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In the first large randomised trial in cancer of unknown primary, choosing a targeted drug or immunotherapy from the tumour's genomic profile after three cycles of chemotherapy held the disease back for longer than simply continuing chemotherapy.
International open-label randomised phase 2 trial in which 636 patients with newly diagnosed unfavourable cancer of unknown primary received three cycles of platinum-based chemotherapy; the 436 with disease control were randomised 3:1 to molecularly guided therapy chosen by a tumour board from comprehensive genomic profiling or to three further cycles of the same chemotherapy.
Median progression-free survival was 6.1 months with molecularly guided therapy against 4.4 months with chemotherapy (hazard ratio 0.72). Overall survival data were immature.
Comprehensive genomic profiling at diagnosis is now justified for unfavourable cancer of unknown primary, with a switch to a matched drug after induction chemotherapy when an actionable target is found.
Shares Cancer of unknown primary, unfavourable (adenocarcinoma and poorly differentiated carcinoma), Paclitaxel / nab-paclitaxel, Carboplatin.
Shares Gemcitabine + cisplatin, The Lancet.
Shares The Lancet, Carboplatin.
Shares The Lancet, Paclitaxel / nab-paclitaxel, Carboplatin.
Shares Gemcitabine + cisplatin, Carboplatin.
Shares The Lancet, Paclitaxel / nab-paclitaxel.
Shares Gemcitabine + cisplatin, Carboplatin.
Shares Gemcitabine + cisplatin, Carboplatin.