Multicenter phase-II trial of irinotecan plus oxaliplatin [IROX regimen] in patients with poor-prognosis cancer of unknown primary: a hellenic cooperative oncology group study

Briasoulis, Evangelos; Fountzilas, George; Bamias, Aristotelis; Dimopoulos, Meletios Α.; Xiros, N.; Aravantinos, G.; Samantas, E.; Kalofonos, Haralabos P.; Makatsoris, Thomas; Mylonakis, N.; Papakostas, Pavlos; Skarlos, Dimosthenis; Varthalitis, Ioannis; Pavlidis, Nicholas

doi:10.1007/s00280-007-0604-7

Cited by 24 publications

(17 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2012

View full text Add to dashboard Cite

Background:Although chemotherapeutic regimens containing a taxane or platinum agent have been widely recommended for unfavourable carcinoma of unknown primary (CUP), no evidence exists for the superiority of any administered regimens. To date, the efficacy has been mostly assessed in the limited setting of phase II trials, and few attempts have been made to synthesise all available data for survival outcomes.Methods:Electronic databases were searched from 1980 to 2011. Survival results were combined for each pre-specified category of regimens using a random-effects model, and meta-regression models were used to adjust for heterogeneity in some known prognostic factors.Results:A total of 32 studies were included for meta-analysis. Tendency towards better survival outcome by platinums or taxanes was indicated. After adjustment for important prognostic factors, however, the difference between the platinum-based and non-platinum regimens became no longer significant. Survival benefits by the taxane-based regimens remained significant, with a prolonged median survival time of 1.52 months (P=0.03) and a higher 1-year survival rate of 6.25% (P=0.05), but the benefit did not sustain for 2 years.Conclusion:Although no effective therapies have been established, this meta-analysis helps to fill an important gap of evidence. However, caution should still be taken because of the potential unmeasured confounding.

show abstract

Section: Resultsmentioning

confidence: 99%

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

et al. 2012

View full text Add to dashboard Cite

show abstract

“…This is also reflected in the latest NCCN recommendations that list 11 polychemotherapy regimens for adenocarcinoma histology, most of which include a platinum agent, and nine platinum-containing regimens for squamous histology (11). The vast majority of these regimens, which frequently contain taxanes, gemcitabine and irinotecan, are based on results from single-arm, phase II data to support their use in CUP at best (23)(24)(25). Additionally, data from randomized studies are scarce and mostly come from small trials providing suggestions rather than clear guidance regarding preferred regimens (26)(27)(28).…”

Section: Current Therapeutic Management Of Cupmentioning

confidence: 99%

“Metastatic Cancer of Unknown Primary” or “Primary Metastatic Cancer”?

et al. 2020

View full text Add to dashboard Cite

Cancer of unknown primary (CUP) is an umbrella term used to classify a heterogeneous group of metastatic cancers based on the absence of an identifiable primary tumor. Clinically, CUPs are characterized by a set of distinct features comprising early metastatic dissemination in an atypical pattern, an aggressive clinical course, poor response to empiric chemotherapy and, consequently, a short life expectancy. Two opposing strategies to change the dismal prognosis for the better are pursued. On the one hand, following the traditional tissue-gnostic approach, more and more sophisticated tissue-of-origin (TOO) classifier assays are employed to push identification of the putative primary to its limits with the clear intent of allowing tumor-site specific treatment. However, robust evidence supporting its routine clinical use is still lacking, notably with two recent randomized clinical trials failing to show a patient benefit of TOO-prediction based site-specific treatment over empiric chemotherapy in CUP. On the other hand, with regards to a tissue-agnostic strategy, precision medicine approaches targeting actionable genomic alterations have already transformed the treatment for many known tumor types. Yet, an unmet need remains for well-designed clinical trials to scrutinize its potential role in CUP beyond anecdotal case reports. In the absence of practice changing results, we believe that the emphasis on finding the presumed unknown primary tumor at all costs, implicit in the term CUP, has biased recent research in the field. Focusing on the distinct clinical features shared by all CUPs, we advocate adopting the term primary metastatic cancer (PMC) to denominate a distinct cancer entity instead. In our view, PMC should be considered the archetype of metastatic disease and as such, despite accounting for a mere 2-3% of malignancies, unraveling the mechanisms at play goes beyond improving the prognosis of patients with PMC and promises to greatly enhance our understanding of the metastatic process and carcinogenesis across all cancer types.

show abstract

“…Surgical treatment with radical regional lymph node dissection remains the mainstay of indicated therapy. Although some successful results of phaseII trials using platinum-based or paclitaxel-based chemotherapy have been reported [5,[15][16][17], neither of these chemotherapies has been recommended as a useful adjuvant therapy following surgical extirpation.…”

Section: Discussionmentioning

confidence: 99%

“…A group classified as poorly differentiated neuroendocrine carcinoma (PDNEC) accompanied by metastases has been especially associated with poor prognosis even if treated with intensive systemic chemotherapy [1][2][3][4][5]. In this tumor group, neuroendocrine features are identified by immunohistochemical staining for chromogranin-A and/or synaptophysin.…”

Section: Introductionmentioning

confidence: 99%

A case of long-term recurrence-free poorly differentiated neuroendocrine carcinoma of lymph nodes treated by surgical resection without any chemotherapy

et al. 2010

View full text Add to dashboard Cite

A 77-year-old man presented with a 2-month history of an enlarged right inguinal lymph node. Diagnostic excisional biopsy of the inguinal lymph node proved it to be a poorly differentiated neuroendocrine carcinoma by histological and immunohistological analyses. We diagnosed a poorly differentiated neuroendocrine carcinoma by histological examination and immunohistological analysis of the resected inguinal lymph node. We performed computed tomographic examination and positron emission tomography, which identified lymph node involvement without any signs of other tumors. Because these tumors had grown expandingly and had been encapsulated locally, we performed an operation to dissect all of the involved lymph nodes. Direct invasion to the right external iliac artery was not detected, and two of the enlarged lymph nodes were successfully resected without any complications. Pathologically, the resected specimen was diagnosed as a neuroendocrine carcinoma with a negative surgical margin and it was similar to the histology of the inguinal lymph node previously resected. The patient had no recurrence for 3 years without receiving any adjuvant treatment. There have been no reports describing a case of poorly differentiated neuroendocrine carcinoma, of unknown origin, which metastasized to other lymph nodes. Although further studies are required, complete resection of the involved lymph nodes should be considered as a choice for localized, expanding growth-pattern disease even if it is undifferentiated type.

show abstract

Multicenter phase-II trial of irinotecan plus oxaliplatin [IROX regimen] in patients with poor-prognosis cancer of unknown primary: a hellenic cooperative oncology group study

Cited by 24 publications

References 36 publications

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

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

“Metastatic Cancer of Unknown Primary” or “Primary Metastatic Cancer”?

A case of long-term recurrence-free poorly differentiated neuroendocrine carcinoma of lymph nodes treated by surgical resection without any chemotherapy

Contact Info

Product

Resources

About