***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose : To examine the clinical utility of soluble mesothelin in patients with malignant pleural mesothelioma . Experimental Design : A total of 97 patients ( female : 11 ; male : 86 ) were prospect ively enrolled , longitudinal serum sample s collected , and mesothelin concentrations determined . Baseline mesothelin levels were analyzed relative to tumor stage , presence of metastatic disease , the positron emission tomography ( PET ) parameters maximum st and ardized uptake value , tumor volume , total glycolytic volume , and survival . Changes in mesothelin level were correlated to objective response to  chemotherapy , as assessed radiologically and by PET imaging , and with patient survival . Results : Baseline mesothelin levels greater than 5 nmol/L were a significant negative prognostic indicator ( HR = 2.25 ; 95 % CI , 1.20–4.21 ) and correlated with tumor stage and volume . In 55 patients who received chemotherapy  , change in mesothelin correlated with radiological response ( χ2 = 11.32 ; P = 0.023 ) and change in metabolically active tumor volume ( r = 0.58 ; P < 0.01 ) . Median survival for patients with a reduction in mesothelin following chemotherapy ( 19 months ) was significantly longer than for patients with increased mesothelin ( 5 months ; P < 0.001 ) . Conclusion : These findings show the potential value of changes in mesothelin levels for prognostication and monitoring of treatment response in mesothelioma . Clin Cancer Res ; 17(5 ) ; 1181–9 . © 2010 AACR BACKGROUND Malignant pleural mesothelioma is an aggressive cancer with poor prognosis , linked to occupational asbestos exposure . Vascular endothelial growth factor is a key mitogen for malignant pleural mesothelioma cells , therefore targeting of vascular endothelial growth factor might prove effective . We aim ed to assess the effect on survival of bevacizumab when added to the present st and ard of care , cisplatin plus pemetrexed , as first-line treatment of advanced malignant pleural mesothelioma . METHODS In this r and omised , controlled , open-label , phase 3 trial , we recruited patients aged 18 - 75 years with unresectable malignant pleural mesothelioma who had not received previous chemotherapy , had an Eastern Cooperative Oncology Group performance status of 0 - 2 , had no substantial cardiovascular comorbidity , were not amenable to curative surgery , had at least one evaluable ( pleural effusion ) or measurable ( pleural tumour solid thickening ) lesion with CT , and a life expectancy of > 12 weeks from 73 hospitals in France . Exclusion criteria were presence of central nervous system metastases , use of antiaggregant treatments ( aspirin ≥325 mg per day , clopidogrel , ticlopidine , or dipyridamole ) , anti-vitamin K drugs at a curative dose , treatment with low-molecular-weight heparin at a curative dose , and treatment with non-steroidal anti-inflammatory drugs . We r and omly allocated patients ( 1:1 ; minimisation method used [ r and om factor of 0·8 ] ; patients stratified by histology [ epithelioid vs sarcomatoid or mixed histology subtypes ] , performance status score [ 0 - 1 vs 2 ] , study centre , or smoking status [ never smokers vs smokers ] ) to receive intravenously 500 mg/m(2 ) pemetrexed plus 75 mg/m(2 ) cisplatin with ( PCB ) or without ( PC ) 15 mg/kg bevacizumab in 21 day cycles for up to six cycles , until progression or toxic effects . The primary outcome was overall survival ( OS ) in the intention-to treat population . Treatment was open label . This IFCT-GFPC-0701 trial is registered with Clinical Trials.gov , number NCT00651456 . FINDINGS From Feb 13 , 2008 , to Jan 5 , 2014 , we r and omly assigned 448 patients to treatment ( 223 [ 50 % ] to PCB and 225 [ 50 % ] to PC ) . OS was significantly longer with PCB ( median 18·8 months [ 95 % CI 15·9 - 22·6 ] ) than with PC ( 16·1 months [ 14·0 - 17·9 ] ; hazard ratio 0·77 [ 0·62 - 0·95 ] ; p=0·0167 ) . Overall , 158 ( 71 % ) of 222 patients given PCB and 139 ( 62 % ) of 224 patients given PC had grade 3 - 4 adverse events . We noted more grade 3 or higher hypertension ( 51 [ 23 % ] of 222 vs 0 ) and thrombotic events ( 13 [ 6 % ] of 222 vs 2 [ 1 % ] of 224 ) with PCB than with PC . INTERPRETATION Addition of bevacizumab to pemetrexed plus cisplatin significantly improved OS in malignant pleural mesothelioma at the cost of expected manageable toxic effects , therefore it should be considered as a suitable treatment for the disease . FUNDING Intergroupe Francophone de Cancérologie Thoracique ( IFCT ) BACKGROUND New tumour biomarkers are being intensely investigated for malignant mesothelioma ( MM ) .  Fibulin-3 is produced in MM but its role remains uncertain . The aim of this study was to evaluate the validity of measuring serum fibulin-3  in the diagnosis and prognosis of MM . MATERIAL S AND METHODS This prospect i ve study was performed on 43 patients and 40 healthy controls who were admitted to our hospital between January 2012 and January 2014 . Data from MM patients , including demographic and clinical features , routine laboratory data , levels of serum fibulin-3 , and treatment outcomes were defined as potential prognostic factors . The receiver operating characteristic ( ROC ) curve for fibulin-3 was used to detect the cut-off value with highest sensitivity and specificity . Univariate survival analysis was performed using the Kaplan-Meier method in patients with MM . Afterwards , the possible factors identified with univariate analyses were entered into the cox regression analysis . RESULTS Our results revealed that patients with MM had significantly higher serum levels of fibulin-3 than controls . The results showed that the best cut-off point was 36.6 ng/ml with an AUC ( area under the curve)=0.976 , sensitivity=93.0 % and specificity=90.0 . In our study , the initial significant poor prognostic factors were advanced stage , high white blood cell count , high platelet count , high C-reactive protein ( p<0.05 for each variable ) . Later , according to multivariate analysis the results showed only advanced stage as significant parameter ( p=0.040 ) . CONCLUSIONS We determined that real use for serum fibulin-3 was not for prognosis but for diagnosis in MM . Also advanced stage was associated with poor MM prognosis PURPOSE In malignant mesothelioma ( MM ) , radiologic assessment of disease status is difficult . Both soluble mesothelin-related peptide ( SMRP ) and osteopontin ( OP ) have utility in distinguishing MM from benign pleural disease . We evaluated whether SMRP and OP also correlated with the disease course of MM . PATIENTS AND METHODS Serial plasma sample s from patients with MM were prospect ively collected , and  SMRP and OP levels were measured . Radiologic tests across time periods showing disease progression , stability , or shrinkage were compared with corresponding changes in SMRP/OP levels . RESULTS From 41 patients , 165 sample s were collected ( range , 2 to 10 ; median 4 ) . At study entry , 37 of 41 patients had measurable disease , of whom 92 % ( 34 of 37 ) had elevated baseline SMRP levels ; four of 41 patients had no evidence of recurrence and each had normal baseline SMRP levels . In 21 patients receiving systemic therapy , percentage change in SMRP more than 10 % correlated with the radiologic assessment by a trained thoracic radiologist ( P < .001 ) , by formal Response Evaluation Criteria in Solid Tumors ( RECIST ; P = .008 ) , or by modified RECIST ( P < .001 ) . All seven patients who underwent surgical resection with negative margins had elevated preoperative SMRP levels that fell to normal postoperatively . Rising SMRP was observed in all patients with radiologic disease progression . No associations were found with OP . CONCLUSION Percentage changes in SMRP levels , but not changes in OP levels , are a potentially useful marker of disease course . These findings should be vali date d prospect ively for a role as an objective adjunctive measure of disease course in both clinical trials and clinical practice BACKGROUND The independent prognostic value of Circulating Tumour Cells ( CTC ) level has been demonstrated in several solid tumours . There is currently few data on Malignant Pleural Mesothelioma ( MPM ) and CTC . We investigated whether the presence of CTC was correlated with prognosis factors and treatment efficacy . METHODS / OBJECTIVES MPM patients ( pts ) were enrolled in a prospect i ve monocentric study .  CTC detection was made using the " Cell Search " assay . The correlation between the presence of CTC and worse prognosis factors was assessed using the X(2 ) test . Comparison of Overall Survival ( OS ) and Progression Free Survival ( PFS ) according to CTC detection was performed using the log-rank test . RESULTS Twenty-seven MPM pts with a median follow-up of 4.2 months were included .  CTC were detected in 44 % of pts with a median level of 1.5 . No significant correlation was observed between the presence of CTC and worse prognosis factors . Moreover , CTC detection was not a significant predictor of OS or PFS ( p=0.155 and p=0.32 respectively ) . CONCLUSIONS  CTC  were detected in a small cohort of MPM patients . We could n't demonstrate a significant prognostic value or a difference in OS/PFS between CTC levels . Further analyses , validation studies and detection techniques are needed to establish their real clinical value in MPM The primary objective of this study was to determine the safety and maximum tolerated dose ( MTD ) of the antimesothelin immunotoxin SS1(dsFv)PE38 ( SS1P ) ( a recombinant antimesothelin immunotoxin consisting of a murine antimesothelin variable antibody fragment [ Fv ] linked to PE38 , a truncated portion of Pseudomonas exotoxin A ) in combination with pemetrexed and cisplatin in  chemotherapy‐naive patients with advanced malignant pleural mesothelioma ( MPM ) . Secondary objectives included tumor response , SS1P pharmacokinetics , and serum biomarkers of response Background : The effect of chemotherapy on health-related quality of life ( HRQoL ) in malignant pleural mesothelioma ( MPM ) is poorly understood . Patient-individualised prognostication and prediction of treatment response from chemotherapy is useful but little evidence exists to guide practice . Method : Consecutive patients with MPM who were fit for first-line chemotherapy with pemetrexed and cisplatin\carboplatin  were recruited and followed up for a minimum of 12 months . This study focussed on the HRQoL outcomes of these patients using the EQ-5D , EORTC QLQ-C30 and LC13 . Results : Seventy-three patients were recruited of which 58 received chemotherapy and 15 opted for best supportive care ( BSC ) .  Compliance with HRQoL question naires was 98 % at baseline . The chemotherapy group maintained HRQoL compared with the BSC group whose overall HRQoL fell ( P=0.006 ) with worsening dyspnoea and pain . The impact of chemotherapy  was irrespective of histological subtype although those with non-epithelioid disease had worse HRQoL at later time points ( P=0.012 ) . Additionally , those with a falling mesothelin or improvement on modified-RECIST CT at early follow-up had a better HRQoL at 16 weeks . Conclusions : HRQoL was maintained following chemotherapy compared with a self-selected BSC group . Once chemotherapy is initiated , a falling mesothelin or improved RECIST CT findings infer a quality -of-life advantage Background : Robust markers that predict prognosis and detect early treatment response in malignant pleural mesothelioma ( MPM ) would enhance patient care . Methods : Consecutive patients with MPM who were considered fit for first-line chemotherapy were prospect ively recruited . Patients of similar performance status opting for best supportive care were included as a comparator group . Baseline and interval CT , PET-CT and serum markers ( mesothelin , fibulin-3 and neutrophil – lymphocyte ratio ( NLR ) ) were obtained , and patients followed up for a minimum 12 months . Findings : Seventy-three patients were recruited ( 58 chemotherapy/15 comparator arm ) .  Baseline TGV ( total glycolytic volume on PET-CT ) was an independent predictor of worse overall survival ( OS ) ( P=0.001 ) . Change in interval TGV(baseline/after two cycles of chemotherapy ) did not predict OS or chemotherapy response on CT . Baseline NLR<4 was an independent predictor of better OS 
    Output:
    
Other biomarkers have shown prognostic utility in individual studies but are yet to be reproduced in large cohort studies .
Conclusions : From the available literature no serum or pleural fluid biomarker was identified that could be recommended currently for routine clinical practice .
However , a falling serum soluble mesothelin might correlate with treatment response and improved survival