Management of Disseminated CUP Patients who present with liver, brain, and adrenal metastatic disease usually have a poor prognosis. Beside primary peritoneal carcinoma, carcinomatosis presenting as CUP in other settings is not uncommon. Gastric, appendicular, colon, pancreas, and cholangiocarcinoma are all possible primaries, and imaging, endoscopy, and pathologic data help in the evaluation. Traditionally, platinum-based combination chemotherapy regimens have been used to treat patients with CUP. In a phase II study by Hainsworth and colleagues, 55 mostly chemotherapy-naive patients were treated with paclitaxel, carboplatin, and oral etoposide every 3 weeks. The overall response rate was 47%, with median overall survival duration. | Chapter 095. Carcinoma of Unknown Primary Part 6 Management of Disseminated CUP Patients who present with liver brain and adrenal metastatic disease usually have a poor prognosis. Beside primary peritoneal carcinoma carcinomatosis presenting as CUP in other settings is not uncommon. Gastric appendicular colon pancreas and cholangiocarcinoma are all possible primaries and imaging endoscopy and pathologic data help in the evaluation. Traditionally platinum-based combination chemotherapy regimens have been used to treat patients with CUP. In a phase II study by Hainsworth and colleagues 55 mostly chemotherapy-naive patients were treated with paclitaxel carboplatin and oral etoposide every 3 weeks. The overall response rate was 47 with median overall survival duration of months. Briasoulis and colleagues reported similar response rates and survival durations in 77 patients with CUP who had been treated with paclitaxel and carboplatin. In this study patients with nodal or pleural disease and women with peritoneal carcinomatosis had higher response rates and overall survival durations of 13 and 15 months respectively. Studies incorporating newer agents including gemcitabine irinotecan and targeted agents are showing higher response rates. In a phase II randomized trial by Culine and colleagues 80 patients were randomly assigned to receive gemcitabine with cisplatin or irinotecan with cisplatin 78 patients were assessible for efficacy and toxicity. Objective responses were observed in 21 patients 55 in the gemcitabine and cisplatin arm and in 15 patients 38 in the irinotecan and cisplatin arm. The median survival was 8 months for gemcitabine and cisplatin and 6 months for irinotecan and cisplatin. The role of second-line chemotherapy in CUP is poorly defined. Gemcitabine as a single agent has shown a partial response rate of 8 and 25 of patients had minor responses or stable disease with improved symptoms. Combination chemotherapy as a second- and third-line .
