Alternative bimonthly cycles of doxorubicin, cyclophosphamide, and etoposide, cisplatin with hematopoietic growth factor support in patients with carcinoma of unknown primary site

Abstract

BACKGROUNDBecause carcinomas of unknown primary origin are highly malignant tumors with a bad prognosis (median survival, 6–12 months) and no current optimal therapy, the authors designed a prospective dose‐dense chemotherapy regimen with the objective of improving the results observed in patients who receive conventional treatment.METHODSEighty‐two patients received alternative bimonthly cycles of doxorubicin 50 mg/m2 with cyclophosphamide 1000 mg/m2 (AC) and etoposide 300 mg/m2 with cisplatin 100 mg/m2 (EP). Cycles were given at 2‐week intervals with granulocyte‐macrophage–stimulating factor support (5 μg/kg per day) from Day 4 to Day 10. Patients without measurable lesions were included, because the major end point was survival.RESULTSThe median number of alternative cycles of AC and EP was 4 cycles (range, 1–12 cycles). An objective response was observed in 24 of 62 patients (39%; 95% confidence interval, 30–48%) with measurable lesions, including 6 patients who achieved a complete response. Among 20 patients with nonmeasurable disease, 9 patients (45%) had no evidence of progressive disease at the end of chemotherapy. The overall median survival of 82 patients was 10 months, with 5 patients surviving clinically disease free at 17 months, 29 months, 45 months, 64 months, and 70 months after the end of treatment. Myelosuppression was the most common toxicity. Two toxic deaths occurred.CONCLUSIONSUsing these doses and schedules, a dose‐dense chemotherapy regimen did not appear to improve the outcome of patients with carcinoma of unknown primary site. Alternative studies dealing with news drugs will be required. Cancer 2002;94:840–6. © 2002 American Cancer Society.DOI 10.1002/cncr.10264

Carboplatin, doxorubicin and etoposide in the treatment of tumours of unknown primary site

“…Response rates to chemotherapy range between 23 and 46% and median survival is between 8 and 11 months (Briasoulis et al, 1998a;Culine et al, 1999;Briasoulis et al, 2000;Greco et al, 2001a;Culine et al, 2002;Greco et al, 2002). It is difficult to compare results of different series, because of the lack of standardised clinical prognostic factors and the limitations of most of the studies, which include small number of patients, variable characterisation of clinical features and short observation period.…”

Phase II trials in patients with carcinoma of unknown primary: a pooled data analysis

“…The response was assessable in 127 patients only. The ORR with salvage regimen was 18/127 (14% [8][9][10][11][12][13][14][15][16][17][18][19][20]), the overall non-progression rate was 69/127 (54% [45-62]). In the context of salvage therapy, the median overall survival was 4.5 months and the median progression-free survival was 3 months.…”

Large Mass Affecting Retroperitoneal Great Vessels: A Rare Presentation of A Cancer of Unknown Primary with Diagnostic Dilemma and Challenged Surgical Intervention

“…Although surgical excision of the metastatic lesion usually followed by radiation therapy should be considered for patients with only a single site of malignancy, chemotherapy has been recognized as the most appropriate therapy for patients suffering from CUP because of the frequent multi-organ involvement [9]. Response rates to chemotherapy range between 23 and 46% and median survival is between 8 and 11 months [10,11]. Recently, the use of platinum-based or taxane/platinum-containing regimens has shown better responses and longer survivals for certain chemosensitive sub-sets [12,13].…”