Precision medicine new standard in cancer of unknown primary?

MedNet.nl: Extensive genomic profiling and molecularly guided therapy appear to improve progression-free survival in patients with a cancer of unknown primary. A longer follow-up of the CUPISCO study should reveal whether this is also true for overall survival. In the phase II study, patients with newly diagnosed, unfavorable, non-squamous primary tumor received unidentified induction chemotherapy cycles, after which those with disease control were randomized 3:1 to molecularly guided therapy (MGT) in the form of investigator's choice of 12 regimens following advice from the molecular tumor board (n = 362), or three or more additional cycles of platinum-based chemotherapy (n = 110). Median progression-free survival (PFS), the primary endpoint of the study, was 6.1 months in patients receiving MGT and 4.4 months in patients receiving standard platinum-based chemotherapy (HR 0.72; p = 0.0079). Overall survival (OS) data are not yet known, but tend to improve with MGT (HR 0.82; p = 0.1779). The objective response rate (ORR) was 17.8 in the MGT group and 8.2 in the chemotherapy group, with similar response times. The number of adverse events was generally similar or lower with MGT versus chemotherapy, and there was no difference between treatment arms in terms of quality of life. The authors advocate genomic profiling and MGT as a standard approach in all patients with primary tumor unknown. Whether this will actually happen depends primarily on location at this time. Patients can already be referred for genomic profiling and precision oncology programs at some centers, but this is far from universal. Mileshkin L, et al. Primary analysis of efficacy and safety in the CUPISCO trial: A randomized, global study of targeted therapy or cancer immunotherapy guided by comprehensive genomic profiling (CGP) vs platinum-based chemotherapy (CTX) in newly diagnosed, unfavorable cancer of unknown primary (CUP). ESMO 2023, abstract LBA16. This article was originally published in Dutch on MedNet.nl

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Precision medicine new standard in cancer of unknown primary?

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