Abstract 519P
Background
Carcinoma of unknown primary (CUP) is a challenging disease to diagnose and treat. Many patients (pts) present with advanced disease at an older age and may not receive optimum diagnostic work-up. We describe pt characteristics, diagnostic work-up, treatments and survival in US pts with CUP.
Methods
From the SEER-Medicare database, we included pts with an incident diagnosis of CUP (ICD-O-3 C80.9) at age ≥66 years from 1.1.2013–31.12.2015. All pts had Medicare A & B enrolment (inpatient, doctor’s services and outpatient cover) for ≥12 months prior to CUP diagnosis until 31.12.2016, and no prior claims for cancer treatment. Pts with a primary cancer identified by death certificate/autopsy, or with a second primary cancer recorded after CUP, were excluded. We describe pt baseline demographics and examine the use of diagnostics such as biopsy, imaging (CT, PET-CT or MRI) and immunohistochemistry (IHC). Median survival was calculated using the Kaplan-Meier method.
Results
The cohort comprised 4562 pts: 29.2%, 37.9% and 32.9% were aged 66–74, 75–84 and ≥85 years, respectively. Most pts (86.3%) were Caucasian and 53.8% were female; 45.6% had a National Cancer Institute comorbidity score ≥2. Diagnosis was confirmed by microscopy for 76.3%, 65.6% and 44.1% of these age groups. In the 12 months (mths) prior to diagnosis, pts with claims for diagnostic work-up of ≥1 biopsy, imaging and IHC, in these age groups, were 28.0%, 25.3% and 17.6%, respectively, which increased to 85.3%, 81.6% and 77.6% among treated, and 59.4%, 53.1% and 32.9% in untreated patients within 30 days post-diagnosis. Only 23.9%, 14.1% and 3.9%, respectively, received any systemic anti-cancer therapy. Only 1.9% of pts received a molecular biomarker test prior to diagnosis. Median survival was 9.5 (95%CI: 8.2–10.5) and 1 mths (95%CI: 0.9–1.0; p<0.0001) for treated and untreated pts, respectively, with little age-group-specific variation (range 9.2–10.5 vs 0.9–1.1 mths).
Conclusions
In this Medicare-insured elderly population diagnosed with CUP, limited diagnostic work-up was common and the majority of patients did not receive systemic anti-cancer therapy. The poor outcomes in this group highlight the high unmet need for timely diagnosis and more effective therapies for pts aged ≥66 years with CUP.
Clinical trial identification
Editorial acknowledgement
Editorial assistance provided by Susannah Thornhill, PhD, and funded by F. Hoffmann-La Roche, Basel, Switzerland.
Legal entity responsible for the study
F. Hoffmann-La Roche, Basel, Switzerland.
Funding
F. Hoffmann-La Roche, Basel, Switzerland.
Disclosure
L. Mileshkin: Travel/Accommodation/Expenses, Non-remunerated activity/ies, F. Hoffmann-La Roche Ltd – Third-party editing assistance; Travel/Accommodation/Expenses: Beigene. T. Bochtler: Non-remunerated activity/ies, F. Hoffmann-La Roche Ltd – Third-party editing assistance; Research grant/Funding (institution), Full/Part-time employment, Works as study oncologist for the CUPISCO trial, which is sponsored by F. Hoffmann-La Roche Ltd; Full/Part-time employment, has received coverage for study related work in the MTB for the benefit of his employer (German Cancer Research Center [DKFZ] and University of Heidelberg): F. Hoffmann-La Roche Ltd. A. Beringer: Full/Part-time employment: F. Hoffmann-La Roche Ltd; Non-remunerated activity/ies, F. Hoffmann-La Roche Ltd – Third-party editing assistance. M. Mueller-Ohldach: Shareholder/Stockholder/Stock options, Full/Part-time employment: F. Hoffmann-La Roche Ltd; Non-remunerated activity/ies, F. Hoffmann-La Roche Ltd – Third-party editing assistance. A. Surinach: Advisory/Consultancy, An employee of Genesis Research, which receives consulting fees from F. Hoffmann-La Roche : Genesis Research; Non-remunerated activity/ies, F. Hoffmann-La Roche Ltd – Third-party editing assistance. C. Perret: Full/Part-time employment, Non-remunerated activity/ies, Third-party editing assistance: F. Hoffmann-La Roche Ltd. M. Thomas: Shareholder/Stockholder/Stock options, Full/Part-time employment, Non-remunerated activity/ies, Third-party editing assistance: F. Hoffmann-La Roche Ltd. A. Gondos: Shareholder/Stockholder/Stock options, Full/Part-time employment, Non-remunerated activity/ies, Third-party editing assistance: F. Hoffmann-La Roche Ltd. A. Krämer: Honoraria (self), Honoraria (institution), Advisory/Consultancy, Leadership role, Travel/Accommodation/Expenses: F. Hoffmann-La Roche Ltd; Non-remunerated activity/ies, F. Hoffmann-La Roche Ltd – Third-party editing assistance; Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: Daiichi Sankyo; Honoraria (institution), Research grant/Funding (institution): Bayer; Advisory/Consultancy: BMS; Research grant/Funding (institution): Merck; Travel/Accommodation/Expenses: Celgene; Advisory/Consultancy: AbbVie.