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Treating cancer patients with broad-spectrum empiric chemotherapy because they carry a label of cancer of unknown primary (CUP) is no longer scientifically appropriate since there are now molecular tools to individualize care, researchers noted in a "Comments and Controversies" article in the Journal of Clinical Oncology.
Vivek Subbiah, MD, and F. Anthony Greco, MD, both of Sarah Cannon Research Institute in Nashville, explained that CUP represents not one disease but a constellation of biologically distinct malignancies that just happen to share a common clinical presentation.
"The future of cancer care requires a bold reimagining of classification and treatment strategies," the authors wrote. "The patients currently labeled with CUP deserve our commitment to seeing their cancers for what molecular science reveals them to be: distinct diseases requiring individualized understanding and treatment. Through this evolutionary approach, CUP becomes not an end point but a beginning, a gateway to precision oncology that respects both current clinical realities and future therapeutic possibilities."
In the following interview, Subbiah, now associate director for drug development and precision oncology at Stanford Cancer Institute in California, elaborates on the commentary and says that the oncologist's mindset should move from asking "What empiric chemotherapy do I give this CUP patient?" to "What does the molecular profile of this patient's tumor tell me about what it is and what will work against it?"
