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Drug therapy of CUP

Chemotherapy as a treatment alternative is assessed based on the patient's age and general condition of health, as well as tumor histology and localization. Due to relatively low response rates and little effect on survival (if any), elderly patients and patients with poor general status should not be treated with chemotherapy. 

If there is indication for chemotherapy, platinum or taxane-containing duo combinations are often used. Second-line chemotherapy is generally not recommended.

 

Suggested treatment regimens for selected cancer types of unknown origin
Unknown origin types  Suggested treatment

Mild differentiated carcinosis,

mainly lymph node involvement

Platinum-based chemotherapy.
Peritoneal carcinosis in women

As for ovarian cancer FIGO III: platinum and taxane.

Isolated axillary metastasis in women As for breast cancer with equivalent lymph node affection including mastectomy or breast irradiation, lymph node dissection and adjuvant treatment.
Squamous cell carcinoma in neck glands

Radiation therapy for N1-N2 disease.

For more advanced disease, cisplatin-based induction therapy is recommended.
Sclerotic bone metastasis with raised PSA As for prostate cancer with endocrine therapy and possibly palliative bone irradiation.
Adenocarcinoma with colon cancer profile Combination therapy such as colon cancer therapy.
Neuroendocrine differentiation Poorly differentiated variants should be considered for treatment with platinum-containing drugs (such as PV), possibly a platinum/taxane combination. Well differentiated variants can be attempted to be treated with somatostatin analogs or interferon, or chemotherapy.
Mid-line distribution With suspicion of extragonadal germinal cell tumors, platinum-containing chemotherapy is recommended.
Liver, bone or multiple metastases from adenocarcinoma Mildly toxic palliative chemotherapy or supportive care alone are recommended.

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