Cancer of unknown primary origin medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: ; Roukoz A. Karam, M.D.[2]

Overview

There is no treatment for cancer of unknown primary origin; the mainstay of therapy is supportive care.

There is no treatment for cancer of unknown primary origin; the mainstay of therapy is supportive care.^[1]
The treatment for cancer of unknown primary origin will depend on several factors, such as metastatic origin, biopsy findings, patients age, and performance status.
Medical therapy for cancer of unknown primary origin should be adjusted on an individual basis and according to well-defined clinicopathologic subsets.^[1]
The table below summarizes different types of medical therapy strategies for cancer of unknown primary origin.

Treatment for cancer of unknown primary origin Adapted from the European Society of Medical Oncology^[2]
Sub-type	Proposed treatment
Poorly differentiated neuroendocrine carcinomas of an unknown primary	Platinum + etoposide combination chemotherapy
Well-differentiated neuroendocrine tumour of unknown primary	Somatostatin analogues, streptozocin + 5-fluorouracil, sunitinib, everolimus
Peritoneal adenocarcinomatosis of a serous papillary histological type in females	Optimal surgical debulking followed by platinum–taxane-based chemotherapy
Isolated axillary nodal metastases in females	Axillary nodal dissection, mastectomy or breast irradiation and adjuvant chemohormonotherapy
Squamous cell carcinoma involving non-supraclavicular cervical lymph nodes	Neck dissection and/or irradiation of bilateral neck and head–neck axis. For advanced stages induction chemotherapy with platinum-based combination or chemoradiation
CUP with a colorectal immunohistochemistry (CK20+ CDX2+ CK7−) or molecular profile	Systemic treatment used for colorectal cancer
Single metastatic deposit from unknown primary	Resection and/or radiotherapy ± systemic therapy
Men with blastic bone metastases or immunohistochemistry/serum PSA expression	Androgen deprivation therapy ± radiotherapy

↑ ^1.0 ^1.1 Briasoulis E, Tolis C, Bergh J, Pavlidis N (2005). "ESMO Minimum Clinical Recommendations for diagnosis, treatment and follow-up of cancers of unknown primary site (CUP)". Ann. Oncol. 16 Suppl 1: i75–6. doi:10.1093/annonc/mdi804. PMID 15888766.
↑ Fizazi K, Greco FA, Pavlidis N, Daugaard G, Oien K, Pentheroudakis G; et al. (2015). "Cancers of unknown primary site: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up". Ann Oncol. 26 Suppl 5: v133–8. doi:10.1093/annonc/mdv305. PMID 26314775.