Aims
Carcinoma of unknown primary (CUP) is a carcinoma diagnosed at a metastatic site where, after appropriate investigation, the primary site cannot be found. It is a disease with a poor prognosis where historically treatment options are limited and palliative. There is little recent published data on how patients are treated in routine practice in Victoria, Australia. The aim of this study was to perform a review of patterns of care for CUP in regional Victoria.
Methods
The Evaluation of Cancer Outcomes (ECO) Registry records clinical and treatment information on all newly diagnosed cancer patients in the Barwon South West Region (BSWR) of Victoria encompassing approximately 380,000 people. This study analysed patterns of care and outcomes for all CUP patients (as defined by the treating clinician) diagnosed in the BSWR from 2009-2017.
Results
There were 442 patients diagnosed with CUP during the 9 year period, with a median age of 77 (range 16-98). The most common histological diagnosis was an untyped neoplasm (146), adenocarcinoma (131) or squamous cell carcinoma (37). The majority of patients (291, 66%) were recorded as not having received any disease modifying therapy with a minority of patients (82, 18%) receiving intravenous systemic therapy (usually carboplatin or cisplatin with smaller numbers receiving etoposide, paclitaxel or gemcitabine). One hundred and eight patients (24%) received palliative radiotherapy. Only 5% of patients were recorded as having any treatment outside the region. The median survival for all patients was 2.23 months, with a slight improvement in the period 2014-17 compared to 2009-2013 (3.0 vs. 2.1 months). Patients deemed fit enough to receive systemic therapy had a median survival of 9.8 months.
Conclusion
This population-based analysis has confirmed the continuing poor outlook of this patient group with a median of less than 3 months. CUP remains an area of unmet clinical need.