Elevated germ cell markers in carcinoma of uncertain primary site do not predict response to platinum based...

We carried out a retrospective review of the medical records of patients with metastatic carcinoma of unknown primary and either raised alpha fetoprotein (AFP) or beta human chorionic gonadotrophin (beta HCG) over a period of 6 years at three teaching hospital oncology units to assess response to platinum based chemotherapy. 15 patients were identified who fitted these criteria. Of these, 3 received no treatment because of poor functional status, 2 patients received only radiotherapy for symptomatic disease and died within 3 months of diagnosis and 1 patient died 2 weeks after diagnosis having received his first cycle of cisplatin-based chemotherapy. 9 patients received at least 2 cycles of chemotherapy. A complete tumour response was seen in only one patient who presented with midline lymphadenopathy and remains disease-free 46 months after treatment. This presentation was consistent with disease already known to herald platinum sensitivity. In the other 8 patients, there was only one partial response that lasted 2 months. The median survival for this group of 9 patients was 4.5 months (range 3 to > 46 months). Our data do not support the postulate that elevated germ cell markers in patients with carcinoma of unknown primary predict a response to cisplatin based chemotherapy.