers sought to develop a predictive and clinically useful test based on the expression of a small number of genes. They also sought to create an easy-to-use test, stating, “The principle utility of this test, in contrast to many proposed predictive tests in cancer, is that it does not depend on highly specific instrumentation and the test can be performed in any laboratory and still deliver a consistent, reproducible result.”
Additionally, standard biopsy procedures used to diagnose mesothelioma already obtain adequate tissue samples for the gene ratio test. This means no additional invasive procedures must be performed for the gene ratio analysis.
The results of the study moved researchers to propose this test become a standard practice in diagnosing and planning treatment for pleural mesothelioma patients. The researchers concluded, “Our successful application of this test indicates that it can be performed on specimens obtained in a minimally invasive biopsy performed before major surgical intervention, can accurately predict postsurgical outcome, and can reliably inform the clinical decision of whether to perform major surgical or trimodal therapies.”
Additional information about mesothelioma may be found through the Mesothelioma Center.
