When the primary site is not identified and when it does not fall neatly into certain specific clinical patterns, empiric broad-spectrum chemotherapy is recommended by NCCN and is generally acceptable. The issue remains second line chemotherapy. Erbitux is approved for squamous cell cacner of head and neck and is an attractive candidate for unknown primary. Unfortunately, these patients have a dismal prognosis despite management with a variety of chemotherapeutic combinations in small clinical studies. A recent meta-analysis showed no evidence of superior efficacy of any of the administered regimens incorporating platinum salts, taxanes or new generation cytotoxic compounds (gemcitabine, vinca alkaloids, irinotecan). Modest if any survival prolongation and symptom palliation with preservation of quality of life are the only realistic aims of therapy for these patients. Consequently, low-toxicity patient-convenient chemotherapy regimens should be administered to reasonably fit poor-risk patients. Currently neither ESMO nor NCCN recommend Erbitux even in first line. NCCN recommendations do nto include Erbitux(OCC-B, 1) and enitehr recommends second line chemotherapy.
N. Pavlidis1, E. Briasoulis, G. Pentheroudakis and On behalf of the ESMOCancers of unknown primary site: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
Ann Oncol (2010) 21 (suppl 5): v228-v231.
K. Hemminki et al, Power and limits of modern cancer diagnostics: cancer of unknown primary
Ann Oncol (2012) 23(3): 760-764
Greco, F. Anthony , Rodriguez, Gladys I. , Shaffer, Don W. , Hermann, Robert , Litchy, Sharlene , Yardley, Denise A. , Burris, Howard A., III , Morrissey, Lisa H. , Erland, Joan B. , Hainsworth, John D. Carcinoma of Unknown Primary Site: Sequential Treatment with Paclitaxel/Carboplatin/Etoposide and Gemcitabine/Irinotecan: A Minnie Pearl Cancer Research Network Phase II Trial Oncologist 2004 9: 644-652;
F. Anthony Greco et al, Carcinoma of Unknown Primary Site: Sequential Treatment with Paclitaxel/Carboplatin/Etoposide and Gemcitabine/Irinotecan: A Minnie Pearl Cancer Research Network Phase II Trial The Oncologist, Vol. 9, No. 6, 644-652, November 2004;
nccn.org, occult primary,2012
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