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Using a gene expression test to guess where a cancer of unknown primary came from, and treating it as that cancer, did not help patients live longer than standard carboplatin and paclitaxel.
Japanese multicentre randomised phase 2 trial of 130 patients with cancer of unknown primary, assigned to site-specific chemotherapy chosen from a 2,000-gene expression tissue-of-origin assay or to empirical carboplatin plus paclitaxel.
One-year survival was 44.2 percent with site-specific treatment against 54.9 percent with empirical chemotherapy, and progression-free survival did not differ. The trial, like the earlier GEFCAPI 04 study, argued against routine tissue-of-origin testing to direct chemotherapy.
Predicting the primary site by gene expression and treating accordingly is not better than empirical chemotherapy, so guidelines do not recommend it; the field moved to genomic profiling for actionable targets instead.
Shares Cancer of unknown primary, favourable subsets, Cancer of unknown primary, unfavourable (adenocarcinoma and poorly differentiated carcinoma).
Shares Cancer of unknown primary, unfavourable (adenocarcinoma and poorly differentiated carcinoma), Paclitaxel / nab-paclitaxel, Carboplatin.
Shares Cancer of unknown primary, favourable subsets, Cancer of unknown primary, unfavourable (adenocarcinoma and poorly differentiated carcinoma).
Shares Cancer of unknown primary, favourable subsets, Cancer of unknown primary, unfavourable (adenocarcinoma and poorly differentiated carcinoma), Paclitaxel / nab-paclitaxel, Carboplatin.
Shares Cancer of unknown primary, unfavourable (adenocarcinoma and poorly differentiated carcinoma), Paclitaxel / nab-paclitaxel, Carboplatin.