Bone metastasis and poor performance status are prognostic factors for survival of carcinoma of unknown primary site in patients treated with systematic chemotherapy

PURPOSE We performed this study to identify prognostic factors in a subgroup of patients with carcinoma of unknown primary site treated with cisplatin combination chemotherapy. PATIENTS AND METHODS Seventy-nine patients with poorly differentiated adenocarcinoma or undifferentiated carcinoma of unknown primary site were treated on two consecutive phase II chemotherapy protocols. The first protocol consisted of treatment with 3-week courses of cisplatin, etoposide, and bleomycin (BEP). In the second protocol, cisplatin was administered weekly combined with oral administration of etoposide (DDP/VP). To identify prognostic factors, univariate and multivariate analyses were conducted. RESULTS In the univariate analysis, performance status, histology, liver or bone metastases, and serum levels of alkaline phosphatase and AST were significant variables to predict survival. In the multivariate analysis, performance status and alkaline phosphatase were the most important prognostic factors. CONCLUSION Good-prognosis patients had a performance score of 0 (World Health Organization [WHO]) and an alkaline phosphatase serum level less than 1.25 times the upper limit of normal (N). These patients had a median survival duration greater than 4 years. Intermediate-prognosis patients were characterized by either a WHO performance status < or = 1 or an alkaline phosphatase level > or = 1.25 N. These patients had a median survival duration of 10 months and a 4-year survival rate of only 15%. The poor-prognosis group had both a WHO performance status > or = 1 and an alkaline phosphatase level > or = 1.25 N. These patients had a median survival duration of only 4 months and none survived beyond 14 months. Treatment strategies for these three groups are discussed. It is suggested that this prognostic model be validated in other patients series.

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Evaluation of prognostic factors and the role of chemotherapy in unfavorable carcinoma of unknown primary site: a 10-year cohort study

BMC Research Notes ◽

10.1186/1756-0500-5-70 ◽

2012 ◽

Vol 5 (1) ◽

Cited By ~ 5

Author(s):

Kuo-Wei Chen ◽

Chia-Jen Liu ◽

Hsueh-Ju Lu ◽

Cheng-Hwai Tzeng ◽

Jin-Hwang Liu ◽

...

Keyword(s):

Cohort Study ◽

Prognostic Factors ◽

Primary Site ◽

Unknown Primary ◽

Unknown Primary Site ◽

Carcinoma Of Unknown Primary

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Evaluation of the prognostic benefit of identifying the probable primary site in cancer of unknown primary

Forum of Clinical Oncology ◽

10.1515/fco-2015-0015 ◽

2015 ◽

Vol 6 (3) ◽

pp. 22-28

Author(s):

Joyutpal Das ◽

Shahid Gilani

Keyword(s):

Median Survival ◽

Cox Regression ◽

Performance Status ◽

Disease Onset ◽

Significant Proportion ◽

Poor Performance ◽

Primary Site ◽

University Hospital ◽

Unknown Primary ◽

Poor Performance Status

Abstract With the development of site-specific cancer therapy, identifying the primary origin allows the oncologist to personalise therapy for patients with the cancer of unknown primaries (CUPs). At present, immunohistochemistry (IHC) screening is the standard method used to postulate the primary site in CUP. In this retrospective study, we evaluated the prognostic benefit of identifying the primary site in CUP. All 84 patients who presented with suspected CUP to the Royal Stoke University Hospital between 2011 and 2012 were included in our study. Forty-eight percent (40/84) of these patients were unable to undergo necessary investigations to identify primary sites because of poor performance status. IHC screening was able to postulate the primary site in 59% (26/44) of the remaining patients with confirmed CUP. Therefore, the primary site was not identified in a significant proportion of patients with CUP. The median survival of confirmed CUP with probable primary site was 2.0 months (95% confidence interval (CI): 1.2 to 2.9 months), whereas the median survival of confirmed CUP with no probable primary site was 4.1 months (95% CI: 1.5 to 9.7 months). This difference in survival time was statistically significant. In addition, using the Cox regression model, we found that patients with confirmed CUP with primary sites had prognostically unfavourable diseases with a shorter median survival, regardless of the age of disease onset, gender, sites of metastases or number of metastases. One approach to improve the survival would be to start systemic therapy at the earliest possible opportunity rather than waiting for all investigation results, such as IHC.

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Gemcitabine, Carboplatin, and Paclitaxel for Patients With Carcinoma of Unknown Primary Site: A Minnie Pearl Cancer Research Network Study

Journal of Clinical Oncology ◽

10.1200/jco.2002.20.6.1651 ◽

2002 ◽

Vol 20 (6) ◽

pp. 1651-1656 ◽

Cited By ~ 45

Author(s):

F. Anthony Greco ◽

Howard A. Burris ◽

Sharlene Litchy ◽

John H. Barton ◽

James E. Bradof ◽

...

Keyword(s):

Performance Status ◽

Primary Site ◽

Research Network ◽

Weekly Paclitaxel ◽

Unknown Primary ◽

Entire Group ◽

Unknown Primary Site ◽

Actuarial Survival ◽

Carcinoma Of Unknown Primary ◽

Prognostic Features

PURPOSE: To evaluate the efficacy and toxicity of the novel chemotherapy combination that includes gemcitabine, carboplatin, and paclitaxel in the treatment of patients with carcinoma of unknown primary site. PATIENTS AND METHODS: One hundred twenty patients were treated with the following regimen, administered every 21 days for a planned four courses: gemcitabine 1,000 mg/m2 intravenously (IV) on days 1 and 8, carboplatin at an estimated area under the concentration-time curve of 5 mg min/mL IV on day 1, and paclitaxel 200 mg/m2 IV on day 1. After four courses, stable and responding patients were given weekly paclitaxel 70 mg/m2 IV for 6 weeks for three 8-week courses. All patients had relatively poor prognostic features. Sixty-three patients had well-differentiated adenocarcinoma, 56 patients had poorly differentiated carcinoma, and 104 patients had performance status of 0 or 1. RESULTS: Twenty-eight (25%) of 113 assessable patients (95% confidence interval, 22% to 30%) had major objective responses to treatment. Response rates were similar in the two major histologic types. Response rate did not seem to be improved by continued therapy with weekly paclitaxel. The median progression-free survival time was 6 months. Median survival for the entire group was 9 months, and the actuarial survival at 1 and 2 years was 42% and 23%, respectively. CONCLUSION: Combination chemotherapy with gemcitabine, carboplatin, and paclitaxel followed by weekly paclitaxel is an active and tolerable treatment for patients with carcinoma of unknown primary site. The survival seen in this poor-prognosis group of patients in this multicenter community-based trial is notable and similar to other taxane-based regimens for these patients. Study of additional combinations or sequences of newer drugs, as well as the exploration of targeted biologic agents for patients with an identified target in their tumors, is warranted.

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Prognostic Factors in Recent Head and Neck Squamous Cell Carcinoma of Unknown Primary Site (HNSCCUP)

Otolaryngology ◽

10.1177/0194599813496044a136 ◽

2013 ◽

Vol 149 (2_suppl) ◽

pp. P187-P187

Author(s):

Kenya Kobayashi ◽

Go Omura ◽

Yuki Saito ◽

Yasuhiro Ebihara ◽

Takahiro Asakage ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Prognostic Factors ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

Primary Site ◽

Neck Squamous Cell Carcinoma ◽

Unknown Primary ◽

Unknown Primary Site ◽

Carcinoma Of Unknown Primary

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Feasibility and effectiveness of afatinib for poor performance status patients with EGFR-mutation-positive non-small-cell lung cancer: a retrospective cohort study

BMC Cancer ◽

10.1186/s12885-021-08587-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chiao-En Wu ◽

Ching-Fu Chang ◽

Chen-Yang Huang ◽

Cheng-Ta Yang ◽

Chih-Hsi Scott Kuo ◽

...

Keyword(s):

Lung Cancer ◽

Prognostic Factors ◽

Small Cell Lung Cancer ◽

Disease Control ◽

Performance Status ◽

Poor Performance ◽

Small Cell ◽

Poor Performance Status ◽

Small Cell Lung ◽

Nsclc Patients

Abstract Background Afatinib is one of the standard treatments for patients with epidermal growth factor receptor (EGFR)-mutated non-small-cell lung cancer (NSCLC). However, data on the use of afatinib in patients with poor performance status (PS ≥ 2) are limited. This study aimed to retrospectively review the clinical outcomes and safety of afatinib treatment in EGFR-mutation-positive (EGFRm+) NSCLC patients with PS ≥ 2. Methods The data for 62 patients who were treated at Linkou Chang Gung Memorial Hospital from January 2010 to August 2019 were retrospectively reviewed. Patients’ clinicopathological features were obtained, and univariate and multivariate analyses were performed to identify possible prognostic factors. Data on adverse events were collected to evaluate general tolerance for afatinib therapy. Results Until February 2020, the objective response rate, disease control rate, median progression-free survival (PFS), and overall survival (OS) were 58.1% (36/62), 69.4% (43/62), 8.8 months, and 12.9 months, respectively. The absence of liver metastasis (PFS: p = 0.044; OS: p = 0.061) and good disease control (p < 0.001 for PFS and OS) were independent favorable prognostic factors for PFS and OS. Bone metastasis (p = 0.036) and dose modification (reduction/interruption, p = 0.021) were predictors of disease control. Conclusion Afatinib demonstrated acceptable efficacy and safety in the current cohort. This study provided evidence to support the use of afatinib as a first-line treatment in EGFRm+ NSCLC patients with poor PS.

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