Metastatic carcinoma of unknown primary with complete metabolic response following sorafenib-based chemotherapy

BACKGROUND: The treatment of carcinoma of unknown primary based on histopathology and immunohistochemistry is generally chemotherapy. The use of molecular markers, genetic profiling platforms, and personalized medicine is under active investigation. CASE REPORT: We report the case of a 56-year-old patient who presented to medical attention with palpable axillary adenopathy. Biopsy confirmed poorly differentiated adenocarcinoma. Formal staging revealed extensive metastatic disease to bone and liver. Initial chemotherapy proved ineffective. We describe the diagnostic evaluation, treatment, and achievement of durable remission using a novel sorafenib-based drug combination that was chosen through the application of a functional analytic laboratory platform. CONCLUSION: The clinical management of patients with carcinoma of unknown primary continues to present a considerable challenge for practicing oncologists. Laboratory platforms capable of examining cellular response to injury, growth factor withdrawal, and cytotoxic insult at the level of cellular function may provide insights for drug selection in this patient population.