Lay Summary: Metastatic cancers of unknown primary source can be treated with broad-spectrum chemotherapy.
Management of cancers of unknown origin is complex. 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. During the 1990s, several new antineoplastic agents with novel mechanisms of action have been introduced into clinical practice. Some of these agents, including the taxanes (paclitaxel, docetaxel), gemcitabine, vinorelbine, and the topoisomerase I inhibitors (irinotecan, topotecan) are active against a wide variety of solid tumors. Therefore, these drugs offer promise in the empiric treatment of carcinoma of unknown primary site. Newer agents, like sorafenib, bevacizumab, antineoplaston, CS-1008 (humanized anti-CD-5 antibody), BMS-690514, ZD1839, are currently being tested in various clinical trials. Combinations of older drugs like carboplatin with weekly paclitaxel, and gemcitabine combinations are recommended by NCCN in first line only.
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