Carcinoma of unknown primary site: treatment with 1-hour paclitaxel, carboplatin, and extended-schedule etoposide.

Hainsworth, John D.; Erland, Joan B.; Kalman, Leonard; Schreeder, Marshall T.; Greco, F. Anthony

doi:10.1200/jco.1997.15.6.2385

Cited by 122 publications

(49 citation statements)

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“…Thus, to obtain clinically meaningful results, randomisation and multicentricity are of major importance even in phase II trials. On the basis of several phase II studies, platinum/taxane combinations are widely used in patients with CUP, yielding response rates of about 30% and a median survival of 7 -11 months (Hainsworth et al, 1997;Briasoulis et al, 1998;Greco et al, 2002;Park et al, 2004;El-Rayes et al, 2005). Gemcitabine has also gained considerable attraction recently.…”

Section: Discussionmentioning

confidence: 99%

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Paclitaxel and carboplatin vs gemcitabine and vinorelbine in patients with adeno- or undifferentiated carcinoma of unknown primary: a randomised prospective phase II trial

et al. 2008

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Platinum/taxane combinations are widely used in patients with carcinoma of unknown primary (CUP), yielding response rates of 30% and median overall survival of 9 -11 months in selected patients. Yet these combinations have not been subject to a randomised trial to overcome selection bias, a major problem in CUP. We randomised 92 patients to either paclitaxel/carboplatin (arm A) or the non-platinum non-taxane regimen gemcitabine/vinorelbine (arm B). The primary endpoint was rate of practicability as defined: application of X2 cycles of therapy (1) with a maximal delay of 1 week (2) and survival of X8 months (3). Practicability was shown in 52.4% (95% CI 36 -68%) in arm A and in 42.2% (95% CI 28 -58%) in arm B, respectively. The median overall survival, 1-year survival -rate and response rate of patients treated in arm A was 11.0 months, 38, and 23.8%, arm B 7.0 months, 29, and 20%. In conclusion, the paclitaxel/carboplatin regimen showed clinically meaningful activity in this randomised trial (Clinical trial registration number 219, 'Deutsches KrebsStudienRegister', German Cancer Society.)

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Section: Discussionmentioning

confidence: 99%

“…Platinum/taxane combinations are widely used in patients with CUP, yielding response rates of about 30% and a median survival of 9 -11 months in selected patients in large phase II studies (Hainsworth et al, 1997;Greco et al, 2002). Gemcitabine has shown efficacy in second-line treatment and has recently been incorporated in first-line regimen.…”

mentioning

confidence: 99%

Paclitaxel and carboplatin vs gemcitabine and vinorelbine in patients with adeno- or undifferentiated carcinoma of unknown primary: a randomised prospective phase II trial

et al. 2008

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“…25 Hopefully, these reports will be the first step toward new progress in the management of patients with CUPs. 12 ViAM 57 30 7 De Campos et al 13 VACy 40 8 4 Hainsworth et al 14 PECa 53 47 13 Lofts et al 15 FcC 44 27 4 Parnis et al 16 FcEpC 43 19 6 Greco et al 17 DC …”

Section: Discussionmentioning

confidence: 99%

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

Culine

Fabbro

Ychou

et al. 2002

Cancer

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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

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“…Nonetheless, a number of investigators, including particularly Hainsworth and Greco [30,48,52,54,55], have reported results. More recent studies have evaluated the use of a taxane/carboplatin [53] regimen coupled with etoposide [54] or gemcitabine [55].…”

Section: David M Mintzer Mdmentioning

confidence: 99%

Cancer of Unknown Primary: Changing Approaches. A Multidisciplinary Case Presentation from the Joan Karnell Cancer Center of Pennsylvania Hospital

et al. 2004

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Cancer of unknown primary is a common clinical syndrome, accounting for 2%-5% of cancer patients. A representative case is presented. This heterogenous group of disorders includes entities such as poorly differentiated carcinoma of unknown primary, adenocarcinoma of unknown primary, neuroendocrine carcinoma of unknown primary, squamous cell carcinoma of unknown primary, poorly differentiated (not otherwise specified) cancer of unknown primary, and melanoma of unknown primary. It is crucial to identify those treatment-responsive presentations of unknown primary with the greatest potential for long-term survival.This discussion emphasizes newer approaches to the diagnosis and treatment of unknown primary cancer, including advances in pathology with immunoperoxidase and molecular genetic techniques, positron emission tomography, and published chemotherapeutic trials. With the increased sophistication of pathologic and radiologic techniques, the frequency of unknown primary cancers will likely continue to decline. Further, as newer and more targeted therapies for specific types of cancer are identified, the previously held nihilism regarding the search for and identification of the primary may become less supportable. The Oncologist 2004;9:330-338 The Oncologist 2004;9:330-338 www.TheOncologist.com Correspondence: David M. Mintzer, M.D., Joan Karnell Cancer Center, 230 West Washington Square, 2nd Floor, Philadelphia, Pennsylvania 19106, USA. Telephone: 215-829-6088; Fax: 215-829-6104; e-mail: dmmonc@aol.com Received September 5, 2003; accepted for publication December 16, 2003. ©AlphaMed Press 1083-7159/2004 CASE PRESENTATIONA 49-year-old female presented with swollen lymph nodes in her left neck. She felt well without any active systemic or localizing symptoms. She had a history of an early cervical cancer treated 15 years previously with cryosurgery and cone resection without known recurrence. TheOncologist ® Cancer Medicine: Case Discussion LEARNING OBJECTIVESAfter completing this course, the reader will be able to:1. Describe the newer pathologic techniques for defining the site of origin of unknown primary cancers, including immunohistochemistry and molecular genetic techniques.2. List the subsets of patients with unknown primary cancers most likely to achieve long-term survival with appropriate therapies.3. Explain how the newer radiologic techniques such as MRI and PET scanning can help to localize unknown primary cancers.Access and take the CME test online and receive 1 hour of AMA PRA category 1 credit at CME.TheOncologist.com CME CMEThis material is protected by U.S. Copyright law. Unauthorized reproduction is prohibited. For reprints contact: Reprints@AlphaMedPress.com Mintzer, Warhol, Martin et al. 331 She had undergone a benign right breast biopsy 3 years previously. Her past medical history was notable for mitral valve prolapse, tonsillectomy, and appendectomy. She had quit smoking 6 years previously, with a 15 pack-year history. Her family history was positive for colon cancer in he...

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Carcinoma of unknown primary site: treatment with 1-hour paclitaxel, carboplatin, and extended-schedule etoposide.

Cited by 122 publications

References 24 publications

Paclitaxel and carboplatin vs gemcitabine and vinorelbine in patients with adeno- or undifferentiated carcinoma of unknown primary: a randomised prospective phase II trial

Paclitaxel and carboplatin vs gemcitabine and vinorelbine in patients with adeno- or undifferentiated carcinoma of unknown primary: a randomised prospective phase II trial

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

Cancer of Unknown Primary: Changing Approaches. A Multidisciplinary Case Presentation from the Joan Karnell Cancer Center of Pennsylvania Hospital

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