Journal of Clinical Oncology, Vol 15, 2385-2393, Copyright © 1997 by American Society of Clinical Oncology
Carcinoma of unknown primary site: treatment with 1-hour paclitaxel, carboplatin, and extended-schedule etoposide
JD Hainsworth, JB Erland, LA Kalman, MT Schreeder and FA Greco
Sarah Cannon-Minnie Pearl Cancer Center, Centennial Medical Center, Nashville, TN 37203, USA.
PURPOSE: To evaluate the efficacy and toxicity of a novel chemotherapy
combination that includes paclitaxel, carboplatin, and extended- schedule
etoposide in the treatment of patients with carcinoma of unknown primary
tumor site. PATIENTS AND METHODS: Fifty-five patients with carcinoma of
unknown primary tumor site were treated with the following regimen,
administered every 21 days: paclitaxel 200 mg/m2 by 1-hour intravenous
(I.V.) infusion on day 1, carboplatin at an estimated area under the
concentration-time curve (AUC) of 6.0 on day 1, and etoposide 50 mg
alternated with 100 mg orally on days 1 through 10. Responding patients
received a total of four courses of treatment. The following histologies
were included: adenocarcinoma, 30 patients; poorly differentiated carcinoma
(PDC) or poorly differentiated adenocarcinoma (PDA), 21; poorly
differentiated neuroendocrine carcinoma, three; and squamous carcinoma,
one. RESULTS: Twenty-five of 53 assessable patients (47%; 95% confidence
interval [CI], 33% to 61%) had major objective responses to treatment
(seven complete responses). Response rates were similar in patients with
adenocarcinoma versus PDC (45% and 48%, respectively). The actuarial median
survival time for the entire group was 13.4 months. The regimen was well
tolerated, with only seven hospitalizations for treatment of neutropenia
and fever (4% of courses) and no treatment-related deaths. CONCLUSION: The
combination of paclitaxel, carboplatin, and extended-schedule etoposide is
highly active and well tolerated in patients with carcinoma of unknown
primary tumor site. Response rates and survival in this multicenter
community- based trial compare favorably with all previously studied
empiric regimens. In addition, this regimen is substantially less toxic and
easier to administer than the cisplatin-based regimens previously used in
this setting. If this level of efficacy is confirmed, this treatment should
be considered standard first-line therapy in patients with carcinoma of
unknown primary tumor site.
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