Management of adenocarcinoma of unknown primary with a 5-fluorouracil-cisplatin chemotherapy regimen (CFTam)

Background: Adenocarcinoma of unknown primary comprises up to 10% of metast atic malignant disease. With few exceptions this diagnosis carries a very p oor prognosis of a few months with minimal survival advantage to chemothera py. However there is the possibility that chemotherapy can improve symptom control and quality of life. Patients and methods: Forty-four patients with adenocarcinoma of unknown pr imary received CFTam chemotherapy regimen (5-FU 750 mg/m(2)/day by protract ed infusion for five days, cisplatin 60 mg/m(2) once and tamoxifen 20 mg da ily on a 21-day cycle). Disease response and toxicity were collected and su rvival compared to patients who were not treated or who received different chemotherapy regimens. Results: Overall response to CFTam was 27% with a median duration of 10 mon ths (range 4-26 months). The chemotherapy was well tolerated with no grade 4 non-haematological toxicity and only three patients (7%) grade 4 neutropa enia with only two (5%) patients developing sepsis. There were no toxic dea ths. Performance status was maintained or improved in responders. Conclusions: CFTam is a well tolerated chemotherapy regimen with similar ef ficacy to other regimens described in the treatment of adenocarcinoma of un known primary. In the absence of a significant survival advantage there is a need to conduct randomised trials of chemotherapy versus best supportive care to quantify any improvement in quality of life or symptom control.