title: Management of "unfavourable" carcinoma of unknown primary site: synthesis of recent literature.
abstract: Carcinomas of unknown primary (CUP) approximately represent 2-3% of all adult cancers. Various clinicopathological subsets of CUP have been identified, which may be treated with tailored approaches. Nevertheless, 80% of CUP do not fall into these subsets. Even when at least 4 prognostic models have been developed and validated in independent patient cohorts, there is no consensus or reliable guidance for estimating the prognosis of these "unfavourable" CUP. Consequently, targeting patients who benefit from palliative chemotherapy is difficult. Thirty-eight phase II trials were published between 1997 and 2011; a systematic analysis of these trials did not allow the recommendation of any of the tested regimens as a standard of care. Currently, there is only one published phase III clinical trial (Paclitaxel/carboplatin/etoposide versus gemcitabine/irinotecan); without significant difference between both regimens. Thus, with the promise of molecular profiling, we are waiting for a large collaborative clinical trial that validates the concept of targeted treatment in this population of patients with "unfavourable" CUP.
authors.affiliation: Department of medical oncology, Centre Oscar Lambret, 3 rue Combemale, 59020 Lille cedex, France.
authors.forename: Eric Yaovi
authors.initials: EY
authors.lastname: Amela
authors.forename: Géraldine
authors.initials: G
authors.lastname: Lauridant-Philippin
authors.forename: Sophie
authors.initials: S
authors.lastname: Cousin
authors.forename: Thomas
authors.initials: T
authors.lastname: Ryckewaert
authors.forename: Antoine
authors.initials: A
authors.lastname: Adenis
authors.forename: Nicolas
authors.initials: N
authors.lastname: Penel
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002277:Carcinoma / Q000175:diagnosis* / Q000188:drug therapy*; D017322:Clinical Trials, Phase II as Topic; D017326:Clinical Trials, Phase III as Topic; D006801:Humans; D058990:Molecular Targeted Therapy; D009382:Neoplasms, Unknown Primary / Q000175:diagnosis* / Q000188:drug therapy*; D011379:Prognosis
chemical_list: D000970:Antineoplastic Agents