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

Abstract

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.

Integrated clinicomolecular characterization identifies RAS activation and CDKN2A deletion as independent adverse prognostic factors in cancer of unknown primary

“…The prognosis of CUP is extremely poor . Our dataset confirms the established conception of clinical risk factors in CUP.…”

“…These cases are classified as favorable-risk in the ESMO (European Society of Medical Oncology) guidelines. 4 The remaining 80-85% have a dismal overall prognosis with life expectancies in the range of 1 year [5][6][7][8][9][10] and are accordingly grouped as unfavorable-risk. 4 Deciphering the molecular profile holds particular promise in CUP.…”

Cancer of unknown primary: a population-based analysis of temporal change and socioeconomic disparities

“…This finding is in contrast to an Australian study where all histological types recorded an improvement over time (Luke et al , 2008) and to many other solid tumours, where improvements in survival have been recorded ((Edwards et al , 2010; Coleman et al , 2011). Likewise, recent reviews of CUP report the median survival as ranging from 8 to 12 months (Greco et al , 2012; Lee et al , 2013), which may be an overestimate of the true value in the general community. One of the strengths of using population-based data is the inclusion of those patients with the poorest prognosis who may not be referred to an academic centre or enrolled onto a clinical trial.…”

Molecular driver alterations and their clinical relevance in cancer of unknown primary site

“…The prognosis of the remaining majority of patients is dismal. The standard approach in these cases is to offer non-specific cytostatic therapy in palliative intention [2, 3, 6]. …”