Occult Primary, Version 3.2014

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  • 1 From The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; University of Colorado Cancer Center; Vanderbilt-Ingram Cancer Center; City of Hope Comprehensive Cancer Center; Fox Chase Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Center Alliance; Massachusetts General Hospital Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Huntsman Cancer Institute at the University of Utah; University of Alabama at Birmingham Comprehensive Cancer Center; Roswell Park Cancer Institute; The University of Texas MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Memorial Sloan Kettering Cancer Center; UC San Diego Moores Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; University of Michigan Comprehensive Cancer Center; Duke Cancer Institute; Moffitt Cancer Center; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; and National Comprehensive Cancer Network.
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The NCCN Guidelines for Occult Primary tumors provide recommendations for the evaluation, workup, management, and follow-up of patients with occult primary tumors (cancers of unknown primary). These NCCN Guidelines Insights summarize major discussion points of the 2014 NCCN Occult Primary panel meeting. The panel discussed gene expression profiling (GEP) for the identification of the tissue of origin and concluded that, although GEP has a diagnostic benefit, a clinical benefit has not been demonstrated. The panel recommends against GEP as standard management, although 20% of the panel believes the diagnostic benefit of GEP warrants its routine use. In addition, the panel discussed testing for actionable mutations (eg, ALK) to help guide choice of therapy, but declined to add this recommendation.

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