title: [Structured diagnostics and therapy of the CUP syndrome].
abstract: BACKGROUND
  In the majority of cases, patients with cancer of unknown primary (CUP) have a poor prognosis with no prospect of being cured. Hence, a reasonable focus of diagnostics on its essential targets seems appropriate.
  
  
  METHODS
  Particularly important is the identification of all patients who can be assigned to subgroups with a favorable prognosis and who might benefit from a specific therapy. For all other patients, platinum-based combination therapy is the standard cytostatic therapy.
  
  
  METHODS
  In addition to platinum derivatives, taxanes, gemcitabine and irinotecan can also be used. Promising innovative approaches include targeted therapies, in particular bevacizumab and erlotinib, and identification of the tissue origin with micro-RNA or gene expression analyses which can help identify the most suitable organ-specific therapy for individual patients.
  
  
  CONCLUSIONS
  It would be desirable if the group of patients treated with unspecific therapy could be reduced by improved diagnostics so that these patients could be treated with organ-specific therapy or with molecularly targeted approaches. Micro-RNA and gene expression analyses appear to be interesting for this purpose. Another complementary approach is to improve the treatment results of patients receiving an unspecific standard combination therapy by additional administration of new targeted substances.
authors.affiliation: Klinische Kooperationseinheit Molekulare Hämatologie/Onkologie des Deutschen Krebsforschungszentrums und der Medizinischen Klinik V, Universität Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland.
authors.forename: H
authors.initials: H
authors.lastname: Löffler
authors.forename: K
authors.initials: K
authors.lastname: Neben
authors.forename: A
authors.initials: A
authors.lastname: Krämer
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000378:metabolism; D019091:Critical Pathways; D003952:Diagnostic Imaging / Q000379:methods*; D006801:Humans; D009382:Neoplasms, Unknown Primary / Q000175:diagnosis* / Q000378:metabolism / Q000628:therapy*; D010166:Palliative Care / Q000379:methods*; D013577:Syndrome
chemical_list: D000964:Antimetabolites, Antineoplastic; D014408:Biomarkers, Tumor