Irinotecan plus carboplatin for patients with carcinoma of unknown primary site

Abstract

Carcinoma of unknown primary site (CUP) is rarely encountered in clinical practice and optimal chemotherapy has not yet been established. This phase II study was conducted to evaluate the efficacy and toxicity of combined irinotecan þ carboplatin therapy in chemotherapy-naive patients with CUP. Irinotecan was administered at 60 mg m À2 as a 90-min intravenous infusion on days 1, 8 and 15. Carboplatin was administered at an area-under-the curve of 5 mg ml À1 min as a 60-min intravenous infusion on day 1. This cycle was repeated every 28 days for up to six cycles. Forty-five patients were enrolled in the study. An intent-to-treat analysis revealed an objective response rate to the treatment of 41.9% (95% confidence interval, 27.0 -57.9%). The median time to progression was 4.8 months and the median survival was 12.2 months. The 1-and 2-year survival rates were 44 and 27%, respectively. The most frequent grade 3 or more severe adverse events were leukopaenia (21%), neutropaenia (33%), anaemia (25%) and thrombocytopaenia (20%). Thus, the combination of irinotecan plus carboplatin was found to be active in patients with CUP. Therefore, the regimen may be one of the potentially available chemotherapeutic options for community standard of care in patients with a good performance status.

Evaluation of survival benefits by platinums and taxanes for an unfavourable subset of carcinoma of unknown primary: a systematic review and meta-analysis

“…There was one consecutive case series study (Gill et al , 1991) and the other 23 studies were single arm clinical trials (Raber et al , 1991; Briasoulis et al , 1998, 2000, 2008; Parnis et al , 2000; Greco et al , 2001, 2002; Guardiola et al , 2001; Macdonald et al , 2002; Balana et al , 2003; Mukai et al , 2003, 2010; Park et al , 2004; Piga et al , 2004; Pouessel et al , 2004; El-Rayes et al , 2005; Pittman et al , 2006; Schneider et al , 2007; Pentheroudakis et al , 2008; Hainsworth et al , 2009; Schuette et al , 2009; Yonemori et al , 2009; Moller et al , 2010). Three trials (Briasoulis et al , 1998, 2000; Pentheroudakis et al , 2008) also involved a small proportion of favourable CUP patients in their studies, and we extracted the data only from the unfavourable subset.…”

“…Two independent reviewers evaluated the responses, which were the primary outcome of the study in only two studies (Culine et al , 2003; Moller et al , 2010). In all, 14 studies reported prospective calculation of the study size (Greco et al , 2002; Macdonald et al , 2002; Pouessel et al , 2004; El-Rayes et al , 2005; Palmeri et al , 2006; Pittman et al , 2006; Schneider et al , 2007; Pentheroudakis et al , 2008; Hainsworth et al , 2009, 2010; Huebner et al , 2009; Schuette et al , 2009; Yonemori et al , 2009; Mukai et al , 2010). Among the RCTs, only one study had a clear description of the method of allocation concealment (Assersohn et al , 2003).…”

Gemcitabine and carboplatin in carcinoma of unknown primary site (CUP) in elderly patients: Analysis of a phase 2 Adelaide Cancer Trials and Education Collaborative (ACTEC) study

“…Alternative non-taxane containing doublets and triplets have also been tested with no apparent improvement in clinical outcomes. [18][19][20][21] Most of these studies were in a younger patient population, so it is not clear whether such regimens are appropriate in elderly patients.…”

Clinical outcomes in patients with cancer of unknown primary site treated by gastrointestinal oncologists

“…Phase II studies evaluating these agents combined with a platinum compound, including clinical trials in patients with CUP, were successively performed and reported. [18][19][20][21][22] Many of these studies obtained a response rate of about 30% and an overall survival of less than 10 months. [18,19] In these studies, an overall survival of longer than 10 months was obtained in patients who received combined chemotherapy with a platinum preparation plus taxane.…”