The evolution of molecular management of carcinoma of unknown primary
- Author(s)
- Sivakumaran, T; Tothill, RW; Mileshkin, LR;
- Details
- Publication Year 2024-09-01,Volume 36,Issue #5,Page 456-464
- Journal Title
- Current Opinion in Oncology
- Publication Type
- Review
- Abstract
- PURPOSE OF REVIEW: There is significant need to improve diagnostic and therapeutic options for patients with cancer of unknown primary (CUP). In this review, we discuss the evolving landscape of molecular profiling in CUP. RECENT FINDINGS: Molecular profiling is becoming accepted into the diagnostic work-up of CUP patients with tumour mutation profiling now described in international CUP guidelines. Although tissue-of-origin (ToO) molecular tests utilising gene-expression and DNA methylation have existed some time, their clinical benefit remains unclear. Novel technologies utilising whole genome sequencing and machine learning algorithms are showing promise in determining ToO, however further research is required prior to clinical application. A recent international clinical trial found patients treated with molecularly-guided therapy based on comprehensive-panel DNA sequencing had improved progression-free survival compared to chemotherapy alone, confirming utility of performing genomic profiling early in the patient journey. Small phase 2 trials have demonstrated that some CUP patients are responsive to immunotherapy, but the best way to select patients for treatment is not clear. SUMMARY: Management of CUP requires a multifaceted approach incorporating clinical, histopathological, radiological and molecular sequencing results to assist with identifying the likely ToO and clinically actionable genomic alternations. Rapidly identifying a subset of CUP patients who are likely to benefit from site specific therapy, targeted therapy and/or immunotherapy will improve patient outcomes.
- Publisher
- Wolters Kluwer
- Keywords
- Humans; *Neoplasms, Unknown Primary/genetics/therapy/drug therapy/diagnosis; Molecular Targeted Therapy
- Department(s)
- Medical Oncology; Laboratory Research
- Publisher's Version
- https://doi.org/10.1097/cco.0000000000001066
- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2024-09-03 07:46:53
Last Modified: 2024-09-03 07:49:20