Skeletal Metastases of Unknown Primary: Biological Landscape and Clinical Overview

Abstract

Skeletal metastases of unknown primary (SMUP) represent a clinical challenge in dealing with patients diagnosed with bone metastases. Management of these patients has improved significantly in the past few years. however, it is fraught with a lack of evidence. While some patients have achieved impressive gains, a more systematic and tailored treatment is required. Nevertheless, in real-life practice, the outlook at the beginning of treatment for SMUP is decidedly somber. An incomplete translational relevance of pathological and clinical data on the mortality and morbidity rate has had unsatisfactory consequences for SMUP patients and their physicians. We examined several approaches to confront the available evidence; three key points emerged. The characterization of the SMUP biological profile is essential to driving clinical decisions by integrating genetic and molecular profiles into a multi-step diagnostic work-up. Nonetheless, a pragmatic investigation plan and therapy of SMUP cannot follow a single template; it must be adapted to different pathophysiological dynamics and coordinated with efforts of a systematic algorithm and high-quality data derived from statistically powered clinical trials. The discussion in this review points out that greater efforts are required to face the unmet needs present in SMUP patients in oncology.

Effect of Baseline Characteristics on Cabazitaxel Treatment Duration in Patients with Metastatic Castration-Resistant Prostate Cancer: A Post Hoc Analysis of the Compassionate Use/Expanded Access Programs and CAPRISTANA Registry

“…However, in another study (GEFCAPI 04), where gene expression analysis was used to identify the most likely primary tumor, the best available targeted therapy and other treatments tailored to the primary tumor failed to improve disease progression or survival compared with chemotherapy [32]. For cancers of unknown primary origin taxanes are recognized as a chemotherapeutic option, so cabazitaxel could be a useful treatment option to be studied in these patients that have resistance to docetaxel [33,34]. Furthermore, it has been shown that patients with some specific subtypes of prostate cancer, such as luminal B (classified using gene expression signatures) experience significant improvements in time to castration resistance and overall survival following treatment with docetaxel plus androgen deprivation therapy (ADT) [35].…”

Anticancer Effects of Cold Atmospheric Plasma in Canine Osteosarcoma Cells

“…Taking this into consideration, applying CAP to canine osteosarcoma as an adjuvant therapy would increase the efficacy of chemotherapy. For example, bisphosphonate is a bone-modifying agent which is used in treating human bone cancer, as it reduces skeletal complications by inhibiting bone resorption [ 38 ]. Thus, it would be worth trying the application of CAP with bisphosphonate therapy.…”

Hepatocellular Carcinoma: First Manifestation as Solitary Humeral Bone Metastasis

“…Incorporating genetic and molecular features in a multistage diagnostic workup is essential for characterizing the biological SMUP profile to direct therapeutic decisions. SMUP is a comprehensive diagnosis and treatment plan that must be adapted to different pathophysiological complexities [ 16 ].…”