Net Guides: Carcinoma of Unknown Primary Orgin

Oncology Nursing NewsDecember 2010
Volume 4
Issue 6

Useful Online Resources and Clinical Trials for Carcinomas of Unknown Primary Origin


CUP Foundation

The Cancer of Unknown Primary (CUP) Foundation is a UK-based charity organization created to provide information and support to patients with CUP. The Website has 2 informational sections: “About CUP” and “Diagnosis and Treatment.” Patients can find information on basic cancer biology, a definition of CUP, cancer FAQs, what a primary is, a chart showing the typical steps of a patient’s battle with cancer, why the primary cannot be found, metastasis, and symptoms. The “Diagnosis and Treatment” pages explain general practitioner and hospital diagnoses, referrals, how patients can ask constructive questions and help doctors make the correct diagnosis, tests, disease classifications, and prognosis. Various treatments are described, such as chemotherapy, radiation therapy, hormone therapy, immunotherapy, and palliative/supportive care. For patients seeking support, the CUP Foundation offers a forum for people affected by CUP, a telephone service, and a section where patients and family members can post their stories.


Significance of serum tumor markers monitoring in carcinomas of unknown primary site

Journal: Vojnosanitetski Pregled

Authors: Pejcic´ I, Vrbic´ S, Filipovic´ S, et al

Purpose: The purpose of this study was to evaluate the prognostic and predictive value of 8 different serum tumor markers in patients with CUP. The study included 63 patients whose primary origin could not be determined using noninvasive methods. Histological findings were split into 3 classifications: planocellular carcinoma (8 patients), adenocarcinoma (33 patients), and unclassifiable carcinoma (22 patients). The 8 serum tumor markers evaluated in the study were: alpha-fetoproteins (AFP); chronic gonadotrophin beta submit, human (beta-HCG); neuron-specific enolase (NSE); marker of malignant ovarian tumors (CA 125); prostate-specific antigen (PSA); marker of malignant breast tumor (CA 15-3); marker of malignant pancreas tumor and gastrointestinal tumor (CA 19-9); and carcinoembryonic antigen (CEA). Thirty-two of the patients underwent chemotherapy and had the markers determined after the third and sixth chemocycles. Those who responded to chemotherapy had the markers determined every 3 months until relapse or disease progression.

Results: NSE values were the most commonly elevated (82.54%), while AFP values were the least commonly elevated (11.11%). Average tumor marker values for NSE and CA 125 were significantly lower after chemotherapy, with significantly better survival in cases of more than 20% decrease in NSE and CA 125. The authors concluded that increased serum tumor markers are common in CUP, and that the tumors show nonspecific overexpression of tumor markers. They also concluded that NSE and CA 125 values showed a correlation with response to chemotherapy; however, they noted that commonly used serum tumor markers seem to show no prognostic or predictive value.


Treatment based on molecular profiling diagnosis carcinoma of unknown primary site

Study Type: Interventional

Age/Sex Requirements: 18 years (None)

Sponsor: Sarah Cannon Research Institute Identifier: NCT00737243

Purpose: This nonrandomized phase II study is testing the 92-gene RT-PCR molecular profiling assay in identifying the primary site in patients with CUP. The assay will be performed on paraffin-embedded tumor tissue from a biopsy specimen. Patients who receive specific diagnoses from the assay will receive treatments that have proved effective for their respective diagnoses. Patients who do not receive specific diagnoses will be administered empiric chemotherapy with paclitaxel, carboplatin, bevacizumab, and erlotinib. The primary outcome measure of the study will be the utility of the 92-gene RT-PCR assay. The secondary measure will be the efficacy of treatments selected according to the assay’s diagnosis.

Carboplatin, paclitaxel, and everolimus in treating patients with previously untreated cancer of unknown primary

Study/Type: Interventional

Age/Sex Requirements: 18 years (None)

Sponsor: North Central Cancer Treatment Group

Purpose: This phase II, interventional, open-label study is examining the efficacy of treatment with carboplatin, paclitaxel, and everolimus in patients with previously untreated cancer of unknown primary. The primary outcome measure for this clinical trial is response rate. Secondary outcome measures for the study include time to progression, overall survival, duration of response, time to treatment failure, and adverse events as assessed by NCI CTCAE v 4.0. Patients will be administered carboplatin IV and paclitaxel IV on day 1, and oral everolimus once daily on days 1, 8, and 15 every

21 days until disease progression or unacceptable toxicity. Patient follow-up will occur every 3 months after treatment until disease progression, and then every 6 months for a maximum of 3 years. The study is taking place at 180 locations throughout the United States, and is being conducting in collaboration with the National Cancer Institute.

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