title: Management of adenocarcinoma of unknown primary with a 5-fluorouracil-cisplatin chemotherapy regimen (CFTam).
abstract: BACKGROUND
  Adenocarcinoma of unknown primary comprises up to 10% of metastatic malignant disease. With few exceptions this diagnosis carries a very poor prognosis of a few months with minimal survival advantage to chemotherapy. However there is the possibility that chemotherapy can improve symptom control and quality of life.
  
  
  METHODS
  Forty-four patients with adenocarcinoma of unknown primary received CFTam chemotherapy regimen (5-FU 750 mg/m2/day by protracted infusion for five days, cisplatin 60 mg/m2 once and tamoxifen 20 mg daily on a 21-day cycle). Disease response and toxicity were collected and survival compared to patients who were not treated or who received different chemotherapy regimens.
  
  
  RESULTS
  Overall response to CFTam was 27% with a median duration of 10 months (range 4-26 months). The chemotherapy was well tolerated with no grade 4 non-haematological toxicity and only three patients (7%) grade 4 neutropaenia with only two (5%) patients developing sepsis. There were no toxic deaths. Performance status was maintained or improved in responders.
  
  
  CONCLUSIONS
  CFTam is a well tolerated chemotherapy regimen with similar efficacy to other regimens described in the treatment of adenocarcinoma of unknown primary. In the absence of a significant survival advantage there is a need to conduct randomised trials of chemotherapy versus best supportive care to quantify any improvement in quality of life or symptom control.
authors.affiliation: Medical Oncology Department, St. George's Hospital, London, UK. wendy.streatfield@ccmail.stgh-tr.sthames.nhs.uk
authors.forename: F J
authors.initials: FJ
authors.lastname: Lofts
authors.forename: H
authors.initials: H
authors.lastname: Gogas
authors.forename: J L
authors.initials: JL
authors.lastname: Mansi
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D016001:Confidence Intervals; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D002945:Cisplatin; D005472:Fluorouracil