{"entity":{"id":"paper-cupisco-molecularly-guided-therapy-cup-lancet-2024","kind":"paper","name":"CUPISCO: molecularly guided therapy versus chemotherapy after disease control in unfavourable cancer of unknown primary","aka":[],"tldr":"In the first large randomised trial in cancer of unknown primary, choosing a targeted drug or immunotherapy from the tumour's genomic profile after three cycles of chemotherapy held the disease back for longer than simply continuing chemotherapy.","summary":"International open-label randomised phase 2 trial in which 636 patients with newly diagnosed unfavourable cancer of unknown primary received three cycles of platinum-based chemotherapy; the 436 with disease control were randomised 3:1 to molecularly guided therapy chosen by a tumour board from comprehensive genomic profiling or to three further cycles of the same chemotherapy.\n\nMedian progression-free survival was 6.1 months with molecularly guided therapy against 4.4 months with chemotherapy (hazard ratio 0.72). Overall survival data were immature.","asOf":"2026-09-18","links":[{"label":"Lancet 2024","url":"https://doi.org/10.1016/S0140-6736(24)00814-6"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/39096924/"}],"tags":[],"related":[],"cancers":["cup-unfavourable"],"sections":[],"technologies":[],"targets":[],"drugs":["carboplatin","paclitaxel","gemcitabine-cisplatin"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["cupisco"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["lancet"],"dependsOn":[],"notes":[],"journal":"The Lancet","year":2024,"doi":"10.1016/S0140-6736(24)00814-6","pmid":"39096924","authors":"Krämer A, Bochtler T, Pauli C, et al.","paperType":"rct","findings":["Median progression-free survival 6.1 months with molecularly guided therapy versus 4.4 months with continued chemotherapy; hazard ratio 0.72.","About one third of enrolled patients progressed during induction and were never randomised."],"whatItMeans":"Comprehensive genomic profiling at diagnosis is now justified for unfavourable cancer of unknown primary, with a switch to a matched drug after induction chemotherapy when an actionable target is found.","caveats":["Open-label, progression-free survival endpoint, and the benefit was modest in absolute terms.","Many patients had no actionable alteration and received drugs of uncertain value."],"changedPractice":true,"participants":436},"route":"/key-papers/paper-cupisco-molecularly-guided-therapy-cup-lancet-2024/","neighbours":{"cancer":[{"id":"cup-unfavourable","kind":"cancer","name":"Cancer of unknown primary, unfavourable (adenocarcinoma and poorly differentiated carcinoma)","route":"/cancers/cup-unfavourable/"}],"drug":[{"id":"carboplatin","kind":"drug","name":"Carboplatin","route":"/drugs/carboplatin/"},{"id":"gemcitabine-cisplatin","kind":"drug","name":"Gemcitabine + cisplatin","route":"/drugs/gemcitabine-cisplatin/"},{"id":"paclitaxel","kind":"drug","name":"Paclitaxel / nab-paclitaxel","route":"/drugs/paclitaxel/"}],"trial":[{"id":"cupisco","kind":"trial","name":"CUPISCO","route":"/trials/cupisco/"}],"journal":[{"id":"lancet","kind":"journal","name":"The Lancet","route":"/journals/lancet/"}]}}