Abstract
Background: Cancers of unknown primary (CUPs) are defined as histologically confirmed metastatic tumours whose primary site cannot be identified during standard pretreatment evaluation. No specific regimen can be recommended as standard of care. Taxanes and platinum-based regimens are commonly used in the first-line treatment of CUPs, but there is no specific regimen for after second-line treatment. In general, late line chemotherapy is not recommended, but we experienced a rare case of CUPs with disseminated disease that showed improvement with fifth-line palliative chemotherapy by specialised approaches based on the reconsideration of histologic type of cancer. We report a rare case in which palliation was achieved by late line chemotherapy based on pathological review. Case: The case was a 65 year-old man. Transverse colectomy and peritoneal metastasectomy were performed for CUPs. The chemotherapy was continued for 3 years afterwards, and the fourth treatment was not effective. The pathological reexamination was carried out in examining the 5th line treatment, and the chemotherapy (pazopanib) was started under the diagnosis of epithelioid sarcoma. The tumor did not shrink, but the antipyretic effect on tumor fever was achieved, resulting in palliation of symptoms. Conclusions: In general, late line chemotherapy for CUPs is not recommended, but palliative chemotherapy based on pathologic profile may be effective and relieve symptoms of CUPs.
Highlights
Cancers of unknown primary (CUPs) are defined as histologically confirmed metastatic tumours whose primary site cannot be identified despite sufficient diagnostic evaluation and patients with disseminated diseases have poor prognosis. [1, 2] CUPs are heterogenous and have a wide variety of clinical presentations [3]
Vascular-endothelial Growth Factor (VEGF) antibody bevacizumab use is associated with an increased risk of gastrointestinal (GI) perforation, but the incidence and risk of GI perforation associated with vascular VEGF tyrosine-kinase inhibitors (VEGFR-TKIs) did not significantly increase the risk of GI perforation [14]
Cytotoxic chemotherapy was more likely to cause a decrease in PS and quality of life (QOL), so pazopanib was used as a therapeutic agent
Summary
Cancers of unknown primary (CUPs) are defined as histologically confirmed metastatic tumours whose primary site cannot be identified despite sufficient diagnostic evaluation and patients with disseminated diseases have poor prognosis. [1, 2] CUPs are heterogenous and have a wide variety of clinical presentations [3]. Cancers of unknown primary (CUPs) are defined as histologically confirmed metastatic tumours whose primary site cannot be identified despite sufficient diagnostic evaluation and patients with disseminated diseases have poor prognosis. Differentiated or undifferentiated occult primary tumours are highly responsive to platinum-based combination chemotherapy [4, 5] but there is no specific regimen for after second-line treatment. It is unclear whether late line chemotherapy provides benefits. We report a case of CUPs with disseminated disease that showed improvement with fifth-line palliative chemotherapy by specialised approaches based on the reconsideration of histologic type of cancer
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