Cancer de Primitif Inconnu (CAPI)

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1 Cancer de Primitif Inconnu (CAPI) Cancer of Unknown Primary origin (CUP) Vincent Berry (Lille) 23/01/2015 Dirigé par le Dr PENEL

2 Définitions Définitions Epidémiologie Anatomo pathologie Explorations Pronostic Traitements (2) Conclusions

3 Définitions Cancer Métastatique Localisation initiale non retrouvée Après un bilan standardisé

4 Définitions Varadhachary GR. Carcinoma of unknown primary origin. Gastrointest Cancer Res Nov;1(6): Tumeur primitive Cachée parmi les métastases Trop petite Dormance Mauvaise vascularisation Destruction par le système immunitaire Métastatique Agressive et/ou évoluée Modification d expression/séquences Ras (92%), Bcl-2 (40%), Her-2 (11%), and p53 (26% 53%)

5 Un concept, des pathologies Briasoulis E, Pavlidis N. Cancer of unknown primary origin. Oncologist 1997; 2:

6 Un concept, des pathologies Autopsies de 302 patients Identification du primitif : 84 % patient vivant : 27% à l autopsie : 57% Pancréas : 26.5% Poumons : 17.2% Reins : 4.6% Colo rectal : 3.6% Le Chevalier T, Cvitkovic E, Caille P et al. Early metastatic cancer of unknown primary origin at presentation: a clinical study of 302 consecutive autopsied patients. Arch Intern Med 1988;148: Pas d identification : 16%.

7 Epidémiologie Définitions Epidémiologie Anatomo pathologie Explorations Pronostic Traitements (2) Conclusions

8 Complexe à obtenir «Autres tumeurs» Epidémiologie Briasoulis E, Pavlidis N. Cancer of Unknown Primary Origin. Oncologist. 1997;2(3): Incidence estimée : 3 à 5% de tous les cancers 7-12/an pour Sex ratio Age médian 59 ans

9

10 Facteurs de risque Kaaks R, Sookthai D, Hemminki K, et al. Risk factors for cancers of unknown primary site: Results from the prospective EPIC cohort. Int J Cancer Nov 15;135(10): Table 2. Hazard ratios and 95% confidence intervals for CUP in relation to smoking, alcohol consumption, levels of education and anthropometric indices of obesity

11 Anatomo pathologie Définitions Epidémiologie Anatomo pathologie Explorations Pronostic Traitements (2) Conclusions

12 Anatomie pathologie Eliminer : Lymphomes Mélanomes Sarcomes Confirmer : Carcinome Affiner : Carcinome épidermoïde Carcinome indifférencié Adénocarcinome

13 Dolled-Filhart MP, Rimm DL. Gene expression array analysis to determine tissue of origin of carcinoma of unknown primary: cutting edge or already obsolete? Cancer Cytopathol Mar;121(3):

14 Varadhachary GR. Carcinoma of unknown primary origin. Gastrointest Cancer Res Nov;1(6):

15 Etudes de l expression génique Dolled-Filhart MP, Rimm DL. Gene expression array analysis to determine tissue of origin of carcinoma of unknown primary: cutting edge or already obsolete? Cancer Cytopathol Mar;121(3):

16 Explorations Définitions Epidémiologie Anatomo pathologie Explorations Pronostic Traitements (2) Conclusions

17 Fizazi K, Greco FA, Pavlidis N, Pentheroudakis G; ESMO Guidelines Working Group. Cancers of unknown primary site: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2011;22 Suppl 6:vi64-8

18 Fizazi K, Greco FA, Pavlidis N, Pentheroudakis G; ESMO Guidelines Working Group. Cancers of unknown primary site: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2011;22 Suppl 6:vi64-8

19 Fizazi K, Greco FA, Pavlidis N, Pentheroudakis G; ESMO Guidelines Working Group. Cancers of unknown primary site: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2011;22 Suppl 6:vi64-8

20 TEP Møller AKH, Loft A, Berthelsen AK, et al. A prospective comparison of 18F-FDG PET/CT and CT as diagnostic tools to identify the primary tumor site in patients with extracervical carcinoma of unknown primary site. Oncologist. 2012;17(9):

21 Fibroscopies digestives Yield of esophagogastroduodenoscopy and colonoscopy in cancer of unknown primary. Usmani MT, Bin Khalid A, Ali Shah SH, et al. Pak J Med Sci Apr;29(2):523-7

22 Evaluation pronostique Définitions Epidémiologie Anatomo pathologie Exploration Pronostic Traitements (2) Conclusions

23 Pavlidis N. Optimal therapeutic management of patients with distinct clinicopathological cancer of unknown primary subsets. Ann Oncol Sep;23 Suppl 10:x282 5.

24 Survie médiane 36 mois Pavlidis N. Optimal therapeutic management of patients with distinct clinicopathological cancer of unknown primary subsets. Ann Oncol Sep;23 Suppl 10:x Curable?? 12mois Curable???? 15mois 20mois NC Curable????

25 Survie médiane Pavlidis N. Optimal therapeutic management of patients with distinct clinicopathological cancer of unknown primary subsets. Ann Oncol Sep;23 Suppl 10:x mois??

26 Amela EY, Lauridant-Philippin G, Cousin S, et al. Management of unfavourable carcinoma of unknown primary site: Synthesis of recent literature. Critical Reviews in Oncology/ Hematology Nov;84(2):

27 Traitements (1) CUP de bon pronostic Définitions Epidémiologie Anatomo pathologie Explorations Pronostic Traitements (2) Conclusions

28 Fizazi K, Greco FA, Pavlidis N, Pentheroudakis G; ESMO Guidelines Working Group. Cancers of unknown primary site: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2011;22 Suppl 6:vi64-8

29 Traitements (2) CUP de mauvais pronostic Définitions Epidémiologie Anatomo pathologie Explorations Pronostic Traitements (2) Conclusions

30 GEFCAPI 01 Culine S, Lortholary A, Voigt J-J, et al. Cisplatin in combination with either gemcitabine or irinotecan in carcinomas of unknown primary site: results of a randomized phase II study--trial for the French Study Group on Carcinomas of Unknown Primary (GEFCAPI 01). J Clin Oncol Sep 15;21(18):

31 GEFCAPI 02 M. Gross-Goupil a,, A. Fourcade a, E. Blot et al. Cisplatin alone or combined with gemcitabine in carcinomas of unknown primary: Results of the randomised GEFCAPI 02 trial. Eur J Cancer 2012 Mar;48(5):721-7

32 GEFCAPI 02 M. Gross-Goupil a,, A. Fourcade a, E. Blot et al. Cisplatin alone or combined with gemcitabine in carcinomas of unknown primary: Results of the randomised GEFCAPI 02 trial. Eur J Cancer 2012 Mar;48(5):721-7

33 Huebner G, Link H, Kohne CH, et al. Paclitaxel and carboplatin vs gemcitabine and vinorelbine in patients with adeno- or undifferentiated carcinoma of unknown primary: a randomised prospective phase II trial. British Journal of Cancer Jan 13;100(1):44 9.

34 Huebner G, Link H, Kohne CH, et al. Paclitaxel and carboplatin vs gemcitabine and vinorelbine in patients with adeno- or undifferentiated carcinoma of unknown primary: a randomised prospective phase II trial. British Journal of Cancer Jan 13;100(1):44 9.

35 Briasoulis E, Fountzilas G, Bamias A, et al. Multicenter phase-ii trial of irinotecan plus oxaliplatin [IROX regimen] in patients with poorprognosis cancer of unknown primary: a hellenic cooperative oncology group study. Cancer Chemotherapy and Pharmacology Jul;62(2):

36 Golfinopoulos V, Pentheroudakis G, Salanti G, et al. Comparative survival with diverse chemotherapy regimens for cancer of unknown primary site: Multiple-treatments meta-analysis. Cancer Treatment Reviews Nov;35(7):570 3.

37 Golfinopoulos V, Pentheroudakis G, Salanti G, et al. Comparative survival with diverse chemotherapy regimens for cancer of unknown primary site: Multiple-treatments meta-analysis. Cancer Treatment Reviews Nov;35(7):570 3.

38 Lee J, Hahn S, Kim D-W, et al. Evaluation of survival benefits by platinums and taxanes for an unfavourable subset of carcinoma of unknown primary: a systematic review and meta-analysis. Br J Cancer Jan 15;108(1):39 48.

39 2 e ligne Ono M, Ando M, Yonemori K, et al. Second-line chemotherapy in patients with primary unknown cancer. Journal of Cancer Research and Clinical Oncology Aug;137(8):

40 2 e ligne Ono M, Ando M, Yonemori K, et al. Second-line chemotherapy in patients with primary unknown cancer. Journal of Cancer Research and Clinical Oncology Aug;137(8):

41 Conclusions Définitions Epidémiologie Anatomo pathologie Exploration Pronostic Traitements (2) Conclusions

42 Fizazi K, Greco FA, Pavlidis N, Pentheroudakis G; ESMO Guidelines Working Group. Cancers of unknown primary site: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2011;22 Suppl 6:vi64-8

43 Ducoulombier A., Adenis A., Robin Y- M., Penel N. Cancer de primitif inconnu : les formes cliniques à expression digestive. Hépato-Gastro & Oncologie Digestive 2012 ; 9 : 730-6

44 Merci! Définitions Epidémiologie Anatomo pathologie Exploration Pronostic Traitements (2) Conclusions

45

46 Cancer de Primitif Inconnu (CAPI) Cancer of Unknown Primary origin (CUP) Vincent Berry (Lille) 23/01/2015 Dirigé par le Dr PENEL

47

48 Kaaks R, Sookthai D, Hemminki K, et al. Risk factors for cancers of unknown primary site: Results from the prospective EPIC cohort. Int J Cancer Nov 15;135(10):

49 Kaaks R, Sookthai D, Hemminki K, et al. Risk factors for cancers of unknown primary site: Results from the prospective EPIC cohort. Int J Cancer Nov 15;135(10):

50 Amela EY, Lauridant-Philippin G, Cousin S, et al. Management of unfavourable carcinoma of unknown primary site: Synthesis of recent literature. Critical Reviews in Oncology/ Hematology Nov;84(2):

51 Dolled-Filhart MP, Rimm DL. Gene expression array analysis to determine tissue of origin of carcinoma of unknown primary: cutting edge or already obsolete? Cancer Cytopathol Mar;121(3):

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