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. 2023 Aug;129(2):301-308.
doi: 10.1038/s41416-023-02254-6. Epub 2023 May 24.

Six-year experience of Australia's first dedicated cancer of unknown primary clinic

Arielle van Mourik  1 , Gina Tonkin-Hill  1 , John O'Farrell  1 , Shohei Waller  1 , Lavinia Tan  1   2 , Richard W Tothill  2   3 , David Bowtell  2   4 , Stephen Fox  2   3   4   5 , Andrew Fellowes  4   5 , Clare Fedele  6 , Penelope Schofield  2   7   8 , Tharani Sivakumaran  1   2 , Hui-Li Wong #  9   10 , Linda Mileshkin #  1   2
Affiliations

Six-year experience of Australia's first dedicated cancer of unknown primary clinic

Arielle van Mourik et al. Br J Cancer. 2023 Aug.

Abstract

Background: Diagnosis and management of cancers of unknown primary (CUP) remain challenging. This study examines the referral patterns, management and outcomes of patients referred to Australia's first dedicated CUP clinic.

Methods: Retrospective medical record review was conducted for patients seen at the Peter MacCallum Cancer Centre CUP clinic between July 2014 and August 2020. Overall survival (OS) was analysed for patients with a CUP diagnosis where treatment information was available.

Results: Of 361 patients referred, fewer than half had completed diagnostic work-up at the time of referral. A diagnosis of CUP was established in 137 (38%), malignancy other than CUP in 177 (49%) and benign pathology in 36 (10%) patients. Genomic testing was successfully completed in 62% of patients with initial provisional CUP and impacted management in 32% by identifying a tissue of origin or actionable genomic alteration. The use of site-specific, targeted therapy or immunotherapy was independently associated with longer OS compared to empirical chemotherapy.

Conclusion: Our specialised CUP clinic facilitated diagnostic work-up among patients with suspected malignancy and provided access to genomic testing and clinical trials for patients with a CUP diagnosis, all of which are important to improve outcomes in this patient population.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. CONSORT diagram of patients seen in the Cancer of Unknown Primary (CUP) clinic.
Diagnostic outcomes are described for all patients following completion of standard investigations. For patients with provisional CUP, diagnosis was updated following discussion at a multi-disciplinary meeting and/or review of clinicopathologic or genomic information.
Fig. 2
Fig. 2. Overall survival of patients with CUP, stratified by type of systemic therapy received.
a Site-specific, targeted therapy and immunotherapy combined. b Site-specific, targeted therapy and immunotherapy presented individually; p-value excluding empirical chemotherapy group. OS overall survival.
See this image and copyright information in PMC

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