scholarly journals Metastatic carcinoma of unknown primary with complete metabolic response following sorafenib-based chemotherapy

2019 ◽  
Vol 7 ◽  
pp. 2050313X1983873
Author(s):  
Pedro Luiz Serrano Usón Junior ◽  
Jairo Wagner ◽  
Marcus Vinicius de Nigro Corpa ◽  
Iracema Moraes Coelho ◽  
Robert A Nagourney ◽  
...  
Keyword(s):  
Cellular Response ◽  
Metabolic Response ◽  
Metastatic Carcinoma ◽  
Medical Attention ◽  
Unknown Primary ◽  
Complete Metabolic Response ◽  
Poorly Differentiated Adenocarcinoma ◽  
Genetic Profiling ◽  
Carcinoma Of Unknown Primary ◽  
Poorly Differentiated

Background: The treatment of carcinoma of unknown primary based on histopathology and immunohistochemistry is generally chemotherapy. The use of molecular markers, genetic profiling platforms, and personalized medicine is under active investigation. Case Report: We report the case of a 56-year-old patient who presented to medical attention with palpable axillary adenopathy. Biopsy confirmed poorly differentiated adenocarcinoma. Formal staging revealed extensive metastatic disease to bone and liver. Initial chemotherapy proved ineffective. We describe the diagnostic evaluation, treatment, and achievement of durable remission using a novel sorafenib-based drug combination that was chosen through the application of a functional analytic laboratory platform. Conclusion: The clinical management of patients with carcinoma of unknown primary continues to present a considerable challenge for practicing oncologists. Laboratory platforms capable of examining cellular response to injury, growth factor withdrawal, and cytotoxic insult at the level of cellular function may provide insights for drug selection in this patient population.

Overexpression of Her-2 in Patients With Poorly Differentiated Carcinoma or Poorly Differentiated Adenocarcinoma of Unknown Primary Site

2000 ◽  
Vol 18 (3) ◽  
pp. 632-632 ◽  
Author(s):  
John D. Hainsworth ◽  
Wayne J. Lennington ◽  
F. Anthony Greco
Keyword(s):  
Tumor Location ◽  
Primary Site ◽  
Immunohistochemical Method ◽  
Unknown Primary ◽  
Unknown Primary Site ◽  
Poorly Differentiated Adenocarcinoma ◽  
Carcinoma Of Unknown Primary ◽  
Poorly Differentiated Carcinoma ◽  
Poorly Differentiated ◽  
Her 2

PURPOSE: To determine the frequency of Her-2 overexpression in patients with poorly differentiated carcinoma or poorly differentiated adenocarcinoma of unknown primary site. PATIENTS AND METHODS: Tumor specimens from 100 patients with poorly differentiated carcinoma or poorly differentiated adenocarcinoma were stained for the Her-2 protein using the Dako immunohistochemical method. Clinical and pathologic characteristics of patients with and without Her-2 overexpression were compared. RESULTS: Staining for Her-2 overexpression was successful in 94 of 100 patients. Ten (11%) of 94 tumor specimens overexpressed Her-2. Eight of 10 overexpressors had poorly differentiated adenocarcinoma, and all overexpressors had predominant tumor location above the diaphragm, usually in the mediastinum or lungs. CONCLUSION: Her-2 overexpression occurs in a minority of patients with poorly differentiated carcinoma/adenocarcinoma of unknown primary site. Because most overexpressors had poorly differentiated adenocarcinoma, further evaluation of patients with adenocarcinoma of unknown primary site is necessary to determine the frequency of Her-2 overexpression in this common subgroup. Evaluation of the efficacy of trastuzumab in Her-2 overexpressors with carcinoma of unknown primary site is indicated.

scholarly journals Pineal Gland Metastasis From Poorly Differentiated Carcinoma of Unknown Primary Origin

2020 ◽  
Vol 11 ◽  
Author(s):  
Joshua A. Cuoco ◽  
Michael W. Kortz ◽  
Michael J. Benko ◽  
Robert W. Jarrett ◽  
Cara M. Rogers ◽  
...  
Keyword(s):  
Pineal Gland ◽  
Unknown Primary ◽  
Carcinoma Of Unknown Primary ◽  
Poorly Differentiated Carcinoma ◽  
Poorly Differentiated ◽  
Primary Origin ◽  
Unknown Primary Origin

Carcinoma of unknown primary site: treatment with 1-hour paclitaxel, carboplatin, and extended-schedule etoposide.

1997 ◽  
Vol 15 (6) ◽  
pp. 2385-2393 ◽  
Author(s):  
J D Hainsworth ◽  
J B Erland ◽  
L A Kalman ◽  
M T Schreeder ◽  
F A Greco
Keyword(s):  
Primary Tumor ◽  
Site Response ◽  
Response Rates ◽  
Unknown Primary ◽  
Tumor Site ◽  
Unknown Primary Tumor ◽  
Primary Tumor Site ◽  
Carcinoma Of Unknown Primary ◽  
Poorly Differentiated Neuroendocrine Carcinoma ◽  
Poorly Differentiated

PURPOSE To evaluate the efficacy and toxicity of a novel chemotherapy combination that includes paclitaxel, carboplatin, and extended-schedule etoposide in the treatment of patients with carcinoma of unknown primary tumor site. PATIENTS AND METHODS Fifty-five patients with carcinoma of unknown primary tumor site were treated with the following regimen, administered every 21 days: paclitaxel 200 mg/m2 by 1-hour intravenous (I.V.) infusion on day 1, carboplatin at an estimated area under the concentration-time curve (AUC) of 6.0 on day 1, and etoposide 50 mg alternated with 100 mg orally on days 1 through 10. Responding patients received a total of four courses of treatment. The following histologies were included: adenocarcinoma, 30 patients; poorly differentiated carcinoma (PDC) or poorly differentiated adenocarcinoma (PDA), 21; poorly differentiated neuroendocrine carcinoma, three; and squamous carcinoma, one. RESULTS Twenty-five of 53 assessable patients (47%; 95% confidence interval [CI], 33% to 61%) had major objective responses to treatment (seven complete responses). Response rates were similar in patients with adenocarcinoma versus PDC (45% and 48%, respectively). The actuarial median survival time for the entire group was 13.4 months. The regimen was well tolerated, with only seven hospitalizations for treatment of neutropenia and fever (4% of courses) and no treatment-related deaths. CONCLUSION The combination of paclitaxel, carboplatin, and extended-schedule etoposide is highly active and well tolerated in patients with carcinoma of unknown primary tumor site. Response rates and survival in this multicenter community-based trial compare favorably with all previously studied empiric regimens. In addition, this regimen is substantially less toxic and easier to administer than the cisplatin-based regimens previously used in this setting. If this level of efficacy is confirmed, this treatment should be considered standard first-line therapy in patients with carcinoma of unknown primary tumor site.

Poorly differentiated carcinoma and poorly differentiated adenocarcinoma of unknown origin: favorable subsets of patients with unknown-primary carcinoma?

1997 ◽  
Vol 15 (5) ◽  
pp. 2056-2066 ◽  
Author(s):  
R Lenzi ◽  
K R Hess ◽  
M C Abbruzzese ◽  
M N Raber ◽  
N G Ordoñez ◽  
...  
Keyword(s):  
Median Survival ◽  
Proportional Hazards ◽  
Primary Carcinoma ◽  
Unknown Primary ◽  
Entire Group ◽  
Poorly Differentiated Adenocarcinoma ◽  
Prognostic Features ◽  
Poorly Differentiated Carcinoma ◽  
Poorly Differentiated ◽  
Unknown Primary Carcinoma

PURPOSE The objectives of this study were to assess clinical outcomes and prognostic factors in unselected, consecutive patients with poorly differentiated carcinoma (PDC) or poorly differentiated adenocarcinoma (PDA). PATIENTS AND METHODS The 1,400 patients analyzed were referred to our unknown-primary tumor (UPT) clinic from January 1, 1987 through July 31, 1994. Clinical data from these patients were entered into a computerized data base for storage, retrieval, and analysis. Survival was measured from the time of diagnosis; survival distribution was estimated using the product-limit method. Multivariate survival analyses were performed using proportional hazards regression and by recursive partitioning. RESULTS Nine hundred seventy-seven patients were diagnosed with unknown-primary carcinoma (UPC) and 337 of these patients had PDC or PDA. No clinical differences were identified among patients with PDC, PDA, or UPC patients with other carcinoma or adenocarcinoma subtypes. PDC patients enjoyed better survival than PDA patients. Poor cellular differentiation was not an important prognostic variable. Variables predictive of survival included lymph node metastases, sex, number of metastatic sites, histology (PDC v PDA), and age. Although chemotherapy did not appear to influence survival for the entire group of PDC or PDA patients, a subset of patients with good prognostic features experienced median survival durations of up to 40 months. CONCLUSION The long median survival and chemotherapy responsiveness of UPC patients with PDC and PDA could not be confirmed. However, subpopulations with prolonged median survival durations could be defined, and the value of chemotherapy in this group remains to be determined. Identification and exclusion of treatable or slow-growing malignancies may account for the poor survival of the PDC and PDA patients reported in this study.

A quantitative reverse transcriptase polymerase chain reaction assay to identify metastatic carcinoma tissue of origin

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 20024-20024
Author(s):  
D. Talantov ◽  
J. Baden ◽  
T. Jatkoe ◽  
J. Yu ◽  
D. Atkins ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Reverse Transcriptase ◽  
Primary Tumor ◽  
Metastatic Carcinoma ◽  
Unknown Primary ◽  
Chain Reaction ◽  
Gene Markers ◽  
Carcinoma Of Unknown Primary ◽  
Polymerase Chain ◽  
Tissue Of Origin

20024 Background: Carcinoma of unknown primary (CUP) wherein metastatic disease presents without an identifiable primary tumor site represents approximately 3–5% of all cancers. Identifying the origin of the primary tumor in patients with CUP can enable rational choice of therapeutic regimens. We developed an optimized set of ten gene markers for a quantitative reverse transcriptase polymerase chain reaction (qRTPCR) assay, and demonstrated high accuracy in predicting the tissue of origin when used on with formalin-fixed, paraffin-embedded (FFPE) metastatic carcinoma samples. Methods: Twenty-three putative tissue-specific markers for lung, colon, pancreas, breast, prostate and ovarian carcinomas were nominated by querying a gene expression profile database and by performing a literature search. Ten of these marker candidates were then selected based on validation by qRTPCR on 205 FFPE metastatic carcinomas of known tissue origin. Next, we optimized the RNA isolation and qRTPCR methods for these ten markers, and tested the qRTPCR assay on two sets of FFPE metastatic tumors. Results: We applied the 10-gene qRTPCR assay to a set of 260 metastatic tumors of known origin, generating an overall accuracy of 78%. Furthermore we tested an independent set of 48 metastatic samples, including thirty-seven samples where either the tissue of origin was known or which initially presented as CUP but were subsequently resolved. In these 48 samples, our assay demonstrated an accuracy of 76%. Conclusions: Our results suggested that optimized ten-gene markers qRTPCR assay reliably predicts tissue of origin of metastatic carcinomas in FFPE tissues. Such assay can significantly improve the rate of tissue of origin identification for carcinoma of unknown primary. [Table: see text]

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