bims-mesote Biomed News
on Mesothelioma
Issue of 2025–04–06
four papers selected by
Laura Mannarino, Humanitas Research



  1. Pulm Ther. 2025 Apr 03.
      Pleural mesothelioma (PM) is a rare incurable disease, predominantly linked to asbestos exposure. Not only is diagnosis difficult, but treatment choices are often limited to systemic anti-cancer treatment with chemotherapy or immunotherapy. Surgery has been employed for decades, but its application has been fiercely debated despite some randomized controlled trials such as the recent Mesothelioma and Radical Surgery 2 (MARS 2) study. We provide a commentary on this controversial topic.
    Keywords:   Pleurectomy; Chemotherapy; Immunotherapy; MARS 2; Pleural mesothelioma; Pneumonectomy; Surgery
    DOI:  https://doi.org/10.1007/s41030-025-00295-1
  2. Ann Diagn Pathol. 2025 Mar 24. pii: S1092-9134(25)00040-1. [Epub ahead of print]77 152475
      Distinguishing pleural mesothelioma (PM) from reactive mesothelial proliferations (RMP) can be challenging. In such cases, immunohistochemistry (IHC)-detected BAP1 or MTAP loss and FISH-detected CDKN2A homozygous deletion are effective. Merlin is the protein product of the NF2 gene, which is frequently altered in mesotheliomas. Recently, IHC-detected loss of Merlin was also shown to be useful in differentiating PM from RMP. To validate these findings, we examined Merlin IHC in PM cases, including for the first time cytologic material. Merlin IHC was performed on 67 PM cases, including 47 samples from tissues and 20 from cell blocks (CBs), and 29 RMP cases. In RMP, Merlin was expressed in cell membranes and cytoplasm, with no loss. Merlin expression was lost in 49 % of PM tissues. In discriminating PM from RMP, addition of Merlin IHC to the combination of BAP1 and MTAP IHC increased sensitivity from 77 % to 95 %. However, Merlin expression could not be assessed in 8.5 % of tissues and 25 % of CBs. In CBs, Merlin loss could be assessed only in sheeted or clustered tumor cells, because PM cells could not be identified precisely in few scattered tumor cells. In cases where both tissue biopsy and CBs were available, results matched in only 50 % of cases, suggesting uneven occurrence of Merlin loss in PM tissues. Our observations support the effectiveness of Merlin IHC in differentiating PM from RMP. However, investigators should be familiar with potential challenges in interpreting Merlin IHC results, especially in CBs.
    Keywords:  BAP1; CDKN2A FISH; Immunohistochemistry; MTAP; Merlin; NF2; Pleural mesothelioma
    DOI:  https://doi.org/10.1016/j.anndiagpath.2025.152475
  3. Cell Death Dis. 2025 Apr 03. 16(1): 241
      Malignant pleural mesothelioma (MPM) is a rare yet highly aggressive malignancy with a severe prognosis. Compounded by the lack of effective treatment modalities, MPM remains a formidable health challenge. Therefore, the identification of actionable liabilities is critical for advancing precision medicine to combat this lethal disease. Here, we exploit an unbiased genome-wide CRISPR screen, integrating and cross-comparing three MPM cell lines with nonmalignant mesothelial cells, to selectively map the gene targets whose depletion indicates a common dependency in MPM cells. This systematic approach unveils a cohort of verifiable genes, among which BUB1, a mitotic checkpoint serine/threonine kinase, emerges as a high-confidence hit in cancer cells. Cellular and molecular studies demonstrate that genetic depletion or pharmacological inhibition of BUB1 profoundly impairs MPM cell survival and growth while inducing G2/M cell cycle arrest, cellular senescence, and apoptosis, and attenuating functional hallmarks of aggressive cancer cells. Transcriptomic profiling of BUB1-depleted cells discloses differential gene expression signatures congruent with cell fate phenotypes, including the reprogramming of mitotic network genes. Mechanistically, BUB1 is indispensable for the proper localization of essential mitotic regulators MAD1, MAD2, and Shugoshin (SGO1), thereby ensuring the functionality of the spindle assembly checkpoint (SAC). Furthermore, BUB1 ablation leads to cytokinesis failure and multinucleation, a phenotype characterized by the downregulation of CDC20, Cyclin A, and Cyclin B, and a reciprocal upregulation of the cyclin-dependent kinase inhibitor p21. Clinically, MPM tumors exhibit elevated levels of BUB1, and high BUB1 expression is associated with shorter patient survival. Our novel findings accentuate comparative CRISPR screens as a powerful platform to explore tumor cell-selective gene essentiality and propose BUB1 kinase as a potential marker and druggable vulnerability with therapeutic implications for MPM.
    DOI:  https://doi.org/10.1038/s41419-025-07587-z
  4. ESMO Open. 2025 Apr 01. pii: S2059-7029(25)00401-6. [Epub ahead of print]10(4): 104532
       INTRODUCTION: Peritoneal, pericardial and pleural mesothelioma (PeM/PcM/PM) are rare and aggressive diseases with limited survival. Molecularly guided therapy is currently not part of standard care.
    METHODS: This study integrates molecular and clinical data from 51 patients (among them 28 PM, one PcM, 21 PeM and one synchronous PeM/PM) enrolled in the National Center for Tumor Diseases and the German Cancer Consortium (NCT/DKTK) Molecularly Aided Stratification for Tumor Eradication Research (MASTER), a multicenter precision oncology registry trial addressing adults with rare advanced-stage cancers. Analysis comprised both somatic and germline whole exome sequencing/whole genome sequencing and transcriptome analysis leading to personalized treatment recommendations issued by a dedicated molecular tumor board. To assess clinical efficacy, progression-free survival (PFS) ratios comparing molecularly informed therapies (PFS2) to preceding systemic therapies (PFS1) were calculated. Efficacy of immune checkpoint inhibition applied during the observation period was assessed accordingly.
    RESULTS: Cancer-related genes altered in more than 5 out of 44 assessable patients were BAP1, CDKN2A, NF2, SETD2 and TP53. Somatic (n = 23) or germline (n = 9) alterations in homologous recombination-related genes were detected in 27/44 patients. In 21/44 cases, they were supported by positive combined homologous recombination deficiency scores or BRCAness signature. Following American College of Medical Genetics and Genomics guidelines, (likely) pathogenic germline variants in autosomal dominant cancer predisposition genes were found in 8/51 patients. Molecular tumor board recommendations were issued in 46 cases and applied in 6 cases. Mean PFS ratio was 2.45 (n = 5). Median PFS2 was 6.5 months (n = 6), median PFS1 was 4.0 months (n = 5). A total of 27 patients received immune checkpoint inhibition during the observation period leading to a mean PFS ratio of 1.69 (n = 19).
    CONCLUSIONS: In mesothelioma, comprehensive molecular analysis can provide valuable clinically actionable information. Molecularly informed therapy recommendations can lead to clinical benefit.
    Keywords:  Key words: precision oncology; homologous repair deficiency; peritoneal mesothelioma; pleural mesothelioma; targeted therapy
    DOI:  https://doi.org/10.1016/j.esmoop.2025.104532