Identification of Clinical Prognostic Factors in Patients with Unknown Primary Tumors Treated with a Platinum-Based Combination

Abstract

Objective: The aim of this study was to evaluate patient and tumor characteristics in 102 patients with unknown primary tumors (UPT) prospectively treated with a combination of carboplatin, doxorubicin, and etoposide, to identify clinical variables predictive of response and survival. Patients and Methods: The association between clinical characteristics and outcome was evaluated by univariate and multivariate analysis: χ² test and logistic regression analysis were used to study variables predictive of response, and survival analysis, comparison of survival curves and Cox multiple regression analysis to study variables predictive of survival. Results: We obtained 26.5% objective responses (95% confidence interval: 18.2–36.1%) and a median survival of 9 months (95% confidence interval: 7–11 months). Several variables were associated with response to treatment and survival at univariate analysis. At multivariate analysis the number of tumor sites, bone/visceral involvement and epithelial tumor markers were significantly predictive of response; presence of pain, serum alkaline phosphatase, carboplatin AUC and response to treatment were significantly associated with survival. Conclusions: The identification of variables that can predict prognosis and response to treatment in patients with UPT may be useful to offer aggressive treatment to sensitive subsets of patients and provide therapeutic alternatives to those with a low probability of benefiting from standard treatment. In our patients the use of carboplatin AUC higher than 6 and response to treatment were the most important factors associated with prognosis, together with presence of pain and serum alkaline phosphatase. However, larger series and identification of new disease markers are necessary to better define predictive and prognostic variables in UPT patients.

Cancer of unknown primary site

“…17,18 Common clinical scenarios with treatment implications for cancer of unknown primary 1 24 If after all efforts the primary site has not been identified, palliative chemotherapy treatment with combination chemotherapy such as carboplatin, gemcitabine and capecitabine can achieve responses in 20-40% of selected patients who have a good prognosis, with median survivals of 9-10 months and 5-10% surviving to five years. 25 …”

Rare axillary cancer of unknown primary originating from the breast of a 64‑year‑old male patient: A case report and literature review

“…The initial diagnostic work-up should include basic blood analyses and relevant tumor markers. A computerized tomography (CT) of chest, abdomen and pelvis is recommended by ESMO guidelines (7) and Positron emission tomography (PET) imaging is frequently additionally employed in CUP to identify unrecognized malignant lesions (8). Only after that an extensive work-up has been performed without the detection of a primitive cancer, the possibility of CUP syndrome should be considered.…”