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ABSTRACT: Background
Patients with carcinoma of unknown primary (CUP) have a dismal prognosis, even when treated with multi-agent chemotherapy. We hypothesised that adding the epidermal growth-factor receptor (EGFR) inhibitor cetuximab to standard first-line chemotherapy with paclitaxel and carboplatin would improve PFS and RR in unfavourable CUP.Methods
This open-labelled, multicentre Phase 2 study included patients with unfavourable, untreated adeno- or undifferentiated CUP. Patients were randomised to receive either paclitaxel/carboplatin (group A) or paclitaxel/carboplatin plus cetuximab (group B) every 3 weeks for a maximum of 6 cycles followed by cetuximab maintenance in group B. The primary endpoint was PFS in the two groups. Secondary endpoints were RR, toxicity and overall survival (OS).Results
One-hundred-and-fifty patients were randomised (group A?=?72, group B?=?78). The median PFS and OS for all patients were 3.8 and 8.1 months (95% confidence interval (CI): 2.9-4.8 and 6.8-9.5). There was no significant difference in PFS (3.7 vs 4.6 months, HR 0.98) or OS (8.1 vs 7.4, HR 1.1) between the two treatment groups. Response rate tended to be better for chemotherapy plus cetuximab compared to chemotherapy alone (22% vs 15%). Adverse events grade ?3 were comparable between the two groups, except for significantly increased skin toxicity in the cetuximab arm.Conclusions
Cetuximab plus paclitaxel/carboplatin did not improve PFS, OS and RR in metastatic CUP compared to paclitaxel/carboplatin alone. Addition of cetuximab resulted in additional skin toxicity.Clinical trial registration
The study was registered at clinicaltrials.gov as NCT00894569.
SUBMITTER: Folprecht G
PROVIDER: S-EPMC7884392 | biostudies-literature | 2021 Feb
REPOSITORIES: biostudies-literature
Folprecht Gunnar G Trautmann Karolin K Stein Alexander A Huebner Gerdt G Stahl Michael M Kasper Stefan S Kretzschmar Albrecht A Köhne Claus-Henning CH Grünwald Viktor V Hofheinz Ralf-Dieter RD Schütte Katharina K Löffler Harald H Bokemeyer Carsten C Krämer Alwin A
British journal of cancer 20201125 4
<h4>Background</h4>Patients with carcinoma of unknown primary (CUP) have a dismal prognosis, even when treated with multi-agent chemotherapy. We hypothesised that adding the epidermal growth-factor receptor (EGFR) inhibitor cetuximab to standard first-line chemotherapy with paclitaxel and carboplatin would improve PFS and RR in unfavourable CUP.<h4>Methods</h4>This open-labelled, multicentre Phase 2 study included patients with unfavourable, untreated adeno- or undifferentiated CUP. Patients wer ...[more]