Mass Spectrometry as a Diagnostic and a Cancer Biomarker Discovery Tool
Opportunities and Potential Limitations*
Eleftherios P. Diamandis
From the Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
Serum proteomic profiling, by using surfaced-enhanced laser desorption/ionization-time-of-flight mass spectrometry, is one of the most promising new approaches for cancer diagnostics. Exceptional sensitivities and specificities have been reported for some cancer types such as prostate, ovarian, breast, and bladder cancers. These sensitivities/specificities are far superior to those obtained by using classical cancer biomarkers. In this review, I concentrate more on questions that cast doubt on the results reported and propose experiments to investigate these questions in detail, before the technique is used at the clinic. It is clear that the method needs to be externally and thoroughly validated before clinical implementation is warranted.
Molecular & Cellular Proteomics 3:367-378, 2004.
Our current efforts to combat cancer are not very successful. Despite the recent spectacular advances in molecular medicine, genomics, proteomics, and translational research, mortality rates for the most prevalent cancers have not been significantly reduced. Some of the best available options to combat cancer include primary prevention, earlier diagnosis, and improved therapeutic interventions. We are now witnessing the development of new drugs against cancer that are based on rational instead of empirical designs. There is hope that some of these drugs will prove to be more effective at the clinic than older generations of medicines. In terms of primary prevention, we do not as yet have at hand any robust strategies, because the mechanisms of cancer initiation and progression are still largely unknown.
One of the best strategies to combat cancer now is by early diagnosis and administration of effective treatment (1). Another approach includes close monitoring of the cancer patient after initial treatment (usually surgery) to detect early relapse and then prescribe additional therapy. A third valuable approach would be the stratification of patients into subgroups that respond better to different types of treatment (individualized therapy). Medical imaging and serum or tissue biomarkers are valuable tools for monitoring these patients in order to optimize clinical outcomes.
In this review, I will concentrate on mass spectrometry as a diagnostic and cancer biomarker discovery tool. Much has been published on this technology, and excellent reviews have already been prepared (2–12). My presentation will be biased toward underlining potential limitations that have not been adequately addressed in the already existing extensive literature.