Towards a Better Understanding of Mesothelioma: A Comprehensive Review of Diagnosis, Therapy and Biomarkers

Malignant pleural mesothelioma (MPM) is a rare but highly aggressive cancer, primarily caused by asbestos exposure, with limited diagnostic and therapeutic options. The disease is characterized by late-stage diagnosis and poor prognosis, necessitating advancements in early detection and treatment strategies. Biomarkers have emerged as vital tools in addressing these challenges, providing opportunities for early diagnosis, prognostic evaluation, and therapeutic guidance. This review explores the recent developments in MPM biomarkers, including soluble mesothelin-related peptides (SMRP), fibulin-3, osteopontin, and novel genetic and epigenetic markers. We also examine the potential of liquid biopsy technologies, encompassing circulating tumor cells (CTCs), cell-free DNA (cfDNA), and exosomal markers, in improving diagnostic precision and monitoring treatment response. Despite promising advancements, significant hurdles remain, including variability in biomarker sensitivity and specificity, lack of standardization in clinical settings, and the need for extensive validation studies. Recommendations for future research include integrating multi-omic approaches, leveraging artificial intelligence for biomarker discovery, implementing appropriate screening guidelines and fostering collaboration among research institutions to expedite translational efforts for personalized, biomarker driven treatment strategies. By addressing these gaps, biomarker research can pave the way for personalized medicine in MPM, improving early detection, treatment efficacy, and overall patient outcomes.