To monitor progression or recurrence of a rare cancer called mesothelioma that affects the membranes that surround the lungs, heart, and abdominal cavity; most cases of mesothelioma are associated with asbestos exposure.
After you have been diagnosed with mesothelioma, this test may be ordered anytime during or after treatment to follow response to treatment.
A blood sample drawn from a vein in your arm
Soluble mesothelin-related peptides (SMRP) are breakdown products from proteins found in the membranes that line the cavities surrounding the lungs, heart, and abdomen. High amounts of SMRP are often seen in the blood of people suffering from mesothelioma, and the amount of SMRP in the blood is thought to be related to the extent of disease. This test measures the amount of SMRP in the blood.
Malignant mesothelioma is a rare cancer of the membranes that cover the outside of internal organs and line body cavities, including the chest (pleural mesothelioma), abdominal cavity (peritoneal mesothelioma), and the heart (pericardial mesothelioma). About 3,000 new cases are diagnosed annually in the U.S., and pleural mesothelioma is the most common type, accounting for 90% of all cases.
Malignant mesotheliomas can also be classified based on the type of cell found:
Most cases of pleural mesothelioma—about 70% to 80%—arise in people with a history of working with asbestos, especially in the shipbuilding, construction, automotive, and fireproofing industries. The disease has a long latency period, meaning that people usually develop mesothelioma 20 to 50 years after asbestos exposure.
The test for soluble mesothelin-related peptides (SMRP) is used to monitor people who have been diagnosed with malignant mesothelioma. It is not used to diagnose the disease.
Malignant mesothelioma is a rare cancer of the membranes that cover the outside of internal organs and line body cavities, including the chest, abdominal cavity, and the heart. It is usually seen in people who have a history of working with asbestos.
SMRP tests are most often used in conjunction with imaging tests such as positron emission tomography (PET) and computed tomography (CT) to:
A healthcare practitioner might order a series of SMRP tests to monitor progression of mesothelioma or its recurrence:
If a series of SMRP tests show SMRP levels are increasing, it may indicate that mesothelioma has progressed. If the series of tests indicates that SMRP levels are decreasing, then the person may be responding to therapy. If the levels are unchanged, it may mean that the disease has stabilized.
The interpretation of SMRP test results will likely be done in conjunction with results from imaging studies. That is because:
This test is not used to diagnose mesothelioma but only used to monitor progression or recurrence. The diagnosis of this disease is often difficult and involves many steps. It usually begins with a review of the person's medical history, including a history of exposure to asbestos, and with a complete physical examination. These may be followed by imaging studies of the chest and abdomen, including X-rays and computed tomography (CT) scans, and with pulmonary function tests (PFTs). Diagnosis may be confirmed by examining tissue from a biopsy or fluid from the affected area for malignant cells.
In the U.S., the Food and Drug Administration has classified the test for SMRP in a special category, as a Humanitarian Use Device (HUD), with a Humanitarian Device Exemption (HDE). The HDE is intended to make medical devices, like laboratory tests, available to those with rare diseases even though the device has not undergone the usual evaluation for effectiveness. To qualify for an HDE, the device must be intended for use in diseases that occur in fewer than 4,000 patients per year. These diseases are so rare that it is not cost effective for a manufacturer to do the extensive evaluation needed for FDA approval. The exemption makes a potentially useful device or test available to the small number of people who might benefit from it.
Nonetheless, manufacturers must show that an exempted device doesn't pose any threat of illness or injury and that its probable benefits outweigh any risks. However, since HDE tests have not been validated as effective, they are considered experimental. So, before a person can have an SMRP test performed, the healthcare provider must obtain the approval of an institutional review board (IRB), a committee charged with overseeing medical research involving humans and protecting the rights and welfare of study subjects. The manufacturer of the SMRP test has contracted with a national IRB to provide the review and oversight for this test. The healthcare provider will receive certification to use SMRP from that review board.
Asbestos is a heat- and fire-resistant insulating material that was widely used in construction, shipbuilding, and the automotive industry after 1945 and through the 1970s. Workers breathed in the tiny fibers that comprise asbestos. Those fibers entered their pleura, the lining of the chest cavity and lung, and damaged its cells. Mesothelioma develops over a long period of between 20 and 50 years. Research has also shown that family members and others living with workers exposed to asbestos are at an increased risk of developing mesothelioma.
The test is not intended for or useful as a general screening tool but only to help evaluate those who have already been diagnosed with mesothelioma. Since mesothelioma is a very rare cancer, most people will never need to have this test performed.
No, the test requires specialized equipment to perform and is not offered by most laboratories. In most cases, your blood will need to be sent to a reference laboratory.
Sources Used in Current Review
Tan, W. (2014 April 23 Updated). Mesothelioma. Medscape Drugs and Diseases Available online at http://emedicine.medscape.com/article/280367-overview. Accessed on 6/19/16.
(2016 February 17 Revised). Malignant Mesothelioma. American Cancer Society. Available online at http://www.cancer.org/cancer/malignantmesothelioma/detailedguide/malignant-mesothelioma-malignant-mesothelioma. Accessed on 6/19/16.
Ai, J. and Stevenson, J. (2014 September). Current Issues in Malignant Pleural Mesothelioma Evaluation and Management. Oncologist. 2014 Sep; 19(9): 975–984. Available online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153452/. Accessed on 6/19/16.
(2016 May Updated). Mesothelioma. ARUP Consult. Available online at https://arupconsult.com/content/mesothelioma/?tab=tab_item-0. Accessed on 6/19/16.
Carletti, A. et al (2012). Soluble Mesothelin-Related Peptide in the Pleural Fluid as a Diagnostic Marker in Malignant Pleural Mesothelioma. Chest. 2012;142(4_MeetingAbstracts):494A. doi:10.1378/chest.1373488. Available online at http://journal.publications.chestnet.org/article.aspx?articleID=1375898. Accessed on 6/19/16.
Mayo Clinic Staff. (2015 October 23). Mesothelioma. Mayo Clinic. Available online at http://www.mayoclinic.org/diseases-conditions/mesothelioma/basics/definition/CON-20026157?p=1. Accessed on 6/19/16.
Opitz, I. et al (2014 March 12) Biomolecular and clinical practice in malignant pleural mesothelioma and lung cancer: what thoracic surgeons should know. European Journal of Cardio-Thoracic Surgery 46 (2014) 602–606. Available online at http://ejcts.oxfordjournals.org/content/46/4/602.full.pdf+html. Accessed on 6/19/16.
Asbestos.com. Mesothelioma Histology. Available online at https://www.asbestos.com/mesothelioma/histology.php. Accessed October 2016.
Mesothelioma.com. Types of Mesothelioma. Available online at http://www.mesothelioma.com/mesothelioma/types/. Accessed October 2016.
Sources Used in Previous Reviews
ARUP Laboratories. Soluble Mesothelin-Related Peptides (MESOMARK®). (March 2007, Issued). PDF available for download through http://www.aruplab.com. Accessed on June 17, 2008.
U.S. Food and Drug Administration, Center for Devices and Radiological Health (February 22, 2007, Updated). New Humanitarian Device Approval: Mesomark ™ - H060004. Available online at http://www.fda.gov/cdrh/mda/docs/H060004.html. Accessed on June 16, 2008.
Email interview with David Grenache, Medical Director, Special Chemistry, ARUP Laboratories, Salt Lake City, Utah. June 20, 2008.
Pacific Heart & Blood Institute. Mesomark. Available online at http://www.phlbi.org/mesomark_available.asp. Accessed June 17, 2008.
ARUP Laboratories. The Physician's Guide to Laboratory Test Selection and Interpretation: Mesothelioma. Available online at http://www.arupconsult.com/Topics/OncologicDz/Mesothelioma.html. Accessed June 17, 2008.
Fujirebio Diagnostics. FAQ: The Mesomark Assay. Available at http://www.fdi.com/mesomark/world/about/faqs.html#4. Accessed June 18, 2008.
Beyer, H. et al. Mesomark™: A Potential Test for Malignant Pleural Mesothelioma. Clinical Chemistry 2007: 53: 666-672.
Creaney, J. et al. Soluble mesothelin in effusions: a useful tool for the diagnosis of malignant mesothelioma. Thorax 2007; 62: 569-576.
U.S. Food and Drug Administration. Center for Devices and Radiological Health Guidance for Industry and FDA Staff: Humanitarian Device Exemption (HDE) Regulation: Questions and Answers. (July 18, 2006, Issued). PDF available for download at http://www.fda.gov/cdrh/ode/guidance/1381.pdf. Accessed June 16, 2008.
Fujirebio Diagnostics. Healthcare Professionals: Mesomark ® Approved for Humanitarian Use in the U.S. Available online at http://www.fdi.com/mesomark/usa/professionals/healthcare_professionals.html. Accessed June 18, 2008.
Cancer Research UK. Mesothelioma Risks and Causes. (February 5, 2008, Updated). Available online at http://www.cancerhelp.org.uk/help/default.asp?page=4395. Accessed June 20, 2008.
National Cancer Institute. Mesothelioma: Questions and Answers. (May 13, 2002, Reviewed). Available online at http://www.cancer.gov/cancertopics/factsheet/Sites-Types/mesothelioma. Accessed June 20, 2008.
(Revised 2011 June 16). How is malignant mesothelioma diagnosed? American Cancer Society [On-line information]. Available online at http://www.cancer.org/Cancer/MalignantMesothelioma/DetailedGuide/malignant-mesothelioma-diagnosed. Accessed November 2011.
(2009 March). Soluble Mesothelin-Related Peptides (MESOMARK®) for Monitoring Patients Diagnosed with Biphasic or Epithellioid Mesothelioma ARUP Technical Bulletins [On-line information]. Available online through https://www.aruplab.com. Accessed November 2011.
Tan, W. (Updated 2010 October 7). Mesothelioma. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/280367-overview. Accessed November 2011.
Wheatley-Price, P. (2010 July 10). Soluble Mesothelin-Related Peptide and Osteopontin As Markers of Response in Malignant Mesothelioma. JCO v(28) 20 [On-line information]. Available online at http://jco.ascopubs.org/content/28/20/3316.full. Accessed November 2011.
Ray, M. and Kindler, H. (2009 September). Malignant Pleural Mesothelioma, An Update on Biomarkers and Treatment. CHEST v 136 (3) [On-line information]. Available online at http://chestjournal.chestpubs.org/content/136/3/888.full. Accessed November 2011.