Molecularly Guided Therapy Versus Continued Chemotherapy in Unfavorable Cancer of Unknown Primary: Updated Efficacy and Safety From the Randomized, Phase II CUPISCO Study.
Alwin Krämer, Tilmann Bochtler, Chantal Pauli et al.
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In 30 seconds
This updated analysis of the multicenter, randomized phase II CUPISCO trial compared molecularly guided therapy (MGT), selected after comprehensive genomic profiling, with continued platinum-based chemotherapy in patients with previously untreated, unfavorable cancer of unknown primary whose disease was controlled after three induction cycles. Among 436 randomized patients, with median follow-up of 37.0 months, median progression-free survival was 6.1 months with MGT versus 4.4 months with chemotherapy (hazard ratio, 0.75; P = .017). Median overall survival was 15.2 versus 12.8 months, respectively, but the difference was not statistically significant. No new safety signals were identified.
Key findings
- Median progression-free survival was 6.1 months with MGT and 4.4 months with chemotherapy (HR, 0.75; 95% CI, 0.59 to 0.95; P = .017).
- Median overall survival was 15.2 months with MGT versus 12.8 months with chemotherapy (HR, 0.79; 95% CI, 0.61 to 1.02; P = .0689).
- No new safety signals were identified during the additional follow-up.
Why it matters
Unfavorable cancer of unknown primary presents a treatment challenge, and these updated randomized results support the potential value of matching therapy to genomic findings after initial disease control. The progression-free survival advantage persisted with longer follow-up, while the overall survival comparison remained inconclusive. The findings underscore the relevance of genomic profiling in treatment planning for this selected patient population.
What to keep in mind
The results apply to patients whose disease was controlled after three induction chemotherapy cycles; the abstract does not establish applicability to patients who do not reach disease control.