Unknown primary

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Unknown primary tumor may also be referred to as carcinoma of unknown primary site, cancer of unknown primary (CUP), occult primary, or unknown primary carcinoma.

14 regimens on this page
15 variants on this page

Contents


Guidelines

ESMO

NCCN

Adenocarcinoma or carcinoma NOS (not otherwise specified)

Bevacizumab & Erlotinib

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Regimen

Study Evidence
Hainsworth et al. 2007 Phase II

Chemotherapy

  • Bevacizumab (Avastin) 10 mg/kg IV once per day on days 1 & 15
    • Infusion time is 90 minutes for the first dose, then if tolerated, 60 minutes for the second dose, and 30 minutes for the third dose and later
  • Erlotinib (Tarceva) 150 mg PO on days 1 to 28, 1 hour before or 2 hours after meals

28-day cycles

References

  1. Hainsworth JD, Spigel DR, Farley C, Thompson DS, Shipley DL, Greco FA; Minnie Pearl Cancer Research Network. Phase II trial of bevacizumab and erlotinib in carcinomas of unknown primary site: the Minnie Pearl Cancer Research Network. J Clin Oncol. 2007 May 1;25(13):1747-52. link to original article contains verified protocol PubMed

Bleomycin, Cisplatin, Etoposide

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Regimen

Study Evidence
Hainsworth et al 1992 Phase II

Chemotherapy

21-day cycles

References

  1. Hainsworth JD, Johnson DH, Greco FA. Cisplatin-based combination chemotherapy in the treatment of poorly differentiated carcinoma and poorly differentiated adenocarcinoma of unknown primary site: results of a 12-year experience. J Clin Oncol. 1992 Jun;10(6):912-22. link to original article contains verified protocol PubMed

Carboplatin & Docetaxel

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Regimen #1

Study Evidence
Pentheroudakis et al. 2008 Phase II

Chemotherapy

Supportive medications

21-day cycle for up to 8 cycles

Regimen #2

Study Evidence
Greco et al. 2000 Phase II

Chemotherapy

Supportive medications

21-day cycle for 4 to 8 cycles

References

  1. Greco FA, Erland JB, Morrissey LH, Burris HA 3rd, Hermann RC, Steis R, Thompson D, Gray J, Hainsworth JD. Carcinoma of unknown primary site: phase II trials with docetaxel plus cisplatin or carboplatin. Ann Oncol. 2000 Feb;11(2):211 to 5. link to original article contains verified protocol PubMed
  2. Pentheroudakis G, Briasoulis E, Kalofonos HP, Fountzilas G, Economopoulos T, Samelis G, Koutras A, Karina M, Xiros N, Samantas E, Bamias A, Pavlidis N; Hellenic Cooperative Oncology Group. Docetaxel and carboplatin combination chemotherapy as outpatient palliative therapy in carcinoma of unknown primary: a multicentre Hellenic Cooperative Oncology Group phase II study. Acta Oncol. 2008;47(6):1148-55. link to original article contains verified protocol PubMed

Carboplatin, Gemcitabine, Paclitaxel

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Regimen

Study Evidence
Greco et al. 2002 Phase II

Chemotherapy

Supportive medications

21-day cycles

References

  1. Greco FA, Burris HA 3rd, Litchy S, Barton JH, Bradof JE, Richards P, Scullin DC Jr, Erland JB, Morrissey LH, Hainsworth JD. Gemcitabine, carboplatin, and paclitaxel for patients with carcinoma of unknown primary site: a Minnie Pearl Cancer Research Network study. J Clin Oncol. 2002 Mar 15;20(6):1651-6. link to original article contains verified protocol PubMed

Carboplatin & Paclitaxel

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Regimen

Study Evidence
Briasoulis et al. 2000 Phase II

Chemotherapy

Supportive medications

21-day cycle for 6 to 8 cycles

References

  1. Briasoulis E, Kalofonos H, Bafaloukos D, Samantas E, Fountzilas G, Xiros N, Skarlos D, Christodoulou C, Kosmidis P, Pavlidis N. Carboplatin plus paclitaxel in unknown primary carcinoma: a phase II Hellenic Cooperative Oncology Group Study. J Clin Oncol. 2000 Sep;18(17):3101-7. link to original article contains verified protocol PubMed

Cisplatin monotherapy

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Regimen

Study Evidence Comparator Efficacy
Gross-Goupil et al. 2012 (GEFCAPI 02) Randomized Phase II Cisplatin & Gemcitabine Seems not superior

Chemotherapy

21-day cycles

References

  1. Gross-Goupil M, Fourcade A, Blot E, Penel N, Négrier S, Culine S, Chaigneau L, Lesimple T, Priou F, Lortholary A, Kaminsky MC, Provencal J, Voog E, Bouzy J, Laplanche A, Fizazi K. Cisplatin alone or combined with gemcitabine in carcinomas of unknown primary: results of the randomised GEFCAPI 02 trial. Eur J Cancer. 2012 Mar;48(5):721-7. Epub 2012 Feb 6. link to original article contains verified protocol PubMed

Cisplatin & Docetaxel

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Regimen

Study Evidence
Greco et al. 2000 Phase II

Chemotherapy

Supportive medications

21-day cycle for up to 8 cycles

References

  1. Greco FA, Erland JB, Morrissey LH, Burris HA 3rd, Hermann RC, Steis R, Thompson D, Gray J, Hainsworth JD. Carcinoma of unknown primary site: phase II trials with docetaxel plus cisplatin or carboplatin. Ann Oncol. 2000 Feb;11(2):211 to 5. link to original article contains verified protocol PubMed

Cisplatin & Gemcitabine

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Regimen

Study Evidence Comparator Efficacy
Culine et al. 2003 (GEFCAPI 01) Randomized Phase II Cisplatin & Irinotecan Not reported
Gross-Goupil et al. 2012 (GEFCAPI 02) Randomized Phase II Cisplatin Seems not superior

Chemotherapy

21-day cycles

References

  1. Culine S, Lortholary A, Voigt JJ, Bugat R, Théodore C, Priou F, Kaminsky MC, Lesimple T, Pivot X, Coudert B, Douillard JY, Merrouche Y, Allouache J, Goupil A, Négrier S, Viala J, Petrow P, Bouzy J, Laplanche A, Fizazi K; Trial for the French Study Group on Carcinomas of Unknown Primary (GEFCAPI 01). Cisplatin in combination with either gemcitabine or irinotecan in carcinomas of unknown primary site: results of a randomized phase II study--trial for the French Study Group on Carcinomas of Unknown Primary (GEFCAPI 01). J Clin Oncol. 2003 Sep 15;21(18):3479-82. link to original article contains verified protocol PubMed content property of HemOnc.org
  2. Gross-Goupil M, Fourcade A, Blot E, Penel N, Négrier S, Culine S, Chaigneau L, Lesimple T, Priou F, Lortholary A, Kaminsky MC, Provencal J, Voog E, Bouzy J, Laplanche A, Fizazi K. Cisplatin alone or combined with gemcitabine in carcinomas of unknown primary: results of the randomised GEFCAPI 02 trial. Eur J Cancer. 2012 Mar;48(5):721-7. Epub 2012 Feb 6. link to original article contains verified protocol PubMed

Cisplatin & Irinotecan

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Regimen

Study Evidence Comparator Efficacy
Culine et al. 2003 (GEFCAPI 01) Randomized Phase II Cisplatin & Gemcitabine Not reported

Chemotherapy

21-day cycles

References

  1. Culine S, Lortholary A, Voigt JJ, Bugat R, Théodore C, Priou F, Kaminsky MC, Lesimple T, Pivot X, Coudert B, Douillard JY, Merrouche Y, Allouache J, Goupil A, Négrier S, Viala J, Petrow P, Bouzy J, Laplanche A, Fizazi K; Trial for the French Study Group on Carcinomas of Unknown Primary (GEFCAPI 01). Cisplatin in combination with either gemcitabine or irinotecan in carcinomas of unknown primary site: results of a randomized phase II study--trial for the French Study Group on Carcinomas of Unknown Primary (GEFCAPI 01). J Clin Oncol. 2003 Sep 15;21(18):3479-82. link to original article contains verified protocol PubMed

Docetaxel & Gemcitabine

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Regimen

Study Evidence
Pouessel et al. 2004 Phase II

Chemotherapy

Supportive medications

21-day cycle for up to 6 cycles

References

  1. Pouessel D, Culine S, Becht C, Ychou M, Romieu G, Fabbro M, Cupissol D, Pinguet F. Gemcitabine and docetaxel as front-line chemotherapy in patients with carcinoma of an unknown primary site. Cancer. 2004 Mar 15;100(6):1257-61. link to original article contains verified protocol PubMed

Gemcitabine & Irinotecan

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Regimen

Study Evidence Comparator Efficacy
Hainsworth et al. 2010 Phase III PCE Seems not superior

Chemotherapy

21-day cycle for up to 6 cycles

References

  1. Hainsworth JD, Spigel DR, Clark BL, Shipley D, Thompson DS, Farley C, West-Osterfield K, Lane CM, Cescon T, Bury MJ, Greco FA. Paclitaxel/carboplatin/etoposide versus gemcitabine/irinotecan in the first-line treatment of patients with carcinoma of unknown primary site: a randomized, phase III Sarah Cannon Oncology Research Consortium Trial. Cancer J. 2010 Jan-Feb;16(1):70-5. link to original article PubMed

PCE

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PCE: Paclitaxel, Carboplatin, Etoposide

Regimen

Study Evidence Comparator Efficacy
Greco et al. 2000 Phase II
Hainsworth et al. 2010 Phase III Gemcitabine & Irinotecan Seems not superior

Chemotherapy

Supportive medications

21-day cycle for 4 to 8 cycles

References

  1. Greco FA, Burris HA 3rd, Erland JB, Gray JR, Kalman LA, Schreeder MT, Hainsworth JD. Carcinoma of unknown primary site. Cancer. 2000 Dec 15;89(12):2655-60. link to original article contains verified protocol PubMed
  2. Hainsworth JD, Spigel DR, Clark BL, Shipley D, Thompson DS, Farley C, West-Osterfield K, Lane CM, Cescon T, Bury MJ, Greco FA. Paclitaxel/carboplatin/etoposide versus gemcitabine/irinotecan in the first-line treatment of patients with carcinoma of unknown primary site: a randomized, phase III Sarah Cannon Oncology Research Consortium Trial. Cancer J. 2010 Jan-Feb;16(1):70-5. link to original article PubMed

Squamous cell carcinoma

Cisplatin, Docetaxel, Fluorouracil

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Regimen

The NCCN, Occult Primary version 1.2012 lists this as a suitable regimen in this setting. The Pointreau et al. 2009 regimen was for larynx and hypopharynx cancer, and the regimen also involved chemoradiation +/- surgery.

Chemotherapy

Supportive medications

21-day cycle for 3 cycles

References

  1. Pointreau Y, Garaud P, Chapet S, Sire C, Tuchais C, Tortochaux J, Faivre S, Guerrif S, Alfonsi M, Calais G. Randomized trial of induction chemotherapy with cisplatin and 5-fluorouracil with or without docetaxel for larynx preservation. J Natl Cancer Inst. 2009 Apr 1;101(7):498-506. Epub 2009 Mar 24. link to original article contains verified protocol--see comment above PubMed

Cisplatin, Fluorouracil, Paclitaxel

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Regimen

Note: The NCCN, Occult Primary version 1.2012 lists this as a suitable regimen in this setting. The Hitt et al. 2005 regimen was for head and neck cancer, and the regimen also involved chemoradiation.

Chemotherapy

Supportive medications

21-day cycle for 3 cycles

References

  1. Hitt R, López-Pousa A, Martínez-Trufero J, Escrig V, Carles J, Rizo A, Isla D, Vega ME, Martí JL, Lobo F, Pastor P, Valentí V, Belón J, Sánchez MA, Chaib C, Pallarés C, Antón A, Cervantes A, Paz-Ares L, Cortés-Funes H. Phase III study comparing cisplatin plus fluorouracil to paclitaxel, cisplatin, and fluorouracil induction chemotherapy followed by chemoradiotherapy in locally advanced head and neck cancer. J Clin Oncol. 2005 Dec 1;23(34):8636-45. Epub 2005 Nov 7. link to original article contains verified protocol--see comment above PubMed

Neuroendocrine tumors