Empiric CUP Chemotherapy — SCE Medical Oncology MCQ

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EasyCancer of Unknown PrimaryEmpiric CUP ChemotherapySCE Medical Oncology

A 45-year-old woman with metastatic CUP (unfavourable subset: liver metastases, adenocarcinoma NOS, no identifiable primary despite comprehensive workup) is started on empiric chemotherapy. What is the standard empiric regimen for unfavourable CUP?

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Correct answer: E — Platinum-taxane doublet (carboplatin + paclitaxel) or platinum-gemcitabine

For unfavourable CUP subsets (visceral metastases, adenocarcinoma/undifferentiated carcinoma without site-specific IHC pattern), empiric platinum-based doublet chemotherapy is standard. Carboplatin + paclitaxel or cisplatin + gemcitabine are the most commonly used regimens, based on the Minnie Pearl Cancer Research Network trials and others. Response rates are approximately 20-40% with median OS of 9-12 months. Molecular profiling to identify tissue of origin may allow site-specific therapy in some patients (CUPISCO trial approach).

Reference: NICE NG36 Cancer of unknown primary; ESMO 2024 CUP Guidelines; Hainsworth et al JCO 2006