Materiały źródłowe

• #1 Cancer of Unknown Primary Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/unknown-primary/hp/unknown-primary-treatment-pdq

  A cancer of unknown primary (CUP) is defined as a biopsy-confirmed malignancy with no established primary site after pathological evaluation and radiographic studies. […] The prognosis for patients with CUP is poor. Approximately 30% of patients are alive at 1 year. […] Although most diseases are relatively refractory to cytotoxic treatments, molecular and genetic diagnostics can identify targeted therapies that may result in a much better prognosis. […] Clinical, pathological, and molecular genetic tests have two goals. The first is to identify tumors that are responsive to available therapies. The second is to identify novel targeted therapies that might be applicable to the particular genetic profile. […] The U.S. Food and Drug Administration (FDA) has approved some novel targeted therapies when a molecular target is identified in a cancer, regardless of primary site (including when no primary site is evident with metastases).

• #2 Metastatic Cancer With Unknown Primary Site: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article//2005218-overview

  In metastatic cancer, the primary site of the cancer usually dictates the treatment, expected outcome, and overall prognosis. Consequently, in patients who present with metastatic cancer without a known primary site, the search for the primary site has high priority. […] CUP is characterized by an aggressive course and resistance to conventional chemotherapy. […] Nevertheless, a precise pathologic diagnosis with next-generation sequencing may identify targetable mutations and help guide therapy. For example, in patients whose tumors are found to have high microsatellite instability/deficient mismatch repair (MSI-H/dMMR), treatment with an immune checkpoint inhibitor (programmed cell death inhibitor) may significantly improve survival. […] Approximately 15-20% of patients with CUP have a favorable prognosis. In these cases, treatment corresponds to that of the equivalent known primary tumor.

• #3 Metastatic Cancer With Unknown Primary Site: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/2005218-overview

  In metastatic cancer, the primary site of the cancer usually dictates the treatment, expected outcome, and overall prognosis. Consequently, in patients who present with metastatic cancer without a known primary site, the search for the primary site has high priority. This search is best conducted by a multidisciplinary team, consisting at a minimum of clinicians, radiologist, internist, radiation oncologist, and pathologist for resolving the most challenging cases. Molecular profiling is essential for all patients, as discovery of a targetable mutation can sometimes dramatically alter the patient’s prognosis. […] CUP is characterized by an aggressive course and resistance to conventional chemotherapy. Nevertheless, a precise pathologic diagnosis with next-generation sequencing may identify targetable mutations and help guide therapy. For example, in patients whose tumors are found to have high microsatellite instability/deficient mismatch repair (MSI-H/dMMR), treatment with an immune checkpoint inhibitor (programmed cell death inhibitor) may significantly improve survival.

• #4

  https://link.springer.com/article/10.1007/s10555-023-10101-6

  Carcinoma of unknown primary (CUP) is a heterogeneous group of metastatic cancers in which the site of origin is not identifiable. […] The aim of the pathologist is to broadly classify and subtype the cancer and, where possible, to confirm the likely primary site as this information best predicts patient outcome and guides treatment. […] An integrated diagnostic report is ideal in cases of CUP, with results discussed at a forum such as a molecular tumour board and matched with targeted treatment. […] The majority of patients with CUP (85-90%) fall within the unfavourable subgroup, however, and have a poor prognosis with median survival of 4-9 months. […] Empiric systemic chemotherapy is considered the standard treatment for metastatic CUP, although improvements in overall survival are modest and unpredictable, particularly in patients with unfavourable factors.

• #5 Carcinoma of Unknown Primary Treatment | NY | Montefiore Einstein Comprehensive Cancer Center

  https://montefioreeinstein.org/cancer/types/unknown-origin/carcinoma-primary-treatment

  Clinical, pathological, and molecular genetic tests have two goals. The first is to identify tumors that are responsive to available therapies. The second is to identify novel targeted therapies that might be applicable to the particular genetic profile. […] Immunological therapy using checkpoint inhibitors such as nivolumab has been given to a general population with unfavorable CUP, resulting in a 22% overall response rate. […] Treatment options for newly diagnosed unfavorable CUP include the following: Site-directed therapy based on molecular tissue of origin/molecular targeted therapy, Immunological therapy, Chemotherapy. […] Most patients with newly diagnosed cancer of unknown primary (CUP) are considered to have an unfavorable prognosis. […] Palliative care and hospice are options for patients with a poor performance status and relapsing disease.

• #6 Metastatic Cancer With Unknown Primary Site: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/2005218-overview

  In metastatic cancer, the primary site of the cancer usually dictates the treatment, expected outcome, and overall prognosis. Consequently, in patients who present with metastatic cancer without a known primary site, the search for the primary site has high priority. This search is best conducted by a multidisciplinary team, consisting at a minimum of clinicians, radiologist, internist, radiation oncologist, and pathologist for resolving the most challenging cases. Molecular profiling is essential for all patients, as discovery of a targetable mutation can sometimes dramatically alter the patient’s prognosis. […] CUP is characterized by an aggressive course and resistance to conventional chemotherapy. Nevertheless, a precise pathologic diagnosis with next-generation sequencing may identify targetable mutations and help guide therapy. For example, in patients whose tumors are found to have high microsatellite instability/deficient mismatch repair (MSI-H/dMMR), treatment with an immune checkpoint inhibitor (programmed cell death inhibitor) may significantly improve survival.

• #7 Metastatic Cancer With Unknown Primary Site: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/2005218-overview

  Approximately 15-20% of patients with CUP have a favorable prognosis. In these cases, treatment corresponds to that of the equivalent known primary tumor. Favorable-risk CUPs are as follows: Single metastatic deposit or oligometastatic disease amenable to local ablative treatment; In women, isolated axillary nodal metastases; In women, peritoneal adenocarcinomatosis of a serous papillary histologic type; In men, blastic bone metastases or IHC/serum prostate-specific antigen (PSA) expression; Squamous cell carcinoma involving non-supraclavicular cervical lymph nodes (head-and-neck); Adenocarcinoma with a colorectal immunohistochemical (CK7-negative, CK20-positive, CDX2-positive) or molecular profile; Carcinoma with a renal-cell histologic and immunohistochemical profile. […] Communication between the clinician and the patient is paramount to optimal patient care. Patients and caregivers should be informed at each step of assessment and treatment. Patients should understand the goal of treatment, whether it is curative or palliative in nature. This should be defined upfront, although it can change as the patient responds or fails to respond to treatment.

• #8 Carcinoma of Unknown Primary Treatment – NCI

  https://www.cancer.gov/types/unknown-primary/patient/unknown-primary-treatment-pdq

  There are different types of treatment for patients with carcinoma of unknown primary (CUP). […] Four types of standard treatment are used: Surgery, Radiation therapy, Chemotherapy, Hormone therapy. […] New types of treatment are being tested in clinical trials. […] Treatment for carcinoma of unknown primary may cause side effects. […] Patients may want to think about taking part in a clinical trial. […] Patients can enter clinical trials before, during, or after starting their cancer treatment. […] Treatment of cervical lymph node carcinoma of unknown primary (CUP) may include the following: Surgery to remove the tonsils, Radiation therapy alone, Radiation therapy followed by surgery to remove the lymph nodes, Surgery to remove the lymph nodes, with or without radiation therapy, A clinical trial of new types of treatment.

• #9 Carcinoma of Unknown Primary Treatment (PDQ®): Treatment – Patient Information [NCI] | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.carcinoma-of-unknown-primary-treatment-pdq%C2%AE-treatment-patient-information-nci.ncicdr0000062729

  Carcinoma of unknown primary (CUP) is a rare disease in which malignant (cancer) cells are found in the body but the place the cancer began is not known. […] When tests are able to find the primary cancer, the cancer is no longer a CUP and treatment is based on the type of primary cancer. […] For most patients with CUP, current treatments do not cure the cancer. Patients may want to take part in one of the many clinical trials being done to improve treatment. […] Different types of treatment are available for patients with CUP. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. […] Four types of standard treatment are used: Surgery, Radiation therapy, Chemotherapy, Hormone therapy. […] After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that cancer will come back, is called adjuvant therapy.

• #10 Cancer of Unknown Primary Treatment | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/cancer-unknown-primary-origin/cancer-unknown-primary-treatment

  Medical oncologist Eileen OReilly treats cancer of unknown primary with chemotherapy and other drugs. […] At Memorial Sloan Kettering, care for cancers of unknown primary is managed by a team of doctors. Each member specializes in using chemotherapy, surgery, radiation therapy, or other therapies to treat cancers of unknown primary. This collaborative approach ensures that every person we care for gets the treatment or combination of treatments that best address their condition. […] Although there are no standard treatments for cancers of unknown primary, chemotherapy is usually the main treatment. […] Chemotherapy is the most common treatment for people with cancer of unknown primary. Given by IV or as a pill, chemotherapy destroys cancer cells throughout the body. This includes areas where cancer may not have been found. Chemotherapy is used to shrink tumors and relieve the symptoms caused by cancer. In rare cases, it can eliminate tumors so that no further treatment is necessary.

• #11 Cancer of unknown primary (CUP) treatment | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/cancer-of-unknown-primary/cancer-of-unknown-primary-treatment

  The aim of treatment for cancer of unknown primary (CUP) is to try to control the cancer, treat the symptoms and improve or maintain your quality of life. […] Active treatment for CUP aims to: control the cancer, help you live longer, relieve your symptoms, improve your quality of life. […] The main treatment for CUP is chemotherapy. This is because chemotherapy goes into the bloodstream and can reach most parts of the body. […] Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. It is the most common treatment for cancer of unknown primary (CUP). The aim of chemotherapy is to shrink the cancer and relieve symptoms. […] Radiotherapy uses high-energy x-rays to destroy cancer cells while doing as little harm as possible to normal cells. Doctors can give radiotherapy to try to shrink and control the cancer, and stop it from growing any further.

• #12 Cancer of Unknown Primary Treatment | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/cancer-unknown-primary-origin/cancer-unknown-primary-treatment

  When possible, doctors at Memorial Sloan Kettering choose a chemotherapy regimen that is effective in treating the organ or part of the body where we suspect the cancer began. Even when the primary site or part of the body cannot be identified, we customize the chemotherapy regimen for each person we care for after determining the type and appearance of the cancer cells, where the cancer has spread, and the individuals overall health. […] Surgery is often the treatment of choice for people with a tumor that is confined to the organ where it began. But because cancer of unknown primary has already spread, surgery does not usually cure the cancer. […] When a tumor of unknown primary is found in only one organ or lymph node, or if there are specific symptoms related to the site of the tumor, our doctors may recommend surgery. If the cancer is suspected to have begun in the breast, a mastectomy (surgical removal of the breast) may be required to ensure that all of the breast cancer cells have been removed. When surgery is used to treat cancer of unknown primary, it is usually followed by chemotherapy or radiation therapy to eliminate any cancer cells that may remain.

• #13 Cancer of Unknown Primary Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/unknown-primary/hp/unknown-primary-treatment-pdq

  Two randomized prospective trials published in 2019 compared standard chemotherapy (carboplatin and paclitaxel or cisplatin and gemcitabine) versus site-specific therapy using gene expression profiling. […] There was no advantage to site-specific therapy in median progression-free survival (PFS) (5 months) or median overall survival (OS) (10-12 months) in either trial. […] A meta-analysis of five studies including 1,114 patients compared site-specific therapy from genomic profiling versus empiric therapy. […] There was no improvement in PFS or OS. […] Treatment options for newly diagnosed unfavorable CUP include the following: Site-directed therapy based on molecular tissue of origin/molecular targeted therapy, Immunological therapy, Chemotherapy. […] Immunological therapy using checkpoint inhibitors such as nivolumab has been given to a general population with unfavorable CUP, resulting in a 22% overall response rate.

• #14

  https://link.springer.com/article/10.1007/s10555-023-10101-6

  Treatment guidelines for the most common subtype, adenocarcinoma, remain general in nature, extrapolated from other tumours including lung, ovarian, and gastric carcinoma. […] The most commonly employed regimen is a combination of carboplatin-paclitaxel, based largely on evidence from a handful of phase II/III trials. […] As mentioned, NGS has the power to identify genomic aberrations within CUP tumours that may be targeted therapeutically, and studies have reported wide ranges of actionable mutations from 30 to 85%. […] Similarly, immunotherapy is also emerging in several cancer types, with promising response rates seen in patients with metastatic disease and may be an option for a minority of patients with CUP.

• #15 Treatments for undifferentiated carcinoma of unknown primary | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/cancer-of-unknown-primary/treatment/undifferentiated-carcinoma

  Undifferentiated carcinoma of unknown primary (undifferentiated CUP) means that the cells of these tumours look very different from normal cells. This makes it difficult for the healthcare team to tell where the cancer may have started or what type of CUP it is. […] Chemotherapy is the main treatment for undifferentiated CUP. Your healthcare team will offer the type of chemotherapy that they think will work best. This is referred to as empiric chemotherapy. They will usually give 2 or more drugs. Most drug combinations include at least one of the following: […] Another drug that may also be offered for undifferentiated CUP is etoposide (Vepesid). […] The most common drug combination used is carboplatin and paclitaxel. […] Researchers are still looking for the most effective drug combinations for undifferentiated CUP. […] Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

• #16 Management of Patients With Cancer of Unknown Primary Site

  https://www.cancernetwork.com/view/management-patients-cancer-unknown-primary-site

  Cancer of unknown primary site represents approximately 3% to 5% of all new cancer diagnoses. Adenocarcinomas account for 60% of all unknown primary cancers and poorly differentiated carcinomas or adenocarcinomas, for 30%. Historically, the prognosis for most patients with unknown primary tumors has been poor, with survival often less than 6 months from diagnosis. Recent advances in diagnostic techniques, including immunocytochemical and molecular genetic methods, have increased the probability of identifying a likely underlying tumor type. Based on clinical and pathologic features, approximately 40% of patients can be categorized within subsets for which specific treatment has been defined. Empiric therapy is an option for the remaining 60% of patients. […] Although experience remains limited, the incorporation of a taxane into empiric regimens appears to improve response rates and survival. A recent study of paclitaxel (Taxol), carbo-platin (Paraplatin), and etoposide in 55 patients with cancer of unknown primary site reported an overall response rate of 47% and a median overall survival of 13.4 months.

• #17 Cancer of Unknown Primary (CUP) Treatment (PDQ®) – PDQ Cancer Information Summaries – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK65811/

  Immunological therapy using checkpoint inhibitors such as nivolumab has been given to a general population with unfavorable CUP, resulting in a 22% overall response rate. Better response rates can be seen when checkpoint inhibitors are given to patients with tumors expressing high levels of microsatellite instability (MSI-H) or deficient mismatch repair (dMMR). […] Patients with unfavorable CUP who are not candidates for molecular targeted therapy or immunotherapy are candidates for clinical trials. Cytotoxic chemotherapy can be a palliative therapy, but the choice of drugs has been based on a few small clinical studies, with no randomized trials establishing their benefit over best supportive care. Several randomized prospective studies demonstrate that platinum-based doublet chemotherapy combined with a taxane or gemcitabine is equivalent to other chemotherapy in response rate and progression-free survival.

• #18

  https://journals.lww.com/md-journal/fulltext/2021/12030/successful_treatment_using_immunotherapy_in.67.aspx

  According to Spanish Society of Medical Oncology (SEOM) clinical guidelines, SCC can be treated with paclitaxel and carboplatin at intervals of 21 days. […] Studies have found that the efficacy of albumin-binding paclitaxel plus carboplatin is better than that of paclitaxel plus carboplatin in SCC, and the toxicity can be tolerated. […] Therefore, the patient was treated with carboplatin, albumin-binding paclitaxel, and immune checkpoint inhibitor (carilizumab). Treatment was well tolerated and could be administered without serious side effects. […] After chemotherapy and immunotherapy, the patient’s lesions were significantly reduced, her general state improved, and her PS score was 0. The patient benefited significantly. […] We know that CUP patients with PD-L1 expression, high TMB, and MSI-H can benefit from immune checkpoint inhibitor treatment.

• #19 Clinical features of cancer with unknown primary site (clinical features, treatment, prognosis of cancer with unknown primary site) | BMC Cancer | Full Text

  https://bmccancer.biomedcentral.com/articles/10.1186/s12885-022-10472-z

  Up to now, there is no uniform and effective treatment method for CUPs. The main treatment for CUPs is chemotherapy, which varies greatly in terms of regimen, duration, dose and route of administration. […] The indications and extent of surgical resection are still controversial and their application is mostly limited. […] The treatment of unknown primary metastatic cancer should be tailored to local conditions, different sites, different pathological types, different stages and available evidence regarding potential biomarkers in CUP. […] The empirical chemotherapy regimen is carboplatin combined with epirubicin, etoposide. […] Most people with CUPs did not respond well to treatment.

• #20 Carcinoma of unknown primary – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/carcinoma-unknown-primary/diagnosis-treatment/drc-20433758

  Targeted therapy for cancer is a treatment that uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die. […] Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources. During radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points on your body. […] Radiation therapy might be used for carcinoma of unknown primary that’s only in a few areas of the body. It also can be used to help control symptoms, such as a growing cancer that’s causing pain. […] Surgery to cut away the cancer might be used for carcinoma of unknown primary that’s only in one area. Healthcare teams might use surgery to remove cancer cells in the liver or in the lymph nodes.

• #21 Cancer of Unknown Primary Treatment | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/cancer-unknown-primary-origin/cancer-unknown-primary-treatment

  Radiation therapy is only used to control tumors that cannot be surgically removed or when cancer of unknown primary spreads to the spine and interferes with neurologic function. […] Genetic testing using MSK-IMPACT can help doctors identify people with tumors that are likely to respond to immunotherapy or targeted therapies through a clinical trial.

• #22 5 Innovative Cancer of Unknown Primary Treatment Options | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/cancer-of-unknown-primary/cancer-of-unknown-primary-treatment.html

  The Proton Therapy Center at MD Anderson is one of the worlds largest and most advanced centers. Proton therapy delivers high radiation doses directly into the tumor, sparing nearby healthy tissue and vital organs. […] MD Anderson is among just a few cancer centers in the nation that are able to offer targeted therapies for some types of cancer of unknown primary. These innovative new drugs stop the growth of cancer cells by interfering with certain proteins and receptors or blood vessels that supply the tumor with what it needs to grow.

• #23

  http://www.cancerhelpessentiahealth.org/Cancer_Types/unknown_primary_203331E2_04.html

  Treatment Options for Carcinoma of Unknown Primary […] Newly Diagnosed Carcinoma of Unknown Primary […] Cancer found in cervical (neck) lymph nodes may have spread from a tumor in the head or neck. Treatment of cervical lymph node carcinoma of unknown primary (CUP) may include the following: Surgery to remove the tonsils. Radiation therapy alone. Intensity-modulated radiation therapy (IMRT) may be used. Radiation therapy followed by surgery to remove the lymph nodes. Surgery to remove the lymph nodes, with or without radiation therapy. A clinical trial of new types of treatment. […] Cancer cells that are poorly differentiated look very different from normal cells. The type of cell they came from is not known. Treatment of poorly differentiated carcinoma of unknown primary, including tumors in the neuroendocrine system (the part of the brain that controls hormone-producing glands throughout the body) may include the following: Combination chemotherapy. A clinical trial of new types of treatment.

• #24 Carcinoma of unknown primary – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/carcinoma-unknown-primary/diagnosis-treatment/drc-20433758

  Targeted therapy for cancer is a treatment that uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die. […] Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources. During radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points on your body. […] Radiation therapy might be used for carcinoma of unknown primary that’s only in a few areas of the body. It also can be used to help control symptoms, such as a growing cancer that’s causing pain. […] Surgery to cut away the cancer might be used for carcinoma of unknown primary that’s only in one area. Healthcare teams might use surgery to remove cancer cells in the liver or in the lymph nodes.

• #25 5 Innovative Cancer of Unknown Primary Treatment Options | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/cancer-of-unknown-primary/cancer-of-unknown-primary-treatment.html

  Your treatment at MD Anderson for a cancer of unknown primary (CUP) is individualized to provide the best options with the least impact on your body. […] Because each patient and each cancer of unknown primary is one of a kind, we tailor your treatment to match your needs. […] Your treatment for cancer of unknown primary will be customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms. […] Surgery may be used if the cancer is in only one area, such as the lymph nodes or one organ. The type of surgery depends on where the CUP is located. Surgery may be combined with chemotherapy or radiation therapy. […] MD Anderson offers the most up-to-date and advanced chemotherapy options for CUP. […] MD Anderson provides the very latest radiation treatments, including:

• #26 Treatment of a Cancer of Unknown Primary by Location | American Cancer Society

  https://www.cancer.org/cancer/types/cancer-unknown-primary/treating/specific-instances.html

  The types of treatment used for a cancer of unknown primary depend on several factors, including the size and location of the cancer, the results of lab tests, and how likely it is to be a certain type of cancer. […] If the origin of the cancer can be determined during testing, the cancer would no longer be an unknown primary and would be treated according to where it started. […] These cancers usually began somewhere in the mouth, throat, or larynx. They are often treated with surgery and/or radiation therapy. […] Surgical treatment removes lymph nodes and other tissue from the neck. This operation is called a neck dissection. […] Radiation therapy might be used instead of surgery. One potential advantage is that the area treated would include both the nodes with metastatic cancer and several of the areas of the neck likely to contain a primary tumor.

• #27 Treatment of a Cancer of Unknown Primary by Location | American Cancer Society

  https://www.cancer.org/cancer/types/cancer-unknown-primary/treating/specific-instances.html

  When large and/or many tumors are present, some patients will be treated with both surgery and radiation therapy. The radiation may be given before or after surgery. […] When tumors are very large or present on both sides of the neck, chemotherapy (chemo) and radiation therapy are often used together. […] The recommended treatment is similar to that for women diagnosed with breast cancer that has spread to these nodes. […] Surgery to remove axillary nodes (called an axillary lymph node dissection) is done, and the breast on the same side may be treated with mastectomy (surgery to remove the breast) or radiation therapy. […] If the primary tumor can’t be found, surgery is usually the main treatment. […] If the cancer appears to be confined to a single lymph node, removing it may be the only treatment. In other cases, more extensive surgery (a lymph node dissection) may be needed.

• #28 Local Treatment Efficacy for Single-Area Squamous Cell Carcinoma of the Unknown Primary Site

  https://www.mdpi.com/1718-7729/30/10/674

  The prognosis for cancer of unknown primary site (CUP) is poor, and squamous cell carcinoma of the unknown primary site (SCCUP) is a rare histological type. CUP is often treated with aggressive multimodal treatments, while the treatment of single-area localized CUP remains controversial. […] The treatment strategies for CUP depend on whether it is classified as a favorable or unfavorable subset. The favorable subset in SCCUP is limited to tumors in the cervical or inguinal lymph node region, and local treatment is recommended, including surgery and radiotherapy, whereas systemic chemotherapy is recommended for the unfavorable subset. […] In the favorable subset, surgical excision, local radiotherapy, and a combination of surgery and radiation formed the basis of treatment. […] Local treatment may be effective for single-area SCCUP, even in the unfavorable subset.

• #29 Carcinoma of Unknown Primary Treatment (PDQ®): Treatment – Patient Information [NCI] | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.carcinoma-of-unknown-primary-treatment-pdq%C2%AE-treatment-patient-information-nci.ncicdr0000062729

  Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. […] Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. […] Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. […] New types of treatment are being tested in clinical trials. […] Treatment for carcinoma of unknown primary may cause side effects. […] Treatment of cervical lymph node carcinoma of unknown primary (CUP) may include surgery to remove the tonsils, radiation therapy alone, or a clinical trial of new types of treatment. […] Treatment of poorly differentiated carcinoma of unknown primary may include combination chemotherapy or a clinical trial of new types of treatment. […] Treatment for women who have peritoneal carcinoma of unknown primary may be the same as for ovarian cancer. […] Treatment of axillary lymph node metastasis is usually surgery to remove the lymph nodes. […] Treatment for recurrent carcinoma of unknown primary is usually within a clinical trial.

• #30 Treatment options for cancer of unknown primary (CUP) | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/cancer-unknown-primary-cup/treatment/decisions

  Treatment for cancer of unknown primary (CUP) can include: chemotherapy, immunotherapy or targeted cancer drugs, radiotherapy, surgery, treatment to help control symptoms. […] Your doctor will discuss your treatment, its benefits and the possible side effects with you. […] Doctors can’t cure most cases of CUP. This is because the cancer has already spread from one part of the body to another. But treatment can control it, relieve symptoms, and give you a good quality of life. […] Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream. […] Immunotherapy uses your immune system to fight cancer. Targeted cancer drugs target the differences between cancer cells and normal cells that help them grow and survive.

• #31 Cancer of Unknown Primary: Treatment Choices | UMass Memorial Health

  https://www.ummhealth.org/health-library/cancer-of-unknown-primary-treatment-choices

  This treatment keeps certain hormones in the body from helping some types of cancer cells to grow. Stopping the hormones can be done in different ways. You may have surgery or radiation. This is done to take out or destroy the organ(s) that make hormones, like the ovaries or testicles. Another option is getting medicines that lower hormone levels or make the cancer cells unable to use them. […] The goal of surgery is to remove cancer from your body. Because CUP has already spread when it’s found, it’s not always helpful. […] Targeted therapy may be beneficial in some cases of CUP. This treatment targets cancer cells while doing little damage to normal cells. The treatment attacks the way cancer cells grow, divide, and interact with other cells. […] Experts are always finding new ways to treat cancer. These new methods are tested in clinical trials. Taking part in a clinical trial means you get the best treatment available today, and you might also get new treatments that are thought to be even better. […] At first, thinking about treatment options may seem overwhelming. Talk with your healthcare team and loved ones. Make a list of questions. Consider the benefits and possible side effects of each option. Discuss your concerns with your healthcare provider before making a decision.

• #32 Metastatic Cancer With Unknown Primary Site: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/2005218-overview

  Approximately 15-20% of patients with CUP have a favorable prognosis. In these cases, treatment corresponds to that of the equivalent known primary tumor. Favorable-risk CUPs are as follows: Single metastatic deposit or oligometastatic disease amenable to local ablative treatment; In women, isolated axillary nodal metastases; In women, peritoneal adenocarcinomatosis of a serous papillary histologic type; In men, blastic bone metastases or IHC/serum prostate-specific antigen (PSA) expression; Squamous cell carcinoma involving non-supraclavicular cervical lymph nodes (head-and-neck); Adenocarcinoma with a colorectal immunohistochemical (CK7-negative, CK20-positive, CDX2-positive) or molecular profile; Carcinoma with a renal-cell histologic and immunohistochemical profile. […] Communication between the clinician and the patient is paramount to optimal patient care. Patients and caregivers should be informed at each step of assessment and treatment. Patients should understand the goal of treatment, whether it is curative or palliative in nature. This should be defined upfront, although it can change as the patient responds or fails to respond to treatment.

• #33 Cancer of Unknown Primary Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/unknown-primary/hp/unknown-primary-treatment-pdq

  A cancer of unknown primary (CUP) is defined as a biopsy-confirmed malignancy with no established primary site after pathological evaluation and radiographic studies. […] The prognosis for patients with CUP is poor. Approximately 30% of patients are alive at 1 year. […] Although most diseases are relatively refractory to cytotoxic treatments, molecular and genetic diagnostics can identify targeted therapies that may result in a much better prognosis. […] Clinical, pathological, and molecular genetic tests have two goals. The first is to identify tumors that are responsive to available therapies. The second is to identify novel targeted therapies that might be applicable to the particular genetic profile. […] The U.S. Food and Drug Administration (FDA) has approved some novel targeted therapies when a molecular target is identified in a cancer, regardless of primary site (including when no primary site is evident with metastases).

• #34 Cancer of Unknown Primary (CUP) Treatment (PDQ®) – PDQ Cancer Information Summaries – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK65811/

  This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of cancer of unknown primary. It is intended as a resource to inform and assist clinicians in the care of their patients. It does not provide formal guidelines or recommendations for making health care decisions. […] Treatment options for newly diagnosed unfavorable CUP include the following: Site-directed therapy based on molecular tissue of origin/molecular targeted therapy. Immunological therapy. Chemotherapy. […] Clinical, pathological, and molecular genetic tests have two goals. The first is to identify tumors that are responsive to available therapies. The second is to identify novel targeted therapies that might be applicable to the particular genetic profile. The U.S. Food and Drug Administration (FDA) has approved some novel targeted therapies when a molecular target is identified in a cancer, regardless of primary site or when no primary site is evident. Examples include tumors with high mutational burden, elevated PD-L1, elevated human epidermal growth factor (HER2), NTRK mutations, BRAF mutations, RET mutations, ROS1 fusion, MET amplification, homologous repair deficiency, microsatellite instability, and EGFR mutations.

• #35 Frontiers | The Quest for Improving Treatment of Cancer of Unknown Primary (CUP) Through Molecularly-Driven Treatments: A Systematic Review

  https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2020.00533/full

  Carcinomas of unknown primary (CUP) account for 3–5% of all malignancy and, despite a reduction in incidence, the overall survival has not improved over the last decade. Chemotherapy regimens have not provided encouraging results. New diagnostic technologies, such as next generation sequencing (NGS), could represent a chance to identify potentially targetable genomic alterations in order to personalize treatment of CUP and provide insights into tumor biology. […] A systematic review of studies of patients with CUP, whose tumor specimen was evaluated through a NGS panel, has been performed on June 10th, 2019 according to PRISMA criteria from PubMed, ASCO meeting library and Clinicaltrial.gov. We have identified potentially targetable alterations for which approved/off-label/in clinical trials drugs are available.

• #36 Cancer of Unknown Primary (CUP) Treatment (PDQ®) – PDQ Cancer Information Summaries – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK65811/

  This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of cancer of unknown primary. It is intended as a resource to inform and assist clinicians in the care of their patients. It does not provide formal guidelines or recommendations for making health care decisions. […] Treatment options for newly diagnosed unfavorable CUP include the following: Site-directed therapy based on molecular tissue of origin/molecular targeted therapy. Immunological therapy. Chemotherapy. […] Clinical, pathological, and molecular genetic tests have two goals. The first is to identify tumors that are responsive to available therapies. The second is to identify novel targeted therapies that might be applicable to the particular genetic profile. The U.S. Food and Drug Administration (FDA) has approved some novel targeted therapies when a molecular target is identified in a cancer, regardless of primary site or when no primary site is evident. Examples include tumors with high mutational burden, elevated PD-L1, elevated human epidermal growth factor (HER2), NTRK mutations, BRAF mutations, RET mutations, ROS1 fusion, MET amplification, homologous repair deficiency, microsatellite instability, and EGFR mutations.

• #37 Frontiers | The Quest for Improving Treatment of Cancer of Unknown Primary (CUP) Through Molecularly-Driven Treatments: A Systematic Review

  https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2020.00533/full

  The aim of this review is to describe genes and molecular pathways involved in CUP pathogenesis and focus on available data of targeted genotype-directed treatment in this setting. […] Although there are no targeted therapies, TP53 is one of the most frequently altered gene in CUPs. This molecular alteration appears to be associated with high VEGF-A levels and clinical data suggest that patients with TP53 mutations have better progression-free survival and improved clinical outcome with anti-VEGF drugs in comparison with patients with wild-type TP53. RAS-driven tumors are potentially targetable with MEK inhibitors (e.g., trametinib and cobimetinib) and some ongoing trials are evaluating the activity of different drugs against KRAS G12C mutation, while PIK3CA mutations have been shown to be associated with response in 45% in patients with advanced cancers when treated with a PI3K inhibitor or mTOR inhibitors.

• #38

  https://link.springer.com/article/10.1007/s10555-023-10101-6

  Treatment guidelines for the most common subtype, adenocarcinoma, remain general in nature, extrapolated from other tumours including lung, ovarian, and gastric carcinoma. […] The most commonly employed regimen is a combination of carboplatin-paclitaxel, based largely on evidence from a handful of phase II/III trials. […] As mentioned, NGS has the power to identify genomic aberrations within CUP tumours that may be targeted therapeutically, and studies have reported wide ranges of actionable mutations from 30 to 85%. […] Similarly, immunotherapy is also emerging in several cancer types, with promising response rates seen in patients with metastatic disease and may be an option for a minority of patients with CUP.

• #39 Frontiers | The Quest for Improving Treatment of Cancer of Unknown Primary (CUP) Through Molecularly-Driven Treatments: A Systematic Review

  https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2020.00533/full

  The aim of this review is to describe genes and molecular pathways involved in CUP pathogenesis and focus on available data of targeted genotype-directed treatment in this setting. […] Although there are no targeted therapies, TP53 is one of the most frequently altered gene in CUPs. This molecular alteration appears to be associated with high VEGF-A levels and clinical data suggest that patients with TP53 mutations have better progression-free survival and improved clinical outcome with anti-VEGF drugs in comparison with patients with wild-type TP53. RAS-driven tumors are potentially targetable with MEK inhibitors (e.g., trametinib and cobimetinib) and some ongoing trials are evaluating the activity of different drugs against KRAS G12C mutation, while PIK3CA mutations have been shown to be associated with response in 45% in patients with advanced cancers when treated with a PI3K inhibitor or mTOR inhibitors.

• #40 Frontiers | The Quest for Improving Treatment of Cancer of Unknown Primary (CUP) Through Molecularly-Driven Treatments: A Systematic Review

  https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2020.00533/full

  In order to overcome both genomic heterogeneity between the primary tumor and all the metastatic lesions and temporal molecular changes occurring during sequential therapies, Kato et al. analyzed the genomic profile of a CUP population of 442 patients using NGS applied on circulating tumor DNA (ctDNA). They found at least a genomic alteration in the 80% of cases, the most common of which interesting TP53, KRAS and PIK3CA. […] Altogether these data highlight the absence of an established distinguishing underlying molecular biology make-up of CUPs, confirming that their molecular pathogenesis is complex and heterogeneous. In order to overcome this lack of knowledge, NGS represents a chance, although not validated by clinical trials, to improve diagnosis and matched treatment of potential actionable molecular alterations.

• #41 Molecularly Targeted Treatment for Cancer of Unknown Primarylogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na57781/2024/08/23/molecularly-targeted-treatment-cancer-unknown-primary

  Molecularly Targeted Treatment for Cancer of Unknown Primary […] Patients showing tumor response or stable disease with chemotherapy did better when switched to molecularly targeted treatments than those who continued chemotherapy. […] Cancer of unknown primary (CUP) has been associated with a poor prognosis, short survival, and treatment approaches that typically utilize generic chemotherapy regimens with antitumor activity in the most likely primary sites of disease. […] To determine the effect of a molecularly guided treatment (MGT) of CUP, researchers conducted an industry-sponsored, multinational, phase 2, open-label trial. […] Patients first received three cycles of induction chemotherapy with a platinum-based regimen (carboplatin-paclitaxel, cisplatin-gemcitabine, or carboplatin-gemcitabine).

• #42 Molecularly Guided Therapy Outperforms Chemo in Cancer of Unknown Primary

  https://www.targetedonc.com/view/molecularly-guided-therapy-outperforms-chemo-in-cancer-of-unknown-primary

  Findings from the CUPISCO study found that molecularly guided therapy is more effective than standard chemotherapy for patients with unfavorable nonsquamous cancer of unknown primary. […] Comprehensive genomic profiling followed by molecularly guided therapy led to longer progression-free survival (PFS) than standard platinum-based chemotherapy in patients with previously untreated, unfavorable, nonsquamous cancer of unknown primary (CUP) who reached disease control on primary induction chemotherapy, based on data from the phase 2, prospective, randomized CUPISCO study (NCT03498521).1,2 […] The results from the CUPISCO study show that, compared with standard platinum-based chemotherapy, [molecularly guided therapy] conferred a significant and clinically meaningful improvement in progression-free survival to patients with previously untreated, unfavorable, nonsquamous CUP who reached disease control during an induction period with 3 platinum-based chemotherapy cycles.

• #43 Carcinoma of unknown primary – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/carcinoma-unknown-primary/diagnosis-treatment/drc-20433758

  Treatment for carcinoma of unknown primary often involves medicines. Cancer treatments that use medicines include chemotherapy, immunotherapy and targeted therapy. Carcinoma of unknown primary is a cancer that has spread in the body. Cancer medicines can travel through the body and kill cancer cells. Sometimes healthcare professionals use other treatments, such as surgery and radiation therapy. […] Chemotherapy treats cancer with strong medicines. Many chemotherapy medicines exist. Most chemotherapy medicines are given through a vein. Some come in pill form. […] Immunotherapy for cancer is a treatment with medicine that helps the body’s immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn’t be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.

• #44 Cancer of Unknown Primary Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/unknown-primary/hp/unknown-primary-treatment-pdq

  Two randomized prospective trials published in 2019 compared standard chemotherapy (carboplatin and paclitaxel or cisplatin and gemcitabine) versus site-specific therapy using gene expression profiling. […] There was no advantage to site-specific therapy in median progression-free survival (PFS) (5 months) or median overall survival (OS) (10-12 months) in either trial. […] A meta-analysis of five studies including 1,114 patients compared site-specific therapy from genomic profiling versus empiric therapy. […] There was no improvement in PFS or OS. […] Treatment options for newly diagnosed unfavorable CUP include the following: Site-directed therapy based on molecular tissue of origin/molecular targeted therapy, Immunological therapy, Chemotherapy. […] Immunological therapy using checkpoint inhibitors such as nivolumab has been given to a general population with unfavorable CUP, resulting in a 22% overall response rate.

• #45 Carcinoma of Unknown Primary Treatment | NY | Montefiore Einstein Comprehensive Cancer Center

  https://montefioreeinstein.org/cancer/types/unknown-origin/carcinoma-primary-treatment

  Clinical, pathological, and molecular genetic tests have two goals. The first is to identify tumors that are responsive to available therapies. The second is to identify novel targeted therapies that might be applicable to the particular genetic profile. […] Immunological therapy using checkpoint inhibitors such as nivolumab has been given to a general population with unfavorable CUP, resulting in a 22% overall response rate. […] Treatment options for newly diagnosed unfavorable CUP include the following: Site-directed therapy based on molecular tissue of origin/molecular targeted therapy, Immunological therapy, Chemotherapy. […] Most patients with newly diagnosed cancer of unknown primary (CUP) are considered to have an unfavorable prognosis. […] Palliative care and hospice are options for patients with a poor performance status and relapsing disease.

• #46 Cancer of Unknown Primary (CUP) Treatment (PDQ®) – PDQ Cancer Information Summaries – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK65811/

  Immunological therapy using checkpoint inhibitors such as nivolumab has been given to a general population with unfavorable CUP, resulting in a 22% overall response rate. Better response rates can be seen when checkpoint inhibitors are given to patients with tumors expressing high levels of microsatellite instability (MSI-H) or deficient mismatch repair (dMMR). […] Patients with unfavorable CUP who are not candidates for molecular targeted therapy or immunotherapy are candidates for clinical trials. Cytotoxic chemotherapy can be a palliative therapy, but the choice of drugs has been based on a few small clinical studies, with no randomized trials establishing their benefit over best supportive care. Several randomized prospective studies demonstrate that platinum-based doublet chemotherapy combined with a taxane or gemcitabine is equivalent to other chemotherapy in response rate and progression-free survival.

• #47 Cancer of Unknown Primary Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/unknown-primary/hp/unknown-primary-treatment-pdq

  Two randomized prospective trials published in 2019 compared standard chemotherapy (carboplatin and paclitaxel or cisplatin and gemcitabine) versus site-specific therapy using gene expression profiling. […] There was no advantage to site-specific therapy in median progression-free survival (PFS) (5 months) or median overall survival (OS) (10-12 months) in either trial. […] A meta-analysis of five studies including 1,114 patients compared site-specific therapy from genomic profiling versus empiric therapy. […] There was no improvement in PFS or OS. […] Treatment options for newly diagnosed unfavorable CUP include the following: Site-directed therapy based on molecular tissue of origin/molecular targeted therapy, Immunological therapy, Chemotherapy. […] Immunological therapy using checkpoint inhibitors such as nivolumab has been given to a general population with unfavorable CUP, resulting in a 22% overall response rate.

• #48

  https://journals.lww.com/md-journal/fulltext/2021/12030/successful_treatment_using_immunotherapy_in.67.aspx

  According to Spanish Society of Medical Oncology (SEOM) clinical guidelines, SCC can be treated with paclitaxel and carboplatin at intervals of 21 days. […] Studies have found that the efficacy of albumin-binding paclitaxel plus carboplatin is better than that of paclitaxel plus carboplatin in SCC, and the toxicity can be tolerated. […] Therefore, the patient was treated with carboplatin, albumin-binding paclitaxel, and immune checkpoint inhibitor (carilizumab). Treatment was well tolerated and could be administered without serious side effects. […] After chemotherapy and immunotherapy, the patient’s lesions were significantly reduced, her general state improved, and her PS score was 0. The patient benefited significantly. […] We know that CUP patients with PD-L1 expression, high TMB, and MSI-H can benefit from immune checkpoint inhibitor treatment.

• #49

  https://journals.lww.com/md-journal/fulltext/2021/12030/successful_treatment_using_immunotherapy_in.67.aspx

  Moreover, a recent study also found that TP53 and KRAS mutation status and PBRM1 mutation can benefit from anti-PD-1 /PD-L1 immunotherapy; it may benefit those with CUP as well. […] Stefan Groschel et al also reported the benefit of immune checkpoint inhibitors in a case of refractory CUP with PD-L1 amplification and overexpression. […] The Phase II global CUP trial (NCT03498521), which is expected to be completed by June 30, 2023, will further evaluate the progress of targeted therapy and immunotherapy in CUP patients and may contribute to the discovery of novel biomarkers.

• #50

  https://journals.lww.com/md-journal/fulltext/2021/12030/successful_treatment_using_immunotherapy_in.67.aspx

  Successful treatment using immunotherapy in combination with chemotherapy for metastatic squamous cell carcinoma of unknown primary origin with bulky abdominal mass: a case report. […] The patient was treated with carboplatin, albumin-binding paclitaxel, and immune checkpoint inhibitor (carilizumab). After 6 cycles, the patient was switched to maintenance treatment with carilizumab. […] The treatment efficacy was assessed as partial remission according to Response Evaluation Criteria in Solid Tumors. The patient benefited from immunotherapy combined with chemotherapy. […] By performing NGS for patients and targeting immune-related positive predictors, immunotherapy combined with chemotherapy may prolong the overall survival of patients. This case report suggests that immunotherapy combined with chemotherapy is feasible and effective in patients with CUP.

• #51

  https://journals.lww.com/md-journal/fulltext/2021/12030/successful_treatment_using_immunotherapy_in.67.aspx

  According to Spanish Society of Medical Oncology (SEOM) clinical guidelines, SCC can be treated with paclitaxel and carboplatin at intervals of 21 days. […] Studies have found that the efficacy of albumin-binding paclitaxel plus carboplatin is better than that of paclitaxel plus carboplatin in SCC, and the toxicity can be tolerated. […] Therefore, the patient was treated with carboplatin, albumin-binding paclitaxel, and immune checkpoint inhibitor (carilizumab). Treatment was well tolerated and could be administered without serious side effects. […] After chemotherapy and immunotherapy, the patient’s lesions were significantly reduced, her general state improved, and her PS score was 0. The patient benefited significantly. […] We know that CUP patients with PD-L1 expression, high TMB, and MSI-H can benefit from immune checkpoint inhibitor treatment.

• #52 Cancer of unknown primary origin – Wikipedia

  https://en.wikipedia.org/wiki/Cancer_of_unknown_primary_origin

  If the site of origin is unknown or undiscovered, then the histology of the tumor (e.g., adenocarcinoma, squamous cell or mesenchymal) can usually be identified, and a probable origin may be assumed. When this is possible, then treatment is based on the type of cell and probable origin. […] No method is standard for all forms of CUP, but chemotherapy, radiation therapy, hormone therapy, and surgery may be used alone or in combination to treat patients who have CUP. Even when the cancer is unlikely to be cured, treatment may help the patient live longer or improve the patient’s quality of life. […] For CUP with an unfavorable prognosis, treatment with taxanes may provide a slight survival benefit.

• #53 Cancer of Unknown Primary Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/unknown-primary/hp/unknown-primary-treatment-pdq

  Two randomized prospective trials published in 2019 compared standard chemotherapy (carboplatin and paclitaxel or cisplatin and gemcitabine) versus site-specific therapy using gene expression profiling. […] There was no advantage to site-specific therapy in median progression-free survival (PFS) (5 months) or median overall survival (OS) (10-12 months) in either trial. […] A meta-analysis of five studies including 1,114 patients compared site-specific therapy from genomic profiling versus empiric therapy. […] There was no improvement in PFS or OS. […] Treatment options for newly diagnosed unfavorable CUP include the following: Site-directed therapy based on molecular tissue of origin/molecular targeted therapy, Immunological therapy, Chemotherapy. […] Immunological therapy using checkpoint inhibitors such as nivolumab has been given to a general population with unfavorable CUP, resulting in a 22% overall response rate.

• #54 Frontiers | The Quest for Improving Treatment of Cancer of Unknown Primary (CUP) Through Molecularly-Driven Treatments: A Systematic Review

  https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2020.00533/full

  NGS may represent a tool to improve diagnosis and treatment of CUP by identifying therapeutically actionable alterations and providing insights into tumor biology. […] CUPs account for 3–5% of all malignancies and disappointingly the overall survival in CUP population has not improved over the last decades, despite advancements in the knowledge of biology of solid tumors. This is partly due to a lack of therapeutic options, with chemotherapy regimens using either platinum or taxanes or both not having proved to prolong survival in patient with CUP. […] Based on the assumption that a treatment directed to the molecularly predicted tissue of origin could improve clinical outcome, a recent randomized phase II trial comparing site-specific treatment based on gene expression profiling vs. carboplatin and paclitaxel for patients with CUP has been performed. This study however demonstrated that site-specific therapy does not result in a significant survival improvement compared with empirical chemotherapy, leaving a clear unmet need for this patient population.

• #55 Carcinoma of Unknown Primary Treatment – NCI

  https://www.cancer.gov/types/unknown-primary/patient/unknown-primary-treatment-pdq

  Treatment of poorly differentiated carcinoma of unknown primary may include the following: Combination chemotherapy, A clinical trial of new types of treatment. […] Treatment for women who have peritoneal carcinoma of unknown primary may be the same as for ovarian cancer. Treatment may include the following: Chemotherapy, A clinical trial of new types of treatment. […] Treatment of axillary lymph node metastasis is usually: Surgery to remove the lymph nodes. […] Treatment of inguinal lymph node metastasis may include the following: Surgery to remove the cancer and/or lymph nodes in the groin, Surgery to remove the cancer and/or lymph nodes in the groin, followed by radiation therapy or chemotherapy. […] There is no standard treatment for carcinoma of unknown primary that is found in several different areas of the body. Treatment may include the following: Hormone therapy, Internal radiation therapy, Chemotherapy with one or more anticancer drugs, A clinical trial. […] Treatment for recurrent carcinoma of unknown primary is usually within a clinical trial.

• #56 Management of Patients With Cancer of Unknown Primary Site

  https://www.cancernetwork.com/view/management-patients-cancer-unknown-primary-site

  Optimal treatment for women with peritoneal carcinomatosis is identical to that currently recommended for those with advanced ovarian cancer; namely, initial laparotomy with maximal surgical cytoreduction followed by chemotherapy with paclitaxel (Taxol) and a platinum agent. […] In our experience, over 75% of patients had major responses, and long-term survival was achieved in 15% to 20% of patients. […] Promising results have been obtained with first-line empiric paclitaxel/carboplatin/etoposide combination chemotherapy. The regimen is well tolerated and has become one of the standard approaches to the systemic management of cancer of unknown primary. […] Additional trials of paclitaxel/carboplatin-containing regimens are in progress. […] The potential to improve empiric therapy for patients with carcinoma of unknown primary site is promising.

• #57 Cancer of unknown primary origin – Wikipedia

  https://en.wikipedia.org/wiki/Cancer_of_unknown_primary_origin

  Cancer of unknown primary origin (CUP) is a cancer that is determined to be at the metastatic stage at the time of diagnosis, but a primary tumor cannot be identified. A diagnosis of CUP requires a clinical picture consistent with metastatic disease and one or more biopsy results inconsistent with a tumor cancer. […] The other 15 to 20% of patients, however, have a relatively long survival with appropriate treatment. […] Because CUP refers to many different cancers, treatment depends on where the cancer is found, the microscopic appearance of the cancer cells, the biochemical characterization of the cells, and the patient’s age and overall physical condition. In women, who present with axillary lymph node involvement, treatment is offered along the lines of breast cancer. In patients, who have neck lymph node involvement, then treatment is offered along the lines of head and neck cancer. If inguinal lymph nodes are involved, then treatment may be offered along the lines of genitourinary cancer.

• #58 Cancer of unknown primary origin – Wikipedia

  https://en.wikipedia.org/wiki/Cancer_of_unknown_primary_origin

  Cancer of unknown primary origin (CUP) is a cancer that is determined to be at the metastatic stage at the time of diagnosis, but a primary tumor cannot be identified. A diagnosis of CUP requires a clinical picture consistent with metastatic disease and one or more biopsy results inconsistent with a tumor cancer. […] The other 15 to 20% of patients, however, have a relatively long survival with appropriate treatment. […] Because CUP refers to many different cancers, treatment depends on where the cancer is found, the microscopic appearance of the cancer cells, the biochemical characterization of the cells, and the patient’s age and overall physical condition. In women, who present with axillary lymph node involvement, treatment is offered along the lines of breast cancer. In patients, who have neck lymph node involvement, then treatment is offered along the lines of head and neck cancer. If inguinal lymph nodes are involved, then treatment may be offered along the lines of genitourinary cancer.

• #59 Cancer of Unknown Primary | Causes, Symptoms & Treatments | Cancer Council

  https://www.cancer.org.au/cancer-information/types-of-cancer/cancer-of-unknown-primary

  Treatment for cancer of unknown primary […] Staging differs for different cancer types. For most cancers there are four stages, with stage I being an early cancer and stage IV an advanced cancer. Staging is a way to describe the spread of cancer. However, CUP cannot be given a stage because the primary cancer is not known and the cancer has already spread to other parts of the body when it is found. […] Types of treatment […] For most cancers, treatment is determined by the type of cancer and depends on correct diagnosis and staging. Because the primary cancer is unknown, there is no standard treatment for CUP. The main treatment used for CUP is broad spectrum chemotherapy, unless the unknown primary is in a very specific area. For example, neck nodes are usually treated like head and neck cancer, axillary node presentations are treated in the same manner as breast cancers, and peritoneal presentations are treated like ovarian cancer.

• #60 Metastatic Cancer With Unknown Primary Site: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/2005218-overview

  Approximately 15-20% of patients with CUP have a favorable prognosis. In these cases, treatment corresponds to that of the equivalent known primary tumor. Favorable-risk CUPs are as follows: Single metastatic deposit or oligometastatic disease amenable to local ablative treatment; In women, isolated axillary nodal metastases; In women, peritoneal adenocarcinomatosis of a serous papillary histologic type; In men, blastic bone metastases or IHC/serum prostate-specific antigen (PSA) expression; Squamous cell carcinoma involving non-supraclavicular cervical lymph nodes (head-and-neck); Adenocarcinoma with a colorectal immunohistochemical (CK7-negative, CK20-positive, CDX2-positive) or molecular profile; Carcinoma with a renal-cell histologic and immunohistochemical profile. […] Communication between the clinician and the patient is paramount to optimal patient care. Patients and caregivers should be informed at each step of assessment and treatment. Patients should understand the goal of treatment, whether it is curative or palliative in nature. This should be defined upfront, although it can change as the patient responds or fails to respond to treatment.

• #61 Metastatic Cancer With Unknown Primary Site: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/2005218-overview

  Approximately 15-20% of patients with CUP have a favorable prognosis. In these cases, treatment corresponds to that of the equivalent known primary tumor. Favorable-risk CUPs are as follows: Single metastatic deposit or oligometastatic disease amenable to local ablative treatment; In women, isolated axillary nodal metastases; In women, peritoneal adenocarcinomatosis of a serous papillary histologic type; In men, blastic bone metastases or IHC/serum prostate-specific antigen (PSA) expression; Squamous cell carcinoma involving non-supraclavicular cervical lymph nodes (head-and-neck); Adenocarcinoma with a colorectal immunohistochemical (CK7-negative, CK20-positive, CDX2-positive) or molecular profile; Carcinoma with a renal-cell histologic and immunohistochemical profile. […] Communication between the clinician and the patient is paramount to optimal patient care. Patients and caregivers should be informed at each step of assessment and treatment. Patients should understand the goal of treatment, whether it is curative or palliative in nature. This should be defined upfront, although it can change as the patient responds or fails to respond to treatment.

• #62 Diagnostic and therapeutic management of cancer of an unknown primary – PubMed

  https://pubmed.ncbi.nlm.nih.gov/12957453/

  Metastatic Cancer of Unknown Primary Site (CUP) accounts for approximately 3% of all malignant neoplasms and is therefore one of the 10 most frequent cancer diagnoses in man. Patients with CUP present with metastatic disease for which the site of origin cannot be identified at the time of diagnosis. […] Several favourable sub-sets of CUP have been identified, which are responsive to systemic chemotherapy and/or locoregional treatment. Identification and treatment of these patients is of paramount importance. The considered responsive sub-sets to platinum-based chemotherapy are the poorly differentiated carcinomas involving the mediastinal-retroperitoneal nodes, the peritoneal papillary serous adenocarcinomatosis in females and the poorly differentiated neuroendocrine carcinomas. Other tumours successfully managed by locoregional treatment with surgery and/or irradiation are the metastatic adenocarcinoma of isolated axillary nodes, metastatic squamous cell carcinoma of cervical nodes, or any other single metastatic site. Empirical chemotherapy benefits some of the patients who do not fit into any favourable sub-set, and should be considered in patients with a good performance status.

• #63 Carcinoma of Unknown Primary Treatment – NCI

  https://www.cancer.gov/types/unknown-primary/patient/unknown-primary-treatment-pdq

  Treatment of poorly differentiated carcinoma of unknown primary may include the following: Combination chemotherapy, A clinical trial of new types of treatment. […] Treatment for women who have peritoneal carcinoma of unknown primary may be the same as for ovarian cancer. Treatment may include the following: Chemotherapy, A clinical trial of new types of treatment. […] Treatment of axillary lymph node metastasis is usually: Surgery to remove the lymph nodes. […] Treatment of inguinal lymph node metastasis may include the following: Surgery to remove the cancer and/or lymph nodes in the groin, Surgery to remove the cancer and/or lymph nodes in the groin, followed by radiation therapy or chemotherapy. […] There is no standard treatment for carcinoma of unknown primary that is found in several different areas of the body. Treatment may include the following: Hormone therapy, Internal radiation therapy, Chemotherapy with one or more anticancer drugs, A clinical trial. […] Treatment for recurrent carcinoma of unknown primary is usually within a clinical trial.

• #64

  http://www.cancerhelpessentiahealth.org/Cancer_Types/unknown_primary_203331E2_04.html

  Treatment Options for Carcinoma of Unknown Primary […] Newly Diagnosed Carcinoma of Unknown Primary […] Cancer found in cervical (neck) lymph nodes may have spread from a tumor in the head or neck. Treatment of cervical lymph node carcinoma of unknown primary (CUP) may include the following: Surgery to remove the tonsils. Radiation therapy alone. Intensity-modulated radiation therapy (IMRT) may be used. Radiation therapy followed by surgery to remove the lymph nodes. Surgery to remove the lymph nodes, with or without radiation therapy. A clinical trial of new types of treatment. […] Cancer cells that are poorly differentiated look very different from normal cells. The type of cell they came from is not known. Treatment of poorly differentiated carcinoma of unknown primary, including tumors in the neuroendocrine system (the part of the brain that controls hormone-producing glands throughout the body) may include the following: Combination chemotherapy. A clinical trial of new types of treatment.

• #65 Carcinoma of Unknown Primary Treatment (PDQ®): Treatment – Patient Information [NCI] | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.carcinoma-of-unknown-primary-treatment-pdq%C2%AE-treatment-patient-information-nci.ncicdr0000062729

  Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. […] Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. […] Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. […] New types of treatment are being tested in clinical trials. […] Treatment for carcinoma of unknown primary may cause side effects. […] Treatment of cervical lymph node carcinoma of unknown primary (CUP) may include surgery to remove the tonsils, radiation therapy alone, or a clinical trial of new types of treatment. […] Treatment of poorly differentiated carcinoma of unknown primary may include combination chemotherapy or a clinical trial of new types of treatment. […] Treatment for women who have peritoneal carcinoma of unknown primary may be the same as for ovarian cancer. […] Treatment of axillary lymph node metastasis is usually surgery to remove the lymph nodes. […] Treatment for recurrent carcinoma of unknown primary is usually within a clinical trial.

• #66 Carcinoma of Unknown Primary Treatment – NCI

  https://www.cancer.gov/types/unknown-primary/patient/unknown-primary-treatment-pdq

  Treatment of poorly differentiated carcinoma of unknown primary may include the following: Combination chemotherapy, A clinical trial of new types of treatment. […] Treatment for women who have peritoneal carcinoma of unknown primary may be the same as for ovarian cancer. Treatment may include the following: Chemotherapy, A clinical trial of new types of treatment. […] Treatment of axillary lymph node metastasis is usually: Surgery to remove the lymph nodes. […] Treatment of inguinal lymph node metastasis may include the following: Surgery to remove the cancer and/or lymph nodes in the groin, Surgery to remove the cancer and/or lymph nodes in the groin, followed by radiation therapy or chemotherapy. […] There is no standard treatment for carcinoma of unknown primary that is found in several different areas of the body. Treatment may include the following: Hormone therapy, Internal radiation therapy, Chemotherapy with one or more anticancer drugs, A clinical trial. […] Treatment for recurrent carcinoma of unknown primary is usually within a clinical trial.

• #67 Treatment of a Cancer of Unknown Primary by Location | American Cancer Society

  https://www.cancer.org/cancer/types/cancer-unknown-primary/treating/specific-instances.html

  When large and/or many tumors are present, some patients will be treated with both surgery and radiation therapy. The radiation may be given before or after surgery. […] When tumors are very large or present on both sides of the neck, chemotherapy (chemo) and radiation therapy are often used together. […] The recommended treatment is similar to that for women diagnosed with breast cancer that has spread to these nodes. […] Surgery to remove axillary nodes (called an axillary lymph node dissection) is done, and the breast on the same side may be treated with mastectomy (surgery to remove the breast) or radiation therapy. […] If the primary tumor can’t be found, surgery is usually the main treatment. […] If the cancer appears to be confined to a single lymph node, removing it may be the only treatment. In other cases, more extensive surgery (a lymph node dissection) may be needed.

• #68 Carcinoma of Unknown Primary Treatment (PDQ®): Treatment – Patient Information [NCI]

  https://www.cham.org/HealthwiseArticle.aspx?id=ncicdr0000062729

  Treatment of axillary lymph node metastasis is usually: Surgery to remove the lymph nodes. […] Treatment also may include one or more of the following: Surgery to remove the breast, Radiation therapy to the breast, Chemotherapy, A clinical trial of new types of treatment. […] Treatment of inguinal lymph node metastasis may include the following: Surgery to remove the cancer and/or lymph nodes in the groin, Surgery to remove the cancer and/or lymph nodes in the groin, followed by radiation therapy or chemotherapy. […] Treatment for recurrent carcinoma of unknown primary is usually within a clinical trial.

• #69 Carcinoma of Unknown Primary Treatment – NCI

  https://www.cancer.gov/types/unknown-primary/patient/unknown-primary-treatment-pdq

  Treatment of poorly differentiated carcinoma of unknown primary may include the following: Combination chemotherapy, A clinical trial of new types of treatment. […] Treatment for women who have peritoneal carcinoma of unknown primary may be the same as for ovarian cancer. Treatment may include the following: Chemotherapy, A clinical trial of new types of treatment. […] Treatment of axillary lymph node metastasis is usually: Surgery to remove the lymph nodes. […] Treatment of inguinal lymph node metastasis may include the following: Surgery to remove the cancer and/or lymph nodes in the groin, Surgery to remove the cancer and/or lymph nodes in the groin, followed by radiation therapy or chemotherapy. […] There is no standard treatment for carcinoma of unknown primary that is found in several different areas of the body. Treatment may include the following: Hormone therapy, Internal radiation therapy, Chemotherapy with one or more anticancer drugs, A clinical trial. […] Treatment for recurrent carcinoma of unknown primary is usually within a clinical trial.

• #70

  http://www.cancerhelpessentiahealth.org/Cancer_Types/unknown_primary_203331E2_04.html

  Treatment for women who have peritoneal (lining of the abdomen) carcinoma of unknown primary may be the same as for ovarian cancer. Treatment may include the following: Chemotherapy. A clinical trial of new types of treatment. […] Cancer found only in the axillary (armpit) lymph nodes may have spread from a tumor in the breast. Treatment of axillary lymph node metastasis is usually: Surgery to remove the lymph nodes. Treatment also may include one or more of the following: Surgery to remove the breast. Radiation therapy to the breast. Chemotherapy. A clinical trial of new types of treatment. […] Cancer found only in the inguinal (groin) lymph nodes most likely began in the genital, anal, or rectal area. Treatment of inguinal lymph node metastasis may include the following: Surgery to remove the cancer and/or lymph nodes in the groin. Surgery to remove the cancer and/or lymph nodes in the groin, followed by radiation therapy or chemotherapy.

• #71 Carcinoma of Unknown Primary Treatment (PDQ®): Treatment – Patient Information [NCI]

  https://www.cham.org/HealthwiseArticle.aspx?id=ncicdr0000062729

  Treatment of axillary lymph node metastasis is usually: Surgery to remove the lymph nodes. […] Treatment also may include one or more of the following: Surgery to remove the breast, Radiation therapy to the breast, Chemotherapy, A clinical trial of new types of treatment. […] Treatment of inguinal lymph node metastasis may include the following: Surgery to remove the cancer and/or lymph nodes in the groin, Surgery to remove the cancer and/or lymph nodes in the groin, followed by radiation therapy or chemotherapy. […] Treatment for recurrent carcinoma of unknown primary is usually within a clinical trial.

• #72 Carcinoma of Unknown Primary Treatment – NCI

  https://www.cancer.gov/types/unknown-primary/patient/unknown-primary-treatment-pdq

  Treatment of poorly differentiated carcinoma of unknown primary may include the following: Combination chemotherapy, A clinical trial of new types of treatment. […] Treatment for women who have peritoneal carcinoma of unknown primary may be the same as for ovarian cancer. Treatment may include the following: Chemotherapy, A clinical trial of new types of treatment. […] Treatment of axillary lymph node metastasis is usually: Surgery to remove the lymph nodes. […] Treatment of inguinal lymph node metastasis may include the following: Surgery to remove the cancer and/or lymph nodes in the groin, Surgery to remove the cancer and/or lymph nodes in the groin, followed by radiation therapy or chemotherapy. […] There is no standard treatment for carcinoma of unknown primary that is found in several different areas of the body. Treatment may include the following: Hormone therapy, Internal radiation therapy, Chemotherapy with one or more anticancer drugs, A clinical trial. […] Treatment for recurrent carcinoma of unknown primary is usually within a clinical trial.

• #73

  http://www.cancerhelpessentiahealth.org/Cancer_Types/unknown_primary_203331E2_04.html

  Treatment of melanoma that is found only in a single lymph node area is usually: Surgery to remove the lymph nodes. […] There is no standard treatment for carcinoma of unknown primary that is found in several different areas of the body. Treatment may include the following: Hormone therapy. Internal radiation therapy. Chemotherapy with one or more anticancer drugs. A clinical trial. […] Treatment for recurrent carcinoma of unknown primary is usually within a clinical trial. Treatment depends on the following: The type of cancer. How the cancer was treated before. Where the cancer has come back in the body. The condition and wishes of the patient.

• #74 Carcinoma of Unknown Primary Treatment – NCI

  https://www.cancer.gov/types/unknown-primary/patient/unknown-primary-treatment-pdq

  Treatment of poorly differentiated carcinoma of unknown primary may include the following: Combination chemotherapy, A clinical trial of new types of treatment. […] Treatment for women who have peritoneal carcinoma of unknown primary may be the same as for ovarian cancer. Treatment may include the following: Chemotherapy, A clinical trial of new types of treatment. […] Treatment of axillary lymph node metastasis is usually: Surgery to remove the lymph nodes. […] Treatment of inguinal lymph node metastasis may include the following: Surgery to remove the cancer and/or lymph nodes in the groin, Surgery to remove the cancer and/or lymph nodes in the groin, followed by radiation therapy or chemotherapy. […] There is no standard treatment for carcinoma of unknown primary that is found in several different areas of the body. Treatment may include the following: Hormone therapy, Internal radiation therapy, Chemotherapy with one or more anticancer drugs, A clinical trial. […] Treatment for recurrent carcinoma of unknown primary is usually within a clinical trial.

• #75 Treatments for undifferentiated carcinoma of unknown primary | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/cancer-of-unknown-primary/treatment/undifferentiated-carcinoma

  Undifferentiated carcinoma of unknown primary (undifferentiated CUP) means that the cells of these tumours look very different from normal cells. This makes it difficult for the healthcare team to tell where the cancer may have started or what type of CUP it is. […] Chemotherapy is the main treatment for undifferentiated CUP. Your healthcare team will offer the type of chemotherapy that they think will work best. This is referred to as empiric chemotherapy. They will usually give 2 or more drugs. Most drug combinations include at least one of the following: […] Another drug that may also be offered for undifferentiated CUP is etoposide (Vepesid). […] The most common drug combination used is carboplatin and paclitaxel. […] Researchers are still looking for the most effective drug combinations for undifferentiated CUP. […] Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

• #76

  http://www.cancerhelpessentiahealth.org/Cancer_Types/unknown_primary_203331E2_04.html

  Treatment Options for Carcinoma of Unknown Primary […] Newly Diagnosed Carcinoma of Unknown Primary […] Cancer found in cervical (neck) lymph nodes may have spread from a tumor in the head or neck. Treatment of cervical lymph node carcinoma of unknown primary (CUP) may include the following: Surgery to remove the tonsils. Radiation therapy alone. Intensity-modulated radiation therapy (IMRT) may be used. Radiation therapy followed by surgery to remove the lymph nodes. Surgery to remove the lymph nodes, with or without radiation therapy. A clinical trial of new types of treatment. […] Cancer cells that are poorly differentiated look very different from normal cells. The type of cell they came from is not known. Treatment of poorly differentiated carcinoma of unknown primary, including tumors in the neuroendocrine system (the part of the brain that controls hormone-producing glands throughout the body) may include the following: Combination chemotherapy. A clinical trial of new types of treatment.

• #77 Treatment of a Cancer of Unknown Primary by Location | American Cancer Society

  https://www.cancer.org/cancer/types/cancer-unknown-primary/treating/specific-instances.html

  Sometimes chemo can be quite helpful. Some people treated with aggressive chemo will have a complete response (with no visible cancer left after treatment), and in some of these the cancer stays away for years. […] Some poorly differentiated small cell cancers of unknown origin can shrink dramatically when chemo combinations originally developed to treat small cell lung cancer are used. […] Some neuroendocrine cancers may respond to treatment with octreotide (Sandostatin) or lanreotide (Somatuline).

• #78 Treatment of a Cancer of Unknown Primary by Location | American Cancer Society

  https://www.cancer.org/cancer/types/cancer-unknown-primary/treating/specific-instances.html

  Sometimes chemo can be quite helpful. Some people treated with aggressive chemo will have a complete response (with no visible cancer left after treatment), and in some of these the cancer stays away for years. […] Some poorly differentiated small cell cancers of unknown origin can shrink dramatically when chemo combinations originally developed to treat small cell lung cancer are used. […] Some neuroendocrine cancers may respond to treatment with octreotide (Sandostatin) or lanreotide (Somatuline).

• #79 All About Cancer of Unknown Primary | OncoLink

  https://www.oncolink.org/cancers/carcinoma-of-unknown-primary/all-about-cancer-of-unknown-primary

  Radiation therapy uses high-energy x-rays to kill cancer cells. It can be used in a few ways. It can be used to treat the cancer itself. If you cant have surgery because of where the metastatic tumor is, or because of other health problems, radiation can be used with or without chemotherapy to try to shrink the tumor. […] Some types of cancer need sex hormones to grow and divide. If prostate cancer is suspected, hormone therapy may be used to lower androgen levels or to block androgen in your body, which slows or stops the cancer from growing. […] Medications that target somatostatin (Octreotide) may be used to treat some CUPs. […] Targeted therapy may be used to treat CUP. Targeted therapies target genes and proteins that control how cancer cells grow, divide, and spread. This slows down or kills the cancer cells.

• #80 Carcinoma of Unknown Primary Treatment – NCI

  https://www.cancer.gov/types/unknown-primary/patient/unknown-primary-treatment-pdq

  Treatment of poorly differentiated carcinoma of unknown primary may include the following: Combination chemotherapy, A clinical trial of new types of treatment. […] Treatment for women who have peritoneal carcinoma of unknown primary may be the same as for ovarian cancer. Treatment may include the following: Chemotherapy, A clinical trial of new types of treatment. […] Treatment of axillary lymph node metastasis is usually: Surgery to remove the lymph nodes. […] Treatment of inguinal lymph node metastasis may include the following: Surgery to remove the cancer and/or lymph nodes in the groin, Surgery to remove the cancer and/or lymph nodes in the groin, followed by radiation therapy or chemotherapy. […] There is no standard treatment for carcinoma of unknown primary that is found in several different areas of the body. Treatment may include the following: Hormone therapy, Internal radiation therapy, Chemotherapy with one or more anticancer drugs, A clinical trial. […] Treatment for recurrent carcinoma of unknown primary is usually within a clinical trial.

• #81 Management of Patients With Cancer of Unknown Primary Site

  https://www.cancernetwork.com/view/management-patients-cancer-unknown-primary-site

  Optimal treatment for women with peritoneal carcinomatosis is identical to that currently recommended for those with advanced ovarian cancer; namely, initial laparotomy with maximal surgical cytoreduction followed by chemotherapy with paclitaxel (Taxol) and a platinum agent. […] In our experience, over 75% of patients had major responses, and long-term survival was achieved in 15% to 20% of patients. […] Promising results have been obtained with first-line empiric paclitaxel/carboplatin/etoposide combination chemotherapy. The regimen is well tolerated and has become one of the standard approaches to the systemic management of cancer of unknown primary. […] Additional trials of paclitaxel/carboplatin-containing regimens are in progress. […] The potential to improve empiric therapy for patients with carcinoma of unknown primary site is promising.

• #82 Carcinoma of Unknown Primary Treatment (PDQ®): Treatment – Patient Information [NCI]

  https://www.cham.org/HealthwiseArticle.aspx?id=ncicdr0000062729

  New types of treatment are being tested in clinical trials. […] Treatment for carcinoma of unknown primary may cause side effects. […] Treatment of cervical lymph node carcinoma of unknown primary (CUP) may include the following: Surgery to remove the tonsils, Radiation therapy alone, Radiation therapy followed by surgery to remove the lymph nodes, Surgery to remove the lymph nodes, with or without radiation therapy, A clinical trial of new types of treatment. […] Treatment of poorly differentiated carcinoma of unknown primary may include the following: Combination chemotherapy, A clinical trial of new types of treatment. […] Treatment for women who have peritoneal carcinoma of unknown primary may be the same as for ovarian cancer. Treatment may include the following: Chemotherapy, A clinical trial of new types of treatment.

• #83 Carcinoma of Unknown Primary Treatment – NCI

  https://www.cancer.gov/types/unknown-primary/patient/unknown-primary-treatment-pdq

  There are different types of treatment for patients with carcinoma of unknown primary (CUP). […] Four types of standard treatment are used: Surgery, Radiation therapy, Chemotherapy, Hormone therapy. […] New types of treatment are being tested in clinical trials. […] Treatment for carcinoma of unknown primary may cause side effects. […] Patients may want to think about taking part in a clinical trial. […] Patients can enter clinical trials before, during, or after starting their cancer treatment. […] Treatment of cervical lymph node carcinoma of unknown primary (CUP) may include the following: Surgery to remove the tonsils, Radiation therapy alone, Radiation therapy followed by surgery to remove the lymph nodes, Surgery to remove the lymph nodes, with or without radiation therapy, A clinical trial of new types of treatment.

• #84 Cancer of Unknown Primary Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/unknown-primary/hp/unknown-primary-treatment-pdq

  Patients with unfavorable CUP who are not candidates for molecular targeted therapy or immunotherapy are candidates for clinical trials. […] Cytotoxic chemotherapy can be a palliative therapy, but the choice of drugs has been based on a few small clinical studies, with no randomized trials establishing their benefit over best supportive care. […] Palliative care and hospice are options for patients with a poor performance status and relapsing disease.

• #85

  https://more.navigatingcare.com/library/unknown/learn/treatment-option-overview

  The way the radiation therapy is given depends on the type and stage of the cancer being treated. External and internal radiation therapy are used to treat carcinoma of unknown primary. […] Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. […] Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. […] New types of treatment are being tested in clinical trials. […] Treatment for carcinoma of unknown primary may cause side effects. […] Patients may want to think about taking part in a clinical trial. […] For some patients, taking part in a clinical trial may be the best treatment choice. […] Patients who take part in clinical trials also help improve the way cancer will be treated in the future. […] Patients can enter clinical trials before, during, or after starting their cancer treatment. […] Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCIs clinical trials search webpage.

• #86 Frontiers | The Quest for Improving Treatment of Cancer of Unknown Primary (CUP) Through Molecularly-Driven Treatments: A Systematic Review

  https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2020.00533/full

  NGS may represent a tool to improve diagnosis and treatment of CUP by identifying therapeutically actionable alterations and providing insights into tumor biology. […] CUPs account for 3–5% of all malignancies and disappointingly the overall survival in CUP population has not improved over the last decades, despite advancements in the knowledge of biology of solid tumors. This is partly due to a lack of therapeutic options, with chemotherapy regimens using either platinum or taxanes or both not having proved to prolong survival in patient with CUP. […] Based on the assumption that a treatment directed to the molecularly predicted tissue of origin could improve clinical outcome, a recent randomized phase II trial comparing site-specific treatment based on gene expression profiling vs. carboplatin and paclitaxel for patients with CUP has been performed. This study however demonstrated that site-specific therapy does not result in a significant survival improvement compared with empirical chemotherapy, leaving a clear unmet need for this patient population.

• #87

  https://journals.lww.com/md-journal/fulltext/2021/12030/successful_treatment_using_immunotherapy_in.67.aspx

  Moreover, a recent study also found that TP53 and KRAS mutation status and PBRM1 mutation can benefit from anti-PD-1 /PD-L1 immunotherapy; it may benefit those with CUP as well. […] Stefan Groschel et al also reported the benefit of immune checkpoint inhibitors in a case of refractory CUP with PD-L1 amplification and overexpression. […] The Phase II global CUP trial (NCT03498521), which is expected to be completed by June 30, 2023, will further evaluate the progress of targeted therapy and immunotherapy in CUP patients and may contribute to the discovery of novel biomarkers.

• #88 Frontiers | The Quest for Improving Treatment of Cancer of Unknown Primary (CUP) Through Molecularly-Driven Treatments: A Systematic Review

  https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2020.00533/full

  In order to overcome both genomic heterogeneity between the primary tumor and all the metastatic lesions and temporal molecular changes occurring during sequential therapies, Kato et al. analyzed the genomic profile of a CUP population of 442 patients using NGS applied on circulating tumor DNA (ctDNA). They found at least a genomic alteration in the 80% of cases, the most common of which interesting TP53, KRAS and PIK3CA. […] Altogether these data highlight the absence of an established distinguishing underlying molecular biology make-up of CUPs, confirming that their molecular pathogenesis is complex and heterogeneous. In order to overcome this lack of knowledge, NGS represents a chance, although not validated by clinical trials, to improve diagnosis and matched treatment of potential actionable molecular alterations.

• #89 Molecularly Guided Therapy Outperforms Chemo in Cancer of Unknown Primary

  https://www.targetedonc.com/view/molecularly-guided-therapy-outperforms-chemo-in-cancer-of-unknown-primary

  Findings from the CUPISCO study found that molecularly guided therapy is more effective than standard chemotherapy for patients with unfavorable nonsquamous cancer of unknown primary. […] Comprehensive genomic profiling followed by molecularly guided therapy led to longer progression-free survival (PFS) than standard platinum-based chemotherapy in patients with previously untreated, unfavorable, nonsquamous cancer of unknown primary (CUP) who reached disease control on primary induction chemotherapy, based on data from the phase 2, prospective, randomized CUPISCO study (NCT03498521).1,2 […] The results from the CUPISCO study show that, compared with standard platinum-based chemotherapy, [molecularly guided therapy] conferred a significant and clinically meaningful improvement in progression-free survival to patients with previously untreated, unfavorable, nonsquamous CUP who reached disease control during an induction period with 3 platinum-based chemotherapy cycles.

• #90 Molecularly Guided Therapy Outperforms Chemo in Cancer of Unknown Primary

  https://www.targetedonc.com/view/molecularly-guided-therapy-outperforms-chemo-in-cancer-of-unknown-primary

  The results of the CUPISCO trial suggest that early [comprehensive genomic profiling] by tissue-based or liquid-based testing, or both, and incorporation of [molecularly guided therapies] into the treatment armamentarium of first-line therapy improves progression-free survival in patients with CUP. Given the overall poor prognosis of unfavorable CUP and the high risk of rapid clinical deterioration of patients with this malignancy, the window of opportunity for [molecularly guided therapies] might otherwise be missed, study authors concluded.

• #91 Metastatic Cancer With Unknown Primary Site: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article//2005218-overview

  Communication between the clinician and the patient is paramount to optimal patient care. Patients and caregivers should be informed at each step of assessment and treatment. Patients should understand the goal of treatment, whether it is curative or palliative in nature. This should be defined upfront, although it can change as the patient responds or fails to respond to treatment. […] Treatment of patients with cancer of an unknown primary site. […] Diagnostic and therapeutic management of cancer of an unknown primary. […] Treatment of the patient with adenocarcinoma of unknown origin. […] Docetaxel and carboplatin combination chemotherapy as outpatient palliative therapy in carcinoma of unknown primary: a multicentre Hellenic Cooperative Oncology Group phase II study. […] Phase II trial of bevacizumab and erlotinib in carcinomas of unknown primary site: the Minnie Pearl Cancer Research Network. […] Paclitaxel/carboplatin plus bevacizumab/erlotinib in the first-line treatment of patients with carcinoma of unknown primary site.

• #92 Molecularly Targeted Treatment for Cancer of Unknown Primarylogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na57781/2024/08/23/molecularly-targeted-treatment-cancer-unknown-primary

  Molecularly Targeted Treatment for Cancer of Unknown Primary […] Patients showing tumor response or stable disease with chemotherapy did better when switched to molecularly targeted treatments than those who continued chemotherapy. […] Cancer of unknown primary (CUP) has been associated with a poor prognosis, short survival, and treatment approaches that typically utilize generic chemotherapy regimens with antitumor activity in the most likely primary sites of disease. […] To determine the effect of a molecularly guided treatment (MGT) of CUP, researchers conducted an industry-sponsored, multinational, phase 2, open-label trial. […] Patients first received three cycles of induction chemotherapy with a platinum-based regimen (carboplatin-paclitaxel, cisplatin-gemcitabine, or carboplatin-gemcitabine).

• #93 Molecularly Targeted Treatment for Cancer of Unknown Primarylogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na57781/2024/08/23/molecularly-targeted-treatment-cancer-unknown-primary

  Those with tumor response or stable disease (n=436) were then randomized to either MGT or continuation of the same chemotherapy. […] Patients randomized to the MGT group who did not have a targetable alteration, high tumor mutational burden, or high microsatellite instability were treated with chemotherapy plus atezolizumab. […] Median progression-free survival (PFS) was 6.1 months in the MGT group and 4.4 months in the chemotherapy group, a significant difference (hazard ratio, 0.72; P=0.0079). […] Among the 88 patients with an actionable mutation receiving MGT, PFS was 8.1 months, versus 4.7 months for those receiving chemotherapy. […] The standard of care for CUP usually involves generic chemotherapy regimens with predictably poor outcomes. […] This study’s approach holds the promise that more-nuanced therapy recommendations based on molecular profiling could improve outcomes and might be further enhanced when more targeted agents become available.

• #94 Treating a Cancer of Unknown Primary | American Cancer Society

  https://www.cancer.org/cancer/types/cancer-unknown-primary/treating.html

  If youve been diagnosed with a cancer of unknown primary, your cancer care team will discuss your treatment options with you. Its important that you think carefully about each of your choices. Weigh the benefits of each treatment option against the possible risks and side effects. […] Treatment for a cancer of unknown primary (CUP) may include: Surgery for a Cancer of Unknown Primary, Radiation Therapy for a Cancer of Unknown Primary, Chemotherapy for a Cancer of Unknown Primary, Hormone Therapy for a Cancer of Unknown Primary, Targeted Therapy for a Cancer of Unknown Primary, Other Drugs for a Cancer of Unknown Primary. […] Often, CUP is too advanced to be cured, and the goal may be to shrink the cancer for a time, in hopes of improving symptoms and helping you live longer. This treatment is considered palliative or supportive care, because its meant to relieve symptoms such as pain, but is not expected to cure the cancer.

• #95 Treatment options for cancer of unknown primary (CUP) | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/cancer-unknown-primary-cup/treatment/decisions

  Radiotherapy uses high energy rays to kill cancer cells. […] Surgery is not often used to treat CUP. This is because the position of the primary cancer is not known; doctors can’t usually remove all the secondary cancers. […] Your doctor might suggest you take part in a clinical trial. […] You might have other treatments to help control symptoms such as painkillers, anti sickness drugs, steroids, bone strengthening drugs such as denosumab. […] Your doctor might offer you a choice of treatments. […] You may decide not to have cancer treatments, such as chemotherapy. But you can still have medicines to help control symptoms, such as sickness or pain.

• #96 Treating a Cancer of Unknown Primary | American Cancer Society

  https://www.cancer.org/cancer/types/cancer-unknown-primary/treating.html

  Its important to discuss all of your treatment options, including their goals and possible side effects, with your doctors to help make the decision that best fits your needs. […] Clinical trials are carefully controlled research studies that are done to get a closer look at promising new treatments or procedures. Clinical trials are one way to get state-of-the-art cancer treatment. […] Be sure to talk to your cancer care team about any method you are thinking about using. They can help you learn what is known (or not known) about the method, which can help you make an informed decision. […] Whether you are thinking about treatment, getting treatment, or not being treated at all, you can still get supportive care to help with pain or other symptoms. […] For some people, when treatments have been tried and are no longer controlling the cancer, it could be time to weigh the benefits and risks of continuing to try new treatments. […] Remember that even if you choose not to treat the cancer, you can still get supportive care to help with pain or other symptoms. […] Hospice care is designed to provide the best possible quality of life for people who are near the end of life.

• #97 Cancer of unknown primary (CUP) treatment | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/cancer-of-unknown-primary/cancer-of-unknown-primary-treatment

  The aim of treatment for cancer of unknown primary (CUP) is to try to control the cancer, treat the symptoms and improve or maintain your quality of life. […] Active treatment for CUP aims to: control the cancer, help you live longer, relieve your symptoms, improve your quality of life. […] The main treatment for CUP is chemotherapy. This is because chemotherapy goes into the bloodstream and can reach most parts of the body. […] Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. It is the most common treatment for cancer of unknown primary (CUP). The aim of chemotherapy is to shrink the cancer and relieve symptoms. […] Radiotherapy uses high-energy x-rays to destroy cancer cells while doing as little harm as possible to normal cells. Doctors can give radiotherapy to try to shrink and control the cancer, and stop it from growing any further.

• #98 Carcinoma of unknown primary – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/carcinoma-unknown-primary/diagnosis-treatment/drc-20433758

  Palliative care is a special type of healthcare that helps people with serious illnesses feel better. If you have cancer, palliative care can help relieve pain and other symptoms. A team of healthcare professionals give palliative care. This can include doctors, nurses and other specially trained professionals. Their goal is to improve the quality of life for you and your family. […] When palliative care is used along with other treatments, people with cancer may feel better and live longer.

• #99 Carcinoma of unknown primary | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/carcinoma-unknown-primary

  Surgery to cut away the cancer might be used for carcinoma of unknown primary that’s only in one area. Healthcare teams might use surgery to remove cancer cells in the liver or in the lymph nodes. […] Palliative care is a special type of healthcare that helps people with serious illnesses feel better. If you have cancer, palliative care can help relieve pain and other symptoms. A team of healthcare professionals give palliative care. This can include doctors, nurses and other specially trained professionals. Their goal is to improve the quality of life for you and your family. […] When palliative care is used along with other treatments, people with cancer may feel better and live longer.

• #100 Carcinoma of unknown primary – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/carcinoma-unknown-primary/diagnosis-treatment/drc-20433758

  Palliative care is a special type of healthcare that helps people with serious illnesses feel better. If you have cancer, palliative care can help relieve pain and other symptoms. A team of healthcare professionals give palliative care. This can include doctors, nurses and other specially trained professionals. Their goal is to improve the quality of life for you and your family. […] When palliative care is used along with other treatments, people with cancer may feel better and live longer.

• #101 Metastatic Cancer With Unknown Primary Site: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/2005218-overview

  Approximately 15-20% of patients with CUP have a favorable prognosis. In these cases, treatment corresponds to that of the equivalent known primary tumor. Favorable-risk CUPs are as follows: Single metastatic deposit or oligometastatic disease amenable to local ablative treatment; In women, isolated axillary nodal metastases; In women, peritoneal adenocarcinomatosis of a serous papillary histologic type; In men, blastic bone metastases or IHC/serum prostate-specific antigen (PSA) expression; Squamous cell carcinoma involving non-supraclavicular cervical lymph nodes (head-and-neck); Adenocarcinoma with a colorectal immunohistochemical (CK7-negative, CK20-positive, CDX2-positive) or molecular profile; Carcinoma with a renal-cell histologic and immunohistochemical profile. […] Communication between the clinician and the patient is paramount to optimal patient care. Patients and caregivers should be informed at each step of assessment and treatment. Patients should understand the goal of treatment, whether it is curative or palliative in nature. This should be defined upfront, although it can change as the patient responds or fails to respond to treatment.

• #102 Treating a Cancer of Unknown Primary | American Cancer Society

  https://www.cancer.org/cancer/types/cancer-unknown-primary/treating.html

  Its important to discuss all of your treatment options, including their goals and possible side effects, with your doctors to help make the decision that best fits your needs. […] Clinical trials are carefully controlled research studies that are done to get a closer look at promising new treatments or procedures. Clinical trials are one way to get state-of-the-art cancer treatment. […] Be sure to talk to your cancer care team about any method you are thinking about using. They can help you learn what is known (or not known) about the method, which can help you make an informed decision. […] Whether you are thinking about treatment, getting treatment, or not being treated at all, you can still get supportive care to help with pain or other symptoms. […] For some people, when treatments have been tried and are no longer controlling the cancer, it could be time to weigh the benefits and risks of continuing to try new treatments. […] Remember that even if you choose not to treat the cancer, you can still get supportive care to help with pain or other symptoms. […] Hospice care is designed to provide the best possible quality of life for people who are near the end of life.

• #103 Metastatic Cancer With Unknown Primary Site: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/2005218-overview

  Approximately 15-20% of patients with CUP have a favorable prognosis. In these cases, treatment corresponds to that of the equivalent known primary tumor. Favorable-risk CUPs are as follows: Single metastatic deposit or oligometastatic disease amenable to local ablative treatment; In women, isolated axillary nodal metastases; In women, peritoneal adenocarcinomatosis of a serous papillary histologic type; In men, blastic bone metastases or IHC/serum prostate-specific antigen (PSA) expression; Squamous cell carcinoma involving non-supraclavicular cervical lymph nodes (head-and-neck); Adenocarcinoma with a colorectal immunohistochemical (CK7-negative, CK20-positive, CDX2-positive) or molecular profile; Carcinoma with a renal-cell histologic and immunohistochemical profile. […] Communication between the clinician and the patient is paramount to optimal patient care. Patients and caregivers should be informed at each step of assessment and treatment. Patients should understand the goal of treatment, whether it is curative or palliative in nature. This should be defined upfront, although it can change as the patient responds or fails to respond to treatment.

• #104 Cancer of Unknown Primary: Treatment Choices

  https://encyclopedia.nm.org/Conditions/Cancer/Specific/Carcinoma/34,19015-1

  You may have questions and concerns about your treatment options. […] Because cancer of unknown primary (CUP) can be linked to many different types of cancers, there’s no 1 way to treat it. The treatment your healthcare provider suggests depends on where the cancer most likely started. […] Today there are many ways to find the origin of CUP. These include genetic testing and antibody testing of the cancer cells. […] Your healthcare provider is the best person to answer questions about treatment. They can explain what your treatment choices are, how well treatment is expected to work, and what the risks and side effects may be. […] Sometimes, even if a cure isn’t possible, treatment may improve your quality of life. It may also help you live longer. […] Treatment is usually started only after trying to figure out the primary cancer. This means a lot of tests will be done, including imaging, blood, and other tests.

• #105 Treatments for cancer of unknown primary | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/cancer-of-unknown-primary/treatment

  Your healthcare team will create a treatment plan just for you. The plan is based on your health and specific information about the cancer. What you want is also important when planning treatment. When deciding which treatments to offer for cancer of unknown primary (CUP), your healthcare team will consider: […] Treatments for cancer of unknown primary (CUP) may be based on where cancer is found and where it may have started. […] Extragonadal germ cell tumours of unknown primary are usually treated with chemotherapy. […] Neuroendocrine carcinoma of unknown primary (neuroendocrine CUP) is often treated with chemotherapy. Somatostatin analogues and targeted therapy may also be used. […] Melanoma of unknown primary is usually treated with surgery. […] Undifferentiated carcinoma of unknown primary (undifferentiated CUP) is treated with chemotherapy.

• #106 Cancer of Unknown Primary: Treatment Choices | UMass Memorial Health

  https://www.ummhealth.org/health-library/cancer-of-unknown-primary-treatment-choices

  You may get just 1 type of treatment or a combination of treatments. Treatment may include chemotherapy, radiation therapy, hormone therapy, or surgery. […] Because cancer of unknown primary (CUP) can be linked to many different types of cancers, there’s no 1 way to treat it. The treatment your healthcare provider suggests depends on where the cancer most likely started. It also depends on the size of the tumor, its location, the results of lab and imaging tests, and the stage or extent of the cancer. Your age and overall health are also taken into account. […] Treatment is usually started only after trying to figure out the primary cancer. This means a lot of tests will be done, including imaging, blood, and other tests. Lab tests will be done to look for genetic mutations in the cancer cells to help find the primary cancer.

• #107 Treating a Cancer of Unknown Primary | American Cancer Society

  https://www.cancer.org/cancer/types/cancer-unknown-primary/treating.html

  Its important to discuss all of your treatment options, including their goals and possible side effects, with your doctors to help make the decision that best fits your needs. […] Clinical trials are carefully controlled research studies that are done to get a closer look at promising new treatments or procedures. Clinical trials are one way to get state-of-the-art cancer treatment. […] Be sure to talk to your cancer care team about any method you are thinking about using. They can help you learn what is known (or not known) about the method, which can help you make an informed decision. […] Whether you are thinking about treatment, getting treatment, or not being treated at all, you can still get supportive care to help with pain or other symptoms. […] For some people, when treatments have been tried and are no longer controlling the cancer, it could be time to weigh the benefits and risks of continuing to try new treatments. […] Remember that even if you choose not to treat the cancer, you can still get supportive care to help with pain or other symptoms. […] Hospice care is designed to provide the best possible quality of life for people who are near the end of life.

• #108 Treatment options for cancer of unknown primary (CUP) | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/cancer-unknown-primary-cup/treatment/decisions

  Radiotherapy uses high energy rays to kill cancer cells. […] Surgery is not often used to treat CUP. This is because the position of the primary cancer is not known; doctors can’t usually remove all the secondary cancers. […] Your doctor might suggest you take part in a clinical trial. […] You might have other treatments to help control symptoms such as painkillers, anti sickness drugs, steroids, bone strengthening drugs such as denosumab. […] Your doctor might offer you a choice of treatments. […] You may decide not to have cancer treatments, such as chemotherapy. But you can still have medicines to help control symptoms, such as sickness or pain.

• #109 Clinical Practice Guideline – Cancers of Unknown Primary Site

  https://www.esmo.org/guidelines/guidelines-by-topic/esmo-clinical-practice-guidelines-cancers-of-unknown-primary-site/clinical-practice-guideline-cancers-of-unknown-primary-site

  This ESMO Clinical Practice Guideline provides key recommendations for managing cancer of unknown primary (CUP). […] The guideline covers CUP diagnosis, risk assessment, classification, treatment and follow-up. […] Recommendations are based on available scientific data and the authors collective expert opinion. […] In clinical practice, all recommendations provided need to be discussed with patients in a shared decision-making approach.

• #110 Carcinoma of Unknown Primary Treatment | NY | Montefiore Einstein Comprehensive Cancer Center

  https://montefioreeinstein.org/cancer/types/unknown-origin/carcinoma-primary-treatment

  Clinical, pathological, and molecular genetic tests have two goals. The first is to identify tumors that are responsive to available therapies. The second is to identify novel targeted therapies that might be applicable to the particular genetic profile. […] Immunological therapy using checkpoint inhibitors such as nivolumab has been given to a general population with unfavorable CUP, resulting in a 22% overall response rate. […] Treatment options for newly diagnosed unfavorable CUP include the following: Site-directed therapy based on molecular tissue of origin/molecular targeted therapy, Immunological therapy, Chemotherapy. […] Most patients with newly diagnosed cancer of unknown primary (CUP) are considered to have an unfavorable prognosis. […] Palliative care and hospice are options for patients with a poor performance status and relapsing disease.

• #111 Cancer of Unknown Primary (CUP) Treatment (PDQ®) – PDQ Cancer Information Summaries – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK65811/

  Immunological therapy using checkpoint inhibitors such as nivolumab has been given to a general population with unfavorable CUP, resulting in a 22% overall response rate. Better response rates can be seen when checkpoint inhibitors are given to patients with tumors expressing high levels of microsatellite instability (MSI-H) or deficient mismatch repair (dMMR). […] Patients with unfavorable CUP who are not candidates for molecular targeted therapy or immunotherapy are candidates for clinical trials. Cytotoxic chemotherapy can be a palliative therapy, but the choice of drugs has been based on a few small clinical studies, with no randomized trials establishing their benefit over best supportive care. Several randomized prospective studies demonstrate that platinum-based doublet chemotherapy combined with a taxane or gemcitabine is equivalent to other chemotherapy in response rate and progression-free survival.

• #112 Molecularly Guided Therapy Outperforms Chemo in Cancer of Unknown Primary

  https://www.targetedonc.com/view/molecularly-guided-therapy-outperforms-chemo-in-cancer-of-unknown-primary

  The results of the CUPISCO trial suggest that early [comprehensive genomic profiling] by tissue-based or liquid-based testing, or both, and incorporation of [molecularly guided therapies] into the treatment armamentarium of first-line therapy improves progression-free survival in patients with CUP. Given the overall poor prognosis of unfavorable CUP and the high risk of rapid clinical deterioration of patients with this malignancy, the window of opportunity for [molecularly guided therapies] might otherwise be missed, study authors concluded.

• #113 Molecularly Guided Therapy Outperforms Chemo in Cancer of Unknown Primary

  https://www.targetedonc.com/view/molecularly-guided-therapy-outperforms-chemo-in-cancer-of-unknown-primary

  The results of the CUPISCO trial suggest that early [comprehensive genomic profiling] by tissue-based or liquid-based testing, or both, and incorporation of [molecularly guided therapies] into the treatment armamentarium of first-line therapy improves progression-free survival in patients with CUP. Given the overall poor prognosis of unfavorable CUP and the high risk of rapid clinical deterioration of patients with this malignancy, the window of opportunity for [molecularly guided therapies] might otherwise be missed, study authors concluded.

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