The evolution of molecular management of carcinoma of unknown primary.
| Autor: | Sivakumaran T; Peter MacCallum Cancer Centre.; Sir Peter MacCallum Department of Oncology., Tothill RW; Sir Peter MacCallum Department of Oncology.; University of Melbourne Centre for Cancer Research.; Department of Clinical Pathology, The University of Melbourne, Melbourne, Australia., Mileshkin LR; Peter MacCallum Cancer Centre.; Sir Peter MacCallum Department of Oncology. |
|---|---|
| Jazyk: | angličtina |
| Zdroj: | Current opinion in oncology [Curr Opin Oncol] 2024 Sep 01; Vol. 36 (5), pp. 456-464. Date of Electronic Publication: 2024 Jun 17. |
| DOI: | 10.1097/CCO.0000000000001066 |
| Abstrakt: | 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. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.) |
| Databáze: | MEDLINE |
| Externí odkaz: |
|