Carboplatin Plus Paclitaxel in Unknown Primary Carcinoma: A Phase II Hellenic Cooperative Oncology Group Study

Briasoulis, Evangelos; Kalofonos, H. P.; Bafaloukos, D.; Samantas, E.; Fountzilas, George; Xiros, Nikolaos I.; Skarlos, Dimosthenis; Christodoulou, Christos; Kosmidis, P.; Pavlidis, Nicholas

doi:10.1200/jco.2000.18.17.3101

Cited by 183 publications

(105 citation statements)

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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. In general, it appears that more recent chemotherapy regimens that employ platinum compounds, and often etoposide or taxanes or both (Briasoulis et al, 1998a;Briasoulis et al, 2000;Saghatchian et al, 2001;Greco et al, 2001a) are superior, in terms of response rate, to more traditional drugs (Kelsen et al, 1992;Nole et al, 1993;Falkson and Cohen, 1998;Lofts et al, 1999).…”

Section: Discussionmentioning

confidence: 99%

“…By restricting diagnostic procedures to a minimum, and with an early start of chemotherapy, median survival has improved from 3 -6 months of the past (Altman and Cadman, 1986;Alberts et al, 1989) to around 1 year in recently reported series (Briasoulis et al, 2000;Greco et al, 2000a).…”

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

et al. 2004

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The aim of this study was to assess the activity and toxicity of a platinum-based treatment on a group of patients with unknown primary tumours (UPTs). Patients with a diagnosis of UPT underwent a standard diagnostic procedure. Treatment was started within 2 weeks from diagnosis and consisted of carboplatin 400 mg m À2 day 1, doxorubicin 50 mg m À2 day 1, etoposide 100 mg m À2 days 1 -3, every 21 days. Response was evaluated after three courses and treatment continued in case of objective response (OR) or symptom control. A total of 102 patients were eligible. The median age was 59 years, sex male/female 54/48, histology was mainly adenocarcinoma or poorly differentiated carcinoma. Nodes, bone, liver and lung were the most frequently involved sites. In all, 79 patients received at least three courses of treatment; 26 patients received six courses or more. Six complete responses and 21 partial responses were observed, for a total of 27 of 102 ORs or 26.5% (95% confidence interval 18.2 -36.1%). The median survival was 9 months and median progression-free survival was 4 months. Toxicity was moderate to severe, with 57.8% of patients experiencing grade III -IV haematological toxicity, mainly leucopenia. The regimen employed has shown activity in tumours of unknown primary site, but was associated with significant toxicity. Such toxicity may be considered unjustified, given the large proportion of patients with tumours not likely to respond. Efforts should therefore be addressed to identify predictors of response to chemotherapy, thus limiting aggressive treatment to those patients who could benefit from it.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2004

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“…More recently, it was shown that the use of taxanes (paclitaxel or docetaxel) in combination with a platinum compound produced improved outcomes for patients who do not fit into these favorable subsets. 5,6 Those nonrandomized clinical studies showed promising results with a median survival that ranged from 8 months to 13 months and with 1-year survival rates from 15% to 29%. These lengths and rates of survival are similar to those observed for patients with chemotherapy-treated metastatic lung, pancreatic, and gastric carcinomas, among others.…”

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The influence of comorbidities, age, and performance status on the prognosis and treatment of patients with metastatic carcinomas of unknown primary site

Sève

Sawyer

Hanson

et al. 2006

Cancer

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BACKGROUNDThe authors investigated how comorbidities, age, and performance status were related to the choice of chemotherapy and to the prognosis of patients with carcinomas of unknown primary site (CUP).METHODSPatients in Northern Alberta who were diagnosed with CUP during 2000 to 2003 were included (n = 389 patients). Survival was compared by age at diagnosis (ages <65 years, 65‐74 years, and >75 years), comorbidity score (Adult Comorbidity Evaluation‐27 [ACE‐27] scores of 0‐1 and >2), performance status (PS), and other explanatory variables, such as gender, histology, and site and number of metastases.RESULTSThe median age was 68 years, and the median overall survival was 12 weeks. An ACE‐27 overall comorbidity score >2 was found in 34% of patients, and a PS >2 was observed in 50% of patients. Multivariate analysis showed that patients who had a PS ≥2 and a high overall ACE‐27 score had a worse prognosis. The impact of comorbidities on survival was limited to patients with low PS. Patients who were not evaluated at a cancer center were older, had a worse functional status, and had more moderate or severe comorbidities. Among the 257 patients who were evaluated at a cancer center, 108 patients received chemotherapy, and 121 patients had a good PS (0‐1). Age was the only independent variable that was related to the likelihood of not receiving chemotherapy among patients who had a good PS. The median overall survival of the 121 patients who had a good PS was 317 days, and overall survival was not associated significantly with chemotherapy. A logistic regression analysis that included all patients who were evaluated at a cancer center identified young age, good PS, lymph node/pleural involvement, and few comorbidities as variables that were associated independently with receiving chemotherapy.CONCLUSIONSPatients with CUP who were not evaluated at a cancer center were older, had a worse functional status, and had more moderate or severe comorbidities; this referral bias largely explained the differences between data from registries and from tertiary centers. Moderate and severe comorbidities impacted survival in patients with who had a PS ≥2. An age‐related decline was observed in the percentage of adults with good PS who received chemotherapy. The current results suggested that older patients with CUP were under treated and that factors other than PS were involved in the decision to use chemotherapy for the treatment of patients with CUP. Cancer 2006. © 2006 American Cancer Society.

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“…Several taxane/platinum regimens have been evaluated as first-line treatments and have usually produced response rates between 30% and 40%, with median survivals of 8 months to 11 months. [1][2][3][4] When patients develop disease recurrence or progression after first-line treatment, effective second-line treatment is usually not available. To the best of our knowledge, only a few treatments to date have been evaluated in the second-line setting (eg, 5-fluorouracil , gemcitabine, gemcitabine/irinotecan), and the activity of these treatments has been modest at best.…”

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Oxaliplatin and capecitabine in the treatment of patients with recurrent or refractory carcinoma of unknown primary site

Hainsworth

Spigel

Burris

et al. 2010

Cancer

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BACKGROUND: Despite the widespread use of oxaliplatin-based regimens for colorectal and other gastrointestinal cancers, there is surprisingly little information regarding their empiric use for the treatment of carcinoma of unknown primary site (CUP). In the current study, the combination of oxaliplatin and capecitabine in patients with recurrent and refractory CUP was examined. METHODS: Patients with CUP who had received at least 1 previous chemotherapy regimen were treated with oxaliplatin (130 mg/m 2 intravenously on Day 1) and capecitabine (1000 mg/m 2 orally twice daily on Days 1-14). Treatment cycles were repeated every 21 days. Patients with objective response or stable disease after 2 cycles continued treatment for 6 cycles or until disease progression. RESULTS: Nine of 48 patients (19%) had objective responses to treatment; an additional 22 patients had stable disease at the time of first re-evaluation. After a median follow-up of 17 months, the median progression-free and overall survivals were 3.7 months and 9.7 months, respectively. This regimen was reasonably well tolerated by most patients. CONCLUSIONS: The combination of oxaliplatin and capecitabine was found to have activity as a salvage treatment for patients with CUP. This regimen should be considered in patients with clinical and pathologic features suggesting a primary site in the gastrointestinal tract. Further development of the regimen as a first-line therapy, or with bevacizumab added, is indicated. Cancer 2010;116:2448-54.

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Carboplatin Plus Paclitaxel in Unknown Primary Carcinoma: A Phase II Hellenic Cooperative Oncology Group Study

Cited by 183 publications

References 24 publications

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

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

The influence of comorbidities, age, and performance status on the prognosis and treatment of patients with metastatic carcinomas of unknown primary site

Oxaliplatin and capecitabine in the treatment of patients with recurrent or refractory carcinoma of unknown primary site

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