Management of “unfavourable” carcinoma of unknown primary site: Synthesis of recent literature

Amela, Eric Yaovi; Lauridant-Philippin, Géraldine; Cousin, Sophie; Ryckewaert, Thomas; Adenis, Antoine; Penel, Nicolas

doi:10.1016/j.critrevonc.2012.03.003

Cited by 36 publications

(33 citation statements)

References 53 publications

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“…Treatment intensity in this cohort could prove to be valuable in establishing costs for treating patients with CUP and the relationship between survival and therapeutic procedures. This link has yet to be clearly demonstrated for CUP populations [23].…”

Section: Discussionmentioning

confidence: 99%

“…for the majority of CUP patients, a platinum-based doublet regimen is often prescribed [22]. a recent systematic review of the unfavourable subset of CUP has raised questions about current clinical practice [23]. Phase II trials completed in the past 15 years have yielded inconclusive results regarding chemotherapy over best supportive care, and have not clarified the benefit of treatment regimens with platinum-based chemotherapy over non-platinum-based chemotherapy with single versus doublet or triplet chemotherapy regimens [23].…”

Section: Discussionmentioning

confidence: 99%

“…additionally, several prognostic scores have been proposed with potential factors associated with CUP patient survival. however, the OCR does not capture the number of metastatic sites or prognostic markers, such as lactate dehydrogenase (Ldh) level, albumin level and performance status [23,25]. application and validation of a prognostic model in this large CUP patient cohort could have important consequences in current clinical practice.…”

Section: Discussionmentioning

confidence: 99%

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Identification and survival outcomes of a cohort of patients with cancer of unknown primary in Ontario, Canada

et al. 2015

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background. Cancer of unknown primary origin (CUP) is defined by the presence of pathologically identified metastatic disease without clinical or radiological evidence of a primary tumour. Our objective was to identify incident cases of CUP in Ontario, Canada, and determine the influence of histology and sites of metastases on overall survival (OS). Material and methods. We used the Ontario Cancer Registry (OCR) and the Same-Day Surgery and Discharge Abstract Database (SDS/DAD) to identify patients diagnosed with CUP in Ontario between 1 January 2000, and 31 December 2005. Patient diagnostic information, including histology and survival data, was obtained from the OCR. We cross-validated CUP diagnosis and obtained additional information about metastasis through data linkage with the SDS/DAD database. OS was assessed using Cox regression models adjusting for histology and sites of metastases. results. We identified 3564 patients diagnosed with CUP. Patients without histologically confirmed disease (n  1821) had a one-year OS of 10.9%, whereas patients with confirmed histology (n  1743) had a one-year OS of 15.6%. The most common metastatic sites were in the respiratory or digestive systems (n  1603), and the most common histology was adenocarcinoma (n  939). Three-year survival rates were 3.5%, 5.3%, 41.6% and 3.6% among adenocarcinoma, unspecified carcinoma, squamous cell carcinoma and undifferentiated histology, respectively. Three-year survival rates were 40%, 2.4%, 8.0% and 4.6% among patients with metastases localised to lymph nodes, the respiratory or digestive systems, other specified sites, and unspecified sites, respectively. conclusion. CUP patients in Ontario have a poor prognosis. Some subgroups may have better survival rates, such as patients with metastases localised to lymph nodes and patients with squamous cell histology.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Identification and survival outcomes of a cohort of patients with cancer of unknown primary in Ontario, Canada

et al. 2015

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“…Se han estudiado otros esquemas de quimioterapia; sin embargo, en una revisión realizada en el 2000, no se encontró evidencia de superioridad de ningún esquema de quimioterapia en los que se incluyeron sales de platino, taxanos o agentes citotóxicos de nueva generación (gemcitabina, alcaloides de la vinca o irinotecán) (27,52,53). Las tasas de respuesta están alrededor del 20%, con supervivencia media de 6 a 7 meses (1), con o sin quimioterapia (1,25).…”

Section: Tratamientounclassified

Cáncer metastásico con primario desconocido. Una revisión

Rodríguez

Regino

Grosso

2018

Rev. Colomb. Gastroenterol.

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ResumenEl tumor metastásico no siempre tiene un origen evidente, hasta en un tercio de los casos nunca se encuentra el tumor primario. Este artículo es una guía de los avances más recientes para mejorar el enfoque diagnóstico y el manejo del paciente con este tumor fatal y frecuente. El objetivo de este artículo, además de ser una guía, es ayudar a evitar errores comunes y graves. Uno de los errores más importantes es no tener en cuenta el papel fundamental de la confirmación histológica, pues esta puede evitar investigaciones innecesarias.En el artículo también se detallan los componentes de la evaluación estándar, la clasificación según su pronóstico y las indicaciones de la evaluación secundaria, que incluye las indicaciones de la endoscopia alta y baja, los marcadores tumorales, la tomografía por emisión de positrones (TEP), el papel que ocupa el perfil genético, la epigenética y el ácido desoxirribonucleico (ADN) viral. Adicionalmente, se indica el momento en que se debe detener la investigación. Recientemente, el tratamiento se ha modificado, lo que parece cambiar la historia de estos pacientes y de sus contrapartes con primario conocido. Palabras claveTumor metastásico, primario desconocido, cáncer. AbstractMetastatic tumors do not always have obvious origins: in one third of these cases, the primary tumor is never found. This article is a guide to the most recent advances in diagnostic approaches and patient management of these fatal and frequent tumors. An additional objective of this article is to help avoid common and serious errors. One of the most important errors is not taking the fundamental role of histological confirmation into account since it can avoid unnecessary investigations.The article also details the components of a standard evaluation, classification according to prognosis and indications for a secondary evaluation. These include indications for upper and lower endoscopy, tumor markers, positron emission tomography, and the roles of genetic profiling, epigenetics and viral DNA. It also indicates the moment at which an investigation should be stopped. Recently, treatment has changed, and these changes seems to have changed the history of these patients and their counterparts with known primary tumors.

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“…[8] Chemotherapy regimens recommendable as standard treatment have yet to be established for patients with CUP, associated with poor prognostic clinical features. [9] CUP has various histologic types and tumor locations. If the main symptoms and primary lesions involve the abdomen, g astrointestinal oncologists often perform treatment on the basis of clinical experience.…”

Section: Introductionmentioning

confidence: 99%

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

Yamane

Katada

Tanabe

et al. 2017

Journal of Translational Internal Medicine

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Objective: To evaluate the clinical outcomes in patients with cancer of an unknown primary site (CUP), who were treated by gastrointestinal oncologists. Methods: We retrospectively studied 29 patients with CUP who were presented at the Department of Gastroenterology, Kitasato University Hospital from October 2005 to October 2013, and were treated by the gastrointestinal oncologists. The patients were divided into two groups, namely chemotherapy group and symptomatic therapy group, and the clinical characteristics and survival times were compared. The clinical course was studied according to the histologic type (adenocarcinoma or non-adenocarcinoma), prognostic subset (favorable or unfavorable), and the presence or absence of chemotherapy. Results: The chemotherapy group comprised 19 patients, and the symptomatic therapy group comprised 10 patients. The median survival time was 11 months in the chemotherapy group and 3 months in the symptomatic therapy group. Twentytwo patients had adenocarcinoma, and 7 had non-adenocarcinoma. Of the 22 patients with adenocarcinoma, 2 belonged to the favorable prognostic subset and received chemotherapy. One of these patients died of cancer at 47 months, and the other was alive and disease free at 58 months. Among the 20 patients with adenocarcinoma in the unfavorable prognostic subset, 16 received chemotherapy and had a median survival of 16 months. Seven (44%) of these patients survived for at least 21 months, and 3 patients who could receive 3 or more regimens survived for at least 46 months. Conclusion: It might be appropriate for gastrointestinal oncologists to treat CUP on the basis of clinical experience, depending on the situation.

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Management of “unfavourable” carcinoma of unknown primary site: Synthesis of recent literature

Cited by 36 publications

References 53 publications

Identification and survival outcomes of a cohort of patients with cancer of unknown primary in Ontario, Canada

Identification and survival outcomes of a cohort of patients with cancer of unknown primary in Ontario, Canada

Cáncer metastásico con primario desconocido. Una revisión

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

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