Cancer of unknown primary origin medical therapy: Difference between revisions

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__NOTOC__
__NOTOC__
{{Cancer of unknown primary origin}}
{{Cancer of unknown primary origin}}
{{CMG}}; {{AE}}
{{CMG}}; {{AE}}; {{RAK}}


==Overview==
==Overview==
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
There is no treatment for cancer of unknown primary origin; the mainstay of [[therapy]] is supportive care. Medical therapy for cancer of unknown primary origin should be adjusted on an individual basis and according to well-defined [[Clinical|clinicopathologic]] subsets.
 
OR
 
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
 
OR
 
The majority of cases of [disease name] are self-limited and require only supportive care.
 
OR
 
[Disease name] is a medical emergency and requires prompt treatment.
 
OR
 
The mainstay of treatment for [disease name] is [therapy].
 
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR
 
[Therapy] is recommended among all patients who develop [disease name].
 
OR
 
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
 
OR
 
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
 
OR
 
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
 
OR
 
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].


==Medical Therapy==
==Medical Therapy==
 
*There is no [[Therapy|treatment]] for cancer of unknown primary origin; the mainstay of therapy is supportive care.<ref name="pmid15888766">{{cite journal |vauthors=Briasoulis E, Tolis C, Bergh J, Pavlidis N |title=ESMO Minimum Clinical Recommendations for diagnosis, treatment and follow-up of cancers of unknown primary site (CUP) |journal=Ann. Oncol. |volume=16 Suppl 1 |issue= |pages=i75–6 |year=2005 |pmid=15888766 |doi=10.1093/annonc/mdi804 |url=}}</ref>
=== Medical Therapy ===
*The treatment for cancer of unknown primary origin will depend on several factors, such as [[metastatic]] origin, [[biopsy]] findings, [[Age|patients age]], and [[performance status]].
*There is no treatment for cancer of unknown primary origin; the mainstay of therapy is supportive care.<ref name="pmid15888766">{{cite journal |vauthors=Briasoulis E, Tolis C, Bergh J, Pavlidis N |title=ESMO Minimum Clinical Recommendations for diagnosis, treatment and follow-up of cancers of unknown primary site (CUP) |journal=Ann. Oncol. |volume=16 Suppl 1 |issue= |pages=i75–6 |year=2005 |pmid=15888766 |doi=10.1093/annonc/mdi804 |url=}}</ref>
*Medical therapy for cancer of unknown primary origin should be adjusted on an individual basis and according to well-defined [[Clinical|clinicopathologic]] subsets.<ref name="pmid15888766">{{cite journal |vauthors=Briasoulis E, Tolis C, Bergh J, Pavlidis N |title=ESMO Minimum Clinical Recommendations for diagnosis, treatment and follow-up of cancers of unknown primary site (CUP) |journal=Ann. Oncol. |volume=16 Suppl 1 |issue= |pages=i75–6 |year=2005 |pmid=15888766 |doi=10.1093/annonc/mdi804 |url=}}</ref>
*The treatment for cancer of unknown primary origin will depend on several factors, such as [[metastatic]] origin, [[biopsy]] findings, patients age, and performance status.
*The table below summarizes different types of medical therapy strategies for cancer of unknown primary origin according to the European Society of Medical Oncology:<ref name="pmid26314775">{{cite journal| author=Fizazi K, Greco FA, Pavlidis N, Daugaard G, Oien K, Pentheroudakis G et al.| title=Cancers of unknown primary site: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. | journal=Ann Oncol | year= 2015 | volume= 26 Suppl 5 | issue=  | pages= v133-8 | pmid=26314775 | doi=10.1093/annonc/mdv305 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26314775  }} </ref>
*Medical therapy for cancer of unknown primary origin should be adjusted on an individual basis and according to well-defined clinicopathologic subsets.<ref name="pmid15888766">{{cite journal |vauthors=Briasoulis E, Tolis C, Bergh J, Pavlidis N |title=ESMO Minimum Clinical Recommendations for diagnosis, treatment and follow-up of cancers of unknown primary site (CUP) |journal=Ann. Oncol. |volume=16 Suppl 1 |issue= |pages=i75–6 |year=2005 |pmid=15888766 |doi=10.1093/annonc/mdi804 |url=}}</ref>
*The table below summarizes different types of medical therapy strategies for cancer of unknown primary origin.


{| class="wikitable"
{| class="wikitable"
! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |''' Treatment for cancer of unknown primary origin'''<br>
! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |''' Treatment for cancer of unknown primary origin'''<br>
<SMALL> Adapted from the European Society of Medical Oncology<ref name="pmid15888766">{{cite journal |vauthors=Briasoulis E, Tolis C, Bergh J, Pavlidis N |title=ESMO Minimum Clinical Recommendations for diagnosis, treatment and follow-up of cancers of unknown primary site (CUP) |journal=Ann. Oncol. |volume=16 Suppl 1 |issue= |pages=i75–6 |year=2005 |pmid=15888766 |doi=10.1093/annonc/mdi804 |url=}}</ref></SMALL>
<SMALL> Adapted from the European Society of Medical Oncology<ref name="pmid26314775">{{cite journal| author=Fizazi K, Greco FA, Pavlidis N, Daugaard G, Oien K, Pentheroudakis G et al.| title=Cancers of unknown primary site: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. | journal=Ann Oncol | year= 2015 | volume= 26 Suppl 5 | issue= | pages= v133-8 | pmid=26314775 | doi=10.1093/annonc/mdv305 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26314775  }} </ref></SMALL>
|-
|-
| style="background:#DCDCDC;" align="center" | '''Sub-type'''
| style="background:#DCDCDC;" align="center" | '''Sub-type'''
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|-
|-
|
|
Poorly differentiated [[carcinoma]], predominately [[Lymphadenopathy|nodal disease]]
Poorly differentiated [[Neuroendocrine tumors|neuroendocrine carcinomas]] of an unknown primary
|  
|  
Platinum based combination chemotherapy
[[Platinum]] + [[etoposide]] combination [[chemotherapy]]
|-
|-
|  
|  
[[Peritoneal carcinomatosis]] in female
Well-differentiated [[Neuroendocrine tumors|neuroendocrine tumour]] of unknown primary
|  
|  
Platinum based chemotherapy
[[Somatostatin]] analogues, [[streptozocin]] + [[5-fluorouracil]], [[sunitinib]], [[everolimus]]
|-
|-
|  
|  
Isolated [[Axillary lymph node|axillary nodal]] metastases in female
[[Peritoneal]] adenocarcinomatosis of a serous papillary histological type in females
|  
|  
Identical to breast cancer with similar nodal involvement
Optimal [[Surgery|surgical]] debulking followed by [[platinum]]–taxane-based chemotherapy
|-
|-
|  
|  
[[Squamous carcinoma]] of [[cervical lymph nodes]]
Isolated [[axillary]] nodal [[metastases]] in [[Female|females]]  
|  
|  
Irradiation for N1-N2 disease.<br>For higher stages induction chemotherapy with platinum-based combination is suggested
[[Axillary]] nodal [[dissection]], [[mastectomy]] or [[breast]] irradiation and adjuvant chemohormonotherapy
|-
|-
|
|
Liver, bone, or multiple-site metastases of [[adenocarcinoma]]
[[Squamous cell carcinoma]] involving non-supraclavicular cervical [[lymph nodes]]
|  
|  
Low toxicity chemotherapy of palliative orientation or best supportive care are acceptable
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]]
|}
|}
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
===Disease Name===
* '''1 Stage 1 - Name of stage'''
** 1.1 '''Specific Organ system involved 1'''
*** 1.1.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' 
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
*** 1.1.2 '''Pediatric'''
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
****1.1.2.2 (Specific population e.g. '<nowiki/>'''''children < 8 years of age'''''')
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 1.2 '''Specific Organ system involved 2'''
*** 1.2.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 1.2.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
* 2 '''Stage 2 - Name of stage'''
** 2.1 '''Specific Organ system involved 1 '''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.1.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)


==References==
==References==

Latest revision as of 13:18, 21 October 2019

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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. Medical therapy for cancer of unknown primary origin should be adjusted on an individual basis and according to well-defined clinicopathologic subsets.

Medical Therapy

  • 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 according to the European Society of Medical Oncology:[2]
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

References

  1. ↑ 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.
  2. ↑ 2.0 2.1 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.

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