Taxane-based chemotherapy for patients with carcinoma of unknown primary site

BACKGROUND The purpose of this study was to determine the long-term followup on surviv al of patients with carcinoma of unknown primary site treated with taxane-b ased chemotherapy in a multicenter community-based setting. PATIENTS AND METHODS Patients were treated with three sequential phase II trials between 1995 an d 1998 as follows: Study I: paclitaxel 200 mg/m(2) intravenously (IV) Day 1 , carboplatin AUC = 6 IV Day 1, and oral etoposide 50 mg daily alternating with 100 mg daily days 1-10 every 3 weeks; Study II: docetaxel 75 mg/m(2) I V Day 1, cisplatin 75 mg/m(2) IV Day 1, repeated every 3 weeks; Study III: docetaxel 65 mg/m(2) IV Day 1, carboplatin AUC 6 IV Day 1, repeated every 3 weeks. A total of 144 patients (71 on Study 1, 26 on Study II, 47 on Study III) were treated (45% had well differentiated carcinoma, 48% had poorly d ifferentiated carcinomas, and 6% poorly differentiated neuroendocrine tumor s). The majority of the patients had multiple sites of metastatic disease. RESULTS Thirty-six percent of all evaluable patients responded to therapy (27% part ial and 9% complete responses). The median survival was 10 months with 1-, 2-, 3-, and 4-year survivals of 42%, 22%, 17%, and 17%, respectively Follow -up ranges from 11 to 50 months. Women survived significantly longer than m en. Thirty-one patients remain alive and 14 are progression-free. The prima ry toxicity was leukopenia with the carboplatin regimens and nausea and vom iting with the cisplatin regimen. A review of the survival of several large previously reported series of patients was compared to results after taxan e-based chemotherapy. A compelling argument is made that chemotherapy is su perior to best supportive care alone and that taxane-based chemotherapy is superior to other forms of chemotherapy. However, prospective randomized tr ials will be necessary to definitively demonstrate the superiority of this treatment compared to other therapies for these patients. CONCLUSION Taxane-based chemotherapy for patients with carcinoma of unknown primary si te appears to be clinically beneficial and is associated with long-term sur vival for a minority of patients at 2-, 3-, and 4-year follow-up.