Metastatic Cancer With Unknown Primary Site Medication

  • Author: Winston W Tan, MD; Chief Editor: Jules E Harris, MD   more...
 
Updated: Jan 17, 2012
 

Medication Summary

The goals of pharmacotherapy are to induce remission, prevent complications, and reduce morbidity. See Medical Care.

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Antineoplastic Agents

Class Summary

These agents inhibit cell growth and differentiation.

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Paclitaxel (Abraxane, Taxol)

 

Mechanisms of action are tubulin polymerization and microtubule stabilization, which in turn inhibits mitosis and may result in breakage of chromosomes.

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Carboplatin (Paraplatin)

 

Analog of cisplatin. This is a heavy metal coordination complex that exerts its cytotoxic effect by platination of DNA, a mechanism analogous to alkylation, leading to interstrand and intrastrand DNA crosslinks and inhibition of DNA replication. Binds to protein and other compounds containing SH group. Cytotoxicity can occur at any stage of the cell cycle, but cell is most vulnerable to action of these drugs in G1 and S phase.

Has same efficacy as cisplatin but with better toxicity profile. Main advantages over cisplatin include less nephrotoxicity and ototoxicity not requiring extensive prehydration, less likely to induce nausea and vomiting, but more likely to induce myelotoxicity.

Dose is based on the following formula: total dose (mg) = (target AUC) x (GFR+25) where AUC (area under plasma concentration-time curve) is expressed in mg/mL/min and GFR (glomerular filtration rate) is expressed in mL/min.

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Contributor Information and Disclosures
Author

Winston W Tan, MD  Assistant Professor of Medicine, Mayo Medical School; Consulting Staff, Mayo Group Practices

Winston W Tan, MD is a member of the following medical societies: American College of Physicians, American Society of Clinical Oncology, American Society of Hematology, Philippine Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Surabhi Amar, MD  Fellow, Department of Internal Medicine, Division of Hematology/Oncology, Mayo Clinic Jacksonville

Surabhi Amar, MD is a member of the following medical societies: American Society of Hematology

Disclosure: Nothing to disclose.

Nasir Shahab, MD  Clinical Assistant Professor, Department of Internal Medicine, Division of Medical Oncology and Hematology, University of Missouri at Columbia

Nasir Shahab, MD is a member of the following medical societies: American College of Physicians and American Society of Hematology

Disclosure: Nothing to disclose.

Michael Perry, MD, MS, MACP  Nellie B Smith Chair of Oncology Emeritus, Director, Division of Hematology and Medical Oncology, Deputy Director, Ellis Fischel Cancer Center, University of Missouri-Columbia School of Medicine

Michael Perry, MD, MS, MACP is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society of Clinical Oncology, American Society of Hematology, International Association for the Study of Lung Cancer, and Missouri State Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert C Shepard, MD, FACP  Associate Professor of Medicine in Hematology and Oncology at University of North Carolina at Chapel Hill; Vice President of Scientific Affairs, Therapeutic Expertise, Oncology, at PRA International

Robert C Shepard, MD, FACP is a member of the following medical societies: American Association for Cancer Research, American College of Physician Executives, American College of Physicians, American Federation for Clinical Research, American Federation for Medical Research, American Medical Association, American Medical Informatics Association, American Society of Hematology, Association of Clinical Research Professionals, Eastern Cooperative Oncology Group, European Society for Medical Oncology, Massachusetts Medical Society, and Society for Biological Therapy

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Benjamin Movsas, MD  Vice-Chairman, Department of Radiation Oncology, Fox Chase Cancer Center

Benjamin Movsas, MD is a member of the following medical societies: American College of Radiology, American Radium Society, and American Society for Therapeutic Radiology and Oncology

Disclosure: Nothing to disclose.

Rajalaxmi McKenna, MD, FACP  Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems

Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis

Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD  Clinical Professor of Medicine, Section of Hematology/Oncology, University of Arizona College of Medicine, Arizona Cancer Center

Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research

Disclosure: GlobeImmune Salary Consulting

References

  1. American Cancer Society. Statistics for 2007. American Cancer Society Statistics. Available at http://www.cancer.org/Research/CancerFactsFigures/index. Accessed July 11, 2007.

  2. Copeland EM, McBride CM. Axillary metastases from unknown primary sites. Ann Surg. Jul 1973;178(1):25-7. [Medline].

  3. Merson M, Andreola S, Galimberti V, et al. Breast carcinoma presenting as axillary metastases without evidence of a primary tumor. Cancer. Jul 15 1992;70(2):504-8. [Medline].

  4. Davidson BJ, Spiro RH, Patel S, et al. Cervical metastases of occult origin: the impact of combined modality therapy. Am J Surg. Nov 1994;168(5):395-9. [Medline].

  5. Levine MN, Drummond MF, Labelle RJ. Cost-effectiveness in the diagnosis and treatment of carcinoma of unknown primary origin. CMAJ. Nov 15 1985;133(10):977-87. [Medline].

  6. Maisey MN, Ellam SV. Investigating the adenocarcinoma of unknown origin (ACUP): a cost benefit analysis. Rev Epidemiol Sante Publique. 1984;32(1):57-61. [Medline].

  7. Schapira DV, Jarrett AR. The need to consider survival, outcome, and expense when evaluating and treating patients with unknown primary carcinoma. Arch Intern Med. Oct 23 1995;155(19):2050-4. [Medline].

  8. Kole AC, Nieweg OE, Pruim J, et al. Detection of unknown occult primary tumors using positron emission tomography. Cancer. Mar 15 1998;82(6):1160-6. [Medline].

  9. Coassin M, Ebrahimi KB, O'Brien JM, Stewart JM. Optical coherence tomography for retinal metastasis with unknown primary tumor. Ophthalmic Surg Lasers Imaging. Dec 8 2011;42:e110-3. [Medline].

  10. Molina R, Bosch X, Auge JM, Filella X, Escudero JM, Molina V, et al. Utility of serum tumor markers as an aid in the differential diagnosis of patients with clinical suspicion of cancer and in patients with cancer of unknown primary site. Tumour Biol. Dec 9 2011;[Medline].

  11. Ariza A, Balañá C, Concha Á, Hitt R, Homet B, Matilla A, et al. Update on the diagnosis of cancer of unknown primary (CUP) origin. Clin Transl Oncol. Jul 2011;13(7):434-41. [Medline].

  12. Battifora H. Recent progress in the immunohistochemistry of solid tumors. Semin Diagn Pathol. Nov 1984;1(4):251-71. [Medline].

  13. Motzer RJ, Rodriguez E, Reuter VE, et al. Molecular and cytogenetic studies in the diagnosis of patients with poorly differentiated carcinomas of unknown primary site. J Clin Oncol. Jan 1995;13(1):274-82. [Medline].

  14. Feinmesser R, Miyazaki I, Cheung R, et a;. Diagnosis of nasopharyngeal carcinoma by DNA amplification of tissue obtained by fine-needle aspiration. N Engl J Med. Jan 2 1992;326(1):17-21. [Medline].

  15. Bosl GJ, Ilson DH, Rodriguez E, et al. Clinical relevance of the i(12p) marker chromosome in germ cell tumors. J Natl Cancer Inst. Mar 2 1994;86(5):349-55. [Medline].

  16. Sandberg AA, Meloni AM, Suijkerbuijk RF. Reviews of chromosome studies in urological tumors. III. Cytogenetics and genes in testicular tumors. J Urol. May 1996;155(5):1531-56. [Medline].

  17. Garrow GC, Greco FA, Hainsworth JD. Poorly differentiated neuroendocrine carcinoma of unknown primary tumor site. Semin Oncol. Jun 1993;20(3):287-91. [Medline].

  18. Hainsworth JD, Greco FA. Treatment of patients with cancer of an unknown primary site. N Engl J Med. Jul 22 1993;329(4):257-63. [Medline].

  19. Pavlidis N, Briasoulis E, Hainsworth J, et al. Diagnostic and therapeutic management of cancer of an unknown primary. Eur J Cancer. Sep 2003;39(14):1990-2005. [Medline].

  20. Moertel CG, Reitemeier RJ, Schutt AJ, et al. Treatment of the patient with adenocarcinoma of unknown origin. Cancer. Dec 1972;30(6):1469-72. [Medline].

  21. Righi PD, Sofferman RA. Screening unilateral tonsillectomy in the unknown primary. Laryngoscope. May 1995;105(5 Pt 1):548-50. [Medline].

  22. Guarischi A, Keane TJ, Elhakim T. Metastatic inguinal nodes from an unknown primary neoplasm. A review of 56 cases. Cancer. Feb 1 1987;59(3):572-7. [Medline].

  23. Mistry RC, Qureshi SS, Talole SD, et al. Cervical lymph node metastases of squamous cell carcinoma from an unknown primary: Outcomes and patterns of failure. Indian J Cancer. Apr-Jun 2008;45(2):54-8. [Medline].

  24. Hainsworth JD, Spigel DR, Farley C, et al. Phase II trial of bevacizumab and erlotinib in carcinomas of unknown primary site: the Minnie Pearl Cancer Research Network. J Clin Oncol. May 1 2007;25(13):1747-52. [Medline].

  25. Abbruzzese JL, Abbruzzese MC, Lenzi R, et al. Analysis of a diagnostic strategy for patients with suspected tumors of unknown origin. J Clin Oncol. Aug 1995;13(8):2094-103. [Medline].

  26. Altman E, Cadman E. An analysis of 1539 patients with cancer of unknown primary site. Cancer. Jan 1 1986;57(1):120-4. [Medline].

  27. Greco FA, Hainsworth JD. Cancer of unknown primary site. In: De Vita VT Jr, Hellman S, Rosenberg SA, eds. Cancer: Principles and Practice. 2005:2213-34.

  28. Hainsworth JD, Erland JB, Kalman LA, et al. Carcinoma of unknown primary site: treatment with 1-hour paclitaxel, carboplatin, and extended-schedule etoposide. J Clin Oncol. Jun 1997;15(6):2385-93. [Medline].

  29. Hainsworth JD, Johnson DH, Greco FA. Cisplatin-based combination chemotherapy in the treatment of poorly differentiated carcinoma and poorly differentiated adenocarcinoma of unknown primary site: results of a 12-year experience. J Clin Oncol. Jun 1992;10(6):912-22. [Medline].

  30. Hess KR, Abbruzzese MC, Lenzi R, et al. Classification and regression tree analysis of 1000 consecutive patients with unknown primary carcinoma. Clin Cancer Res. Nov 1999;5(11):3403-10. [Medline].

  31. Montero AJ, Varadhachary GR, Abbruzzese JL. Unknown Primary Carcinomas. In: Kantarjian HN, Koller CM, Wolff RA. MD Anderson Manual of Medical Oncology. McGraw Hill; 2006:937-954.

  32. Neumann KH, Nystrom JS. Metastatic cancer of unknown origin: nonsquamous cell type. Semin Oncol. Dec 1982;9(4):427-34. [Medline].

  33. Panagopoulos E, Murray D. Metastatic malignant melanoma of unknown primary origin: a study of 30 cases. J Surg Oncol. May 1983;23(1):8-10. [Medline].

  34. Pavlidis N, Fizazi K. Cancer of unknown primary (CUP). Crit Rev Oncol Hematol. Jun 2005;54(3):243-50. [Medline].

  35. Reintgen DS, McCarty KS, Woodard B, et al. Metastatic malignant melanoma with an unknown primary. Surg Gynecol Obstet. Mar 1983;156(3):335-40. [Medline].

  36. Ringenberg QS. Tumors of unknown origin. Med Pediatr Oncol. 1985;13(5):301-6. [Medline].

 
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