Skip to main content
Erschienen in:

01.09.2008 | Leitthema

Prognoseadaptierte Therapie beim fortgeschrittenen CUP-Syndrom

verfasst von: Dr. A. Kretzschmar

Erschienen in: Die Onkologie | Ausgabe 9/2008

Einloggen, um Zugang zu erhalten

Zusammenfassung

Patienten mit disseminierter Metastasierung eines CUP-Syndroms haben eine ernste Prognose mit einem medianen Überleben von 3–10 Monaten je nach Allgemeinzustand und Ausmaß der Erkrankung. Spezifisch behandelbare Subgruppen wie neuroendokrine Karzinome oder extragonadale Keimzelltumoren müssen unbedingt erkannt werden, da sie bei sachgerechter Therapie eine wesentlich günstigere Prognose haben. Ansonsten sollte versucht werden, aufgrund des Musters der Metastasierung und der Immunhistologie eine Arbeitsdiagnose zu finden, um ein Chemotherapieregime zu wählen. Für das CUP-Syndrom ohne Arbeitsdiagnose ist die Kombination von Carboplatin und Paclitaxel das Standardschema, welches zu objektiven Remissionraten von etwa 20–40% und zu medianen Überlebenszeiten von 10–12 Monaten führt. Sequenzielle Chemotherapieregime oder gezielte Therapien wie monoklonale Antikörper und Tyrosinkinasehemmer erwiesen sich bisher nicht als klar überlegen und werden aktuell im Rahmen von Studien geprüft.
Literatur
1.
Zurück zum Zitat Hübner G, Wildfang I, Schmoll H (2006) Metastasen bei unbekanntem Primärtumor. In Schmoll HJ HKPK (ed) Kompendium internistische onkologie standards in diagnostik und therapie. Springer, Heidelberg, pp 5317–5364 Hübner G, Wildfang I, Schmoll H (2006) Metastasen bei unbekanntem Primärtumor. In Schmoll HJ HKPK (ed) Kompendium internistische onkologie standards in diagnostik und therapie. Springer, Heidelberg, pp 5317–5364
2.
Zurück zum Zitat van de Wouw AJ, Janssen-Heijnen ML, Coebergh JW, Hillen HF (2002) Epidemiology of unknown primary tumours; incidence and population-based survival of 1285 patients in Southeast Netherlands, 1984–1992. Eur J Cancer 38(3): 409–413CrossRef van de Wouw AJ, Janssen-Heijnen ML, Coebergh JW, Hillen HF (2002) Epidemiology of unknown primary tumours; incidence and population-based survival of 1285 patients in Southeast Netherlands, 1984–1992. Eur J Cancer 38(3): 409–413CrossRef
3.
Zurück zum Zitat Cunningham D, Starling N, Rao S et al. (2008) Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med 358(1): 36–46PubMedCrossRef Cunningham D, Starling N, Rao S et al. (2008) Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med 358(1): 36–46PubMedCrossRef
4.
Zurück zum Zitat Moore MJ, Goldstein D, Hamm J et al. (2007) Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National cancer institute of canada clinical trials group. J Clin Oncol 25(15): 1960–1966PubMedCrossRef Moore MJ, Goldstein D, Hamm J et al. (2007) Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National cancer institute of canada clinical trials group. J Clin Oncol 25(15): 1960–1966PubMedCrossRef
5.
Zurück zum Zitat Schiller JH, Harrington D, Belani CP et al. (2002) Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med 346(2): 92–98PubMedCrossRef Schiller JH, Harrington D, Belani CP et al. (2002) Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med 346(2): 92–98PubMedCrossRef
6.
Zurück zum Zitat Heinemann V, Labianca R, Hinke A, Louvet C (2007) Increased survival using platinum analog combined with gemcitabine as compared to single-agent gemcitabine in advanced pancreatic cancer: pooled analysis of two randomized trials, the GERCOR/GISCAD intergroup study and a German multicenter study. Ann Oncol 18(10): 1652–1659PubMedCrossRef Heinemann V, Labianca R, Hinke A, Louvet C (2007) Increased survival using platinum analog combined with gemcitabine as compared to single-agent gemcitabine in advanced pancreatic cancer: pooled analysis of two randomized trials, the GERCOR/GISCAD intergroup study and a German multicenter study. Ann Oncol 18(10): 1652–1659PubMedCrossRef
7.
Zurück zum Zitat Herrmann R, Bodoky G, Ruhstaller T et al. (2007) Gemcitabine plus capecitabine compared with gemcitabine alone in advanced pancreatic cancer: a randomized, multicenter, phase III trial of the Swiss group for clinical cancer research and the central european cooperative oncology group. J Clin Oncol 25(16): 2212–2217PubMedCrossRef Herrmann R, Bodoky G, Ruhstaller T et al. (2007) Gemcitabine plus capecitabine compared with gemcitabine alone in advanced pancreatic cancer: a randomized, multicenter, phase III trial of the Swiss group for clinical cancer research and the central european cooperative oncology group. J Clin Oncol 25(16): 2212–2217PubMedCrossRef
8.
Zurück zum Zitat Goldberg R, Köhne C, Seymour M et al. (2007) A pooled safety and efficacy analysis examining the effect of performance status on outcomes in nine first-line treatment (rx) trials of 6,286 patients with metastatic colorectal cancer. J Clin Oncol 25(No. 18S: 4011) Goldberg R, Köhne C, Seymour M et al. (2007) A pooled safety and efficacy analysis examining the effect of performance status on outcomes in nine first-line treatment (rx) trials of 6,286 patients with metastatic colorectal cancer. J Clin Oncol 25(No. 18S: 4011)
9.
Zurück zum Zitat Gupta S, Johnson MM, Murthy R et al. (2005) Hepatic arterial embolization and chemoembolization for the treatment of patients with metastatic neuroendocrine tumors: variables affecting response rates and survival. Cancer 104(8): 1590–1602PubMedCrossRef Gupta S, Johnson MM, Murthy R et al. (2005) Hepatic arterial embolization and chemoembolization for the treatment of patients with metastatic neuroendocrine tumors: variables affecting response rates and survival. Cancer 104(8): 1590–1602PubMedCrossRef
10.
Zurück zum Zitat Vogl TJ, Zangos S, Eichler K et al. (2008) Palliative hepatic intraarterial chemotherapy (HIC) using a novel combination of gemcitabine and mitomycin C: results in hepatic metastases. Eur Radiol 18(3): 468–476PubMedCrossRef Vogl TJ, Zangos S, Eichler K et al. (2008) Palliative hepatic intraarterial chemotherapy (HIC) using a novel combination of gemcitabine and mitomycin C: results in hepatic metastases. Eur Radiol 18(3): 468–476PubMedCrossRef
11.
Zurück zum Zitat Sugarbaker PH, Acherman YI, Gonzalez-Moreno S et al. (2002) Diagnosis and treatment of peritoneal mesothelioma: The Washington cancer institute experience. Semin Oncol 29(1): 51–61PubMedCrossRef Sugarbaker PH, Acherman YI, Gonzalez-Moreno S et al. (2002) Diagnosis and treatment of peritoneal mesothelioma: The Washington cancer institute experience. Semin Oncol 29(1): 51–61PubMedCrossRef
12.
Zurück zum Zitat Yan TD, Esquivel J, Carmignani P, Sugarbaker PH (2003) Cytoreduction and intraperitoneal chemotherapy for the management of non-gynecological peritoneal surface malignancy. J Exp Clin Cancer Res 22(4 Suppl): 109–117PubMed Yan TD, Esquivel J, Carmignani P, Sugarbaker PH (2003) Cytoreduction and intraperitoneal chemotherapy for the management of non-gynecological peritoneal surface malignancy. J Exp Clin Cancer Res 22(4 Suppl): 109–117PubMed
13.
Zurück zum Zitat Oberg K (2001) Chemotherapy and biotherapy in the treatment of neuroendocrine tumours. Ann Oncol 12(Suppl 2): S111–S114PubMedCrossRef Oberg K (2001) Chemotherapy and biotherapy in the treatment of neuroendocrine tumours. Ann Oncol 12(Suppl 2): S111–S114PubMedCrossRef
14.
Zurück zum Zitat Hainsworth JD, Spigel DR, Litchy S, Greco FA (2006) Phase II trial of paclitaxel, carboplatin and etoposide in advanced poorly differentiated neuroendocrine carcinoma: a Minnie pearl cancer research network study. J Clin Oncol 24(22): 3548–3554PubMedCrossRef Hainsworth JD, Spigel DR, Litchy S, Greco FA (2006) Phase II trial of paclitaxel, carboplatin and etoposide in advanced poorly differentiated neuroendocrine carcinoma: a Minnie pearl cancer research network study. J Clin Oncol 24(22): 3548–3554PubMedCrossRef
15.
Zurück zum Zitat Bridgewater J, van LR, Floore A, Van’T VL (2008) Gene expression profiling may improve diagnosis in patients with carcinoma of unknown primary. Br J Cancer 98(8): 1425–1430PubMedCrossRef Bridgewater J, van LR, Floore A, Van’T VL (2008) Gene expression profiling may improve diagnosis in patients with carcinoma of unknown primary. Br J Cancer 98(8): 1425–1430PubMedCrossRef
16.
Zurück zum Zitat Eagan RT, Therneau TM, Rubin J et al. (1987) Lack of value for cisplatin added to mitomycin-doxorubicin combination chemotherapy for carcinoma of unknown primary site. A randomized trial. Am J Clin Oncol 10(1): 82–85PubMedCrossRef Eagan RT, Therneau TM, Rubin J et al. (1987) Lack of value for cisplatin added to mitomycin-doxorubicin combination chemotherapy for carcinoma of unknown primary site. A randomized trial. Am J Clin Oncol 10(1): 82–85PubMedCrossRef
17.
Zurück zum Zitat Falkson CI, Cohen GL: Mitomycin C (1998) Epirubicin and cisplatin versus mitomycin C alone as therapy for carcinoma of unknown primary origin. Oncology 55(2): 116–121PubMedCrossRef Falkson CI, Cohen GL: Mitomycin C (1998) Epirubicin and cisplatin versus mitomycin C alone as therapy for carcinoma of unknown primary origin. Oncology 55(2): 116–121PubMedCrossRef
18.
Zurück zum Zitat Milliken ST, Tattersall MH, Woods RL et al. (1987) Metastatic adenocarcinoma of unknown primary site. A randomized study of two combination chemotherapy regimens. Eur J Cancer Clin Oncol 23(11): 1645–1648PubMedCrossRef Milliken ST, Tattersall MH, Woods RL et al. (1987) Metastatic adenocarcinoma of unknown primary site. A randomized study of two combination chemotherapy regimens. Eur J Cancer Clin Oncol 23(11): 1645–1648PubMedCrossRef
19.
Zurück zum Zitat Briasoulis E, Kalofonos H, Bafaloukos D et al. (2000) Carboplatin plus paclitaxel in unknown primary carcinoma: a phase II Hellenic cooperative oncology group study. J Clin Oncol 18(17): 3101–3107PubMed Briasoulis E, Kalofonos H, Bafaloukos D et al. (2000) Carboplatin plus paclitaxel in unknown primary carcinoma: a phase II Hellenic cooperative oncology group study. J Clin Oncol 18(17): 3101–3107PubMed
20.
Zurück zum Zitat Huebner G, Steinbach S, Kohne C, et al. (2005) Paclitaxel carboplatin versus gemcitabine / vinorelbine in patients with adeno- or undifferentiated carcinoma of unknown primary - a randomized prospective phase-II-trial. J Clin Oncol 23 (Suppl) 20-5-2005. Ref Type: Abstract Huebner G, Steinbach S, Kohne C, et al. (2005) Paclitaxel carboplatin versus gemcitabine / vinorelbine in patients with adeno- or undifferentiated carcinoma of unknown primary - a randomized prospective phase-II-trial. J Clin Oncol 23 (Suppl) 20-5-2005. Ref Type: Abstract
21.
Zurück zum Zitat Greco FA, Erland JB, Morrissey LH et al. (2000) Carcinoma of unknown primary site: phase II trials with docetaxel plus cisplatin or carboplatin. Ann Oncol 11(2): 211–215PubMedCrossRef Greco FA, Erland JB, Morrissey LH et al. (2000) Carcinoma of unknown primary site: phase II trials with docetaxel plus cisplatin or carboplatin. Ann Oncol 11(2): 211–215PubMedCrossRef
22.
Zurück zum Zitat Greco FA, Burris HA III, Litchy S et al. (2002) Gemcitabine, carboplatin and paclitaxel for patients with carcinoma of unknown primary site: a Minnie pearl cancer research network study. J Clin Oncol 20(6): 1651–1656PubMedCrossRef Greco FA, Burris HA III, Litchy S et al. (2002) Gemcitabine, carboplatin and paclitaxel for patients with carcinoma of unknown primary site: a Minnie pearl cancer research network study. J Clin Oncol 20(6): 1651–1656PubMedCrossRef
23.
Zurück zum Zitat Greco FA, Rodriguez GI, Shaffer DW et al. (2004) Carcinoma of unknown primary site: sequential treatment with paclitaxel/carboplatin/etoposide and gemcitabine/irinotecan: a Minnie pearl cancer research network phase II trial. Oncologist 9(6): 644–652PubMedCrossRef Greco FA, Rodriguez GI, Shaffer DW et al. (2004) Carcinoma of unknown primary site: sequential treatment with paclitaxel/carboplatin/etoposide and gemcitabine/irinotecan: a Minnie pearl cancer research network phase II trial. Oncologist 9(6): 644–652PubMedCrossRef
24.
Zurück zum Zitat Huebner G, Steinbach S, Kohne CH et al. (2005) Paclitaxel / carboplatin versus gemcitabine / vinorelbine in patients with adeno- or undifferentiated carcinoma of unknown primary - a randomized prospective phase-II-trial. J Clin Oncol ASCO Annual Meeting Proceedings 23 (Suppl) 2005. Ref Type: Abstract Huebner G, Steinbach S, Kohne CH et al. (2005) Paclitaxel / carboplatin versus gemcitabine / vinorelbine in patients with adeno- or undifferentiated carcinoma of unknown primary - a randomized prospective phase-II-trial. J Clin Oncol ASCO Annual Meeting Proceedings 23 (Suppl) 2005. Ref Type: Abstract
25.
Zurück zum Zitat Hainsworth JD, Spigel DR, Raefsky EL et al. (2005) Combination chemotherapy with gemcitabine and irinotecan in patients with previously treated carcinoma of an unknown primary site: a Minnie Pearl Cancer Research Network Phase II trial. Cancer 104(9): 1992–1997PubMedCrossRef Hainsworth JD, Spigel DR, Raefsky EL et al. (2005) Combination chemotherapy with gemcitabine and irinotecan in patients with previously treated carcinoma of an unknown primary site: a Minnie Pearl Cancer Research Network Phase II trial. Cancer 104(9): 1992–1997PubMedCrossRef
26.
Zurück zum Zitat Greco FA, Rodriguez GI, Shaffer DW et al. (2004) Carcinoma of unknown primary site: sequential treatment with paclitaxel/carboplatin/etoposide and gemcitabine/irinotecan: a Minnie pearl cancer research network phase II trial. Oncologist 9(6): 644–652PubMedCrossRef Greco FA, Rodriguez GI, Shaffer DW et al. (2004) Carcinoma of unknown primary site: sequential treatment with paclitaxel/carboplatin/etoposide and gemcitabine/irinotecan: a Minnie pearl cancer research network phase II trial. Oncologist 9(6): 644–652PubMedCrossRef
27.
Zurück zum Zitat Massard C, Voigt JJ, Laplanche A et al. (2007) Carcinoma of an unknown primary: are EGF receptor, Her-2/neu and c-Kit tyrosine kinases potential targets for therapy? Br J Cancer 97(7): 857–861PubMed Massard C, Voigt JJ, Laplanche A et al. (2007) Carcinoma of an unknown primary: are EGF receptor, Her-2/neu and c-Kit tyrosine kinases potential targets for therapy? Br J Cancer 97(7): 857–861PubMed
28.
Zurück zum Zitat Vermorken JB, Mesia J, Vega-Villegas R et al. (2006) Cetuximab in combination with cisplatin or carboplatin and 5-fluorouracil in the first-line treatment of patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck. J Clin Oncol 24, No. 18S (Suppl), Annual Meeting Proceedings, Abstract 5537) Vermorken JB, Mesia J, Vega-Villegas R et al. (2006) Cetuximab in combination with cisplatin or carboplatin and 5-fluorouracil in the first-line treatment of patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck. J Clin Oncol 24, No. 18S (Suppl), Annual Meeting Proceedings, Abstract 5537)
29.
Zurück zum Zitat Pirker R, Szczesna A, von Pawel J et al. (2008) A randomized, multicenter, phase III study of cetuximab in combination with cisplatin/vinorelbine versus CV alone in the first-line treatment of patients with advanced non-small cell lung cancer. J Clin Oncol 26 (Suppl abstr 3) Pirker R, Szczesna A, von Pawel J et al. (2008) A randomized, multicenter, phase III study of cetuximab in combination with cisplatin/vinorelbine versus CV alone in the first-line treatment of patients with advanced non-small cell lung cancer. J Clin Oncol 26 (Suppl abstr 3)
30.
Zurück zum Zitat Cohen DJ, Hochster HS (2007) Update on clinical data with regimens inhibiting angiogenesis and epidermal growth factor receptor for patients with newly diagnosed metastatic colorectal cancer. Clin Colorectal Cancer 7 (Suppl 1): S21–S27PubMedCrossRef Cohen DJ, Hochster HS (2007) Update on clinical data with regimens inhibiting angiogenesis and epidermal growth factor receptor for patients with newly diagnosed metastatic colorectal cancer. Clin Colorectal Cancer 7 (Suppl 1): S21–S27PubMedCrossRef
31.
Zurück zum Zitat Bokemeyer C, Bondarenko I, Hartmann J et al. (2008) KRAS status and efficacy of first-line treatment of patients with metastatic colorectal cancer (mCRC) with FOLFOX with or without cetuximab: The OPUS experience. J Clin Oncol 26 Bokemeyer C, Bondarenko I, Hartmann J et al. (2008) KRAS status and efficacy of first-line treatment of patients with metastatic colorectal cancer (mCRC) with FOLFOX with or without cetuximab: The OPUS experience. J Clin Oncol 26
32.
Zurück zum Zitat Shepherd FA, Rodrigues PJ, Ciuleanu T et al. (2005) Erlotinib in previously treated non-small-cell lung cancer. N Engl J Med 353(2): 123–132PubMedCrossRef Shepherd FA, Rodrigues PJ, Ciuleanu T et al. (2005) Erlotinib in previously treated non-small-cell lung cancer. N Engl J Med 353(2): 123–132PubMedCrossRef
33.
Zurück zum Zitat Tsao MS, Sakurada A, Cutz JC et al. (2005) Erlotinib in lung cancer – molecular and clinical predictors of outcome. N Engl J Med 353(2): 133–144PubMedCrossRef Tsao MS, Sakurada A, Cutz JC et al. (2005) Erlotinib in lung cancer – molecular and clinical predictors of outcome. N Engl J Med 353(2): 133–144PubMedCrossRef
34.
Zurück zum Zitat Hainsworth JD, Spigel DR, Farley C et al. (2007) Phase II trial of bevacizumab and erlotinib in carcinomas of unknown primary site: the Minnie pearl cancer research network. J Clin Oncol 25(13): 1747–1752PubMedCrossRef Hainsworth JD, Spigel DR, Farley C et al. (2007) Phase II trial of bevacizumab and erlotinib in carcinomas of unknown primary site: the Minnie pearl cancer research network. J Clin Oncol 25(13): 1747–1752PubMedCrossRef
35.
Zurück zum Zitat Greco FA, Burris A, Spigel DR et al. Paclitaxel/carboplatin plus bevacizumab/erlotinib as first-line treatment for patients with carcinoma of unknown primary site. J Clin Oncol 8 A.D. 26: 4607 Greco FA, Burris A, Spigel DR et al. Paclitaxel/carboplatin plus bevacizumab/erlotinib as first-line treatment for patients with carcinoma of unknown primary site. J Clin Oncol 8 A.D. 26: 4607
36.
Zurück zum Zitat Culine S, Lortholary A, Voigt JJ et al. (2003) Cisplatin in combination with either gemcitabine or irinotecan in carcinomas of unknown primary site: results of a randomized phase II study – trial for the French Study Group on Carcinomas of Unknown Primary (GEFCAPI 01). J Clin Oncol 21(18): 3479–3482PubMedCrossRef Culine S, Lortholary A, Voigt JJ et al. (2003) Cisplatin in combination with either gemcitabine or irinotecan in carcinomas of unknown primary site: results of a randomized phase II study – trial for the French Study Group on Carcinomas of Unknown Primary (GEFCAPI 01). J Clin Oncol 21(18): 3479–3482PubMedCrossRef
37.
Zurück zum Zitat Palmeri S, Lorusso V, Palmeri L et al. (2006) Cisplatin and gemcitabine with either vinorelbine or paclitaxel in the treatment of carcinomas of unknown primary site: results of an Italian multicenter, randomized, phase II study. Cancer 107(12): 2898–2905PubMedCrossRef Palmeri S, Lorusso V, Palmeri L et al. (2006) Cisplatin and gemcitabine with either vinorelbine or paclitaxel in the treatment of carcinomas of unknown primary site: results of an Italian multicenter, randomized, phase II study. Cancer 107(12): 2898–2905PubMedCrossRef
Metadaten
Titel
Prognoseadaptierte Therapie beim fortgeschrittenen CUP-Syndrom
verfasst von
Dr. A. Kretzschmar
Publikationsdatum
01.09.2008
Verlag
Springer-Verlag
Erschienen in
Die Onkologie / Ausgabe 9/2008
Print ISSN: 2731-7226
Elektronische ISSN: 2731-7234
DOI
https://doi.org/10.1007/s00761-008-1437-7

Weitere Artikel der Ausgabe 9/2008

Die Onkologie 9/2008 Zur Ausgabe

Onkologie im Internet

Webadressen zum CUP-Syndrom

Einführung zum Thema

Das CUP-Syndrom

Neu im Fachgebiet Onkologie

Was das Überwachen von Risikopersonen für Pankreaskrebs bringt

12.07.2024 Pankreaskarzinom Nachrichten

Programme zur Überwachung von Hochrisikokandidaten für duktales Adenokarzinom des Pankreas führen womöglich zu früherer Diagnose. Ob sich das auch in einem Überlebensvorteil niederschlägt, hat eine Studie getestet.

Prostatakarzinome der ISUP-Gruppe 1 nicht immer harmlos

11.07.2024 Prostatakarzinom Nachrichten

Nicht bei allen Prostatakarzinomen der Gleason-Graduierungsgruppe 1 kann man davon ausgehen, dass sie benigne sind. In einer Studie aus dem UKE Hamburg hatten auch in dieser Gruppe bestimmte Patienten ein deutlich erhöhtes Risiko für einen ungünstigen Verlauf.

Taugen Risikoscores für Schlaganfall und Blutungen auch bei Krebskranken?

Britische Registerdaten sprechen dafür, dass sich die Blutungsrisikoprädiktion bei Personen mit Vorhofflimmern, die zugleich an Krebs leiden, nicht einfach aus Kohorten ohne Krebs übertragen lässt.

Weitere Studie zur adjuvanten Immuntherapie beim RCC negativ

09.07.2024 Nierenkarzinom Nachrichten

Im Vergleich mit einer alleinigen Operation konnte eine perioperative Immuntherapie das rezidivfreie Überleben bei Personen mit Hochrisiko-Nierenkarzinom in der Studie PROSPER EA8143 nicht verbessern. Ein Kommentar zur Studie ordnet die Ergebnisse ein.

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.