5-FLUOROURACIL, ADRIAMYCIN, AND MITOMYCIN IN THE TREATMENT OF ADENOCARCINOMA OF UNKNOWN PRIMARY

The combination of 5-fluorouracil (5-FU), doxorubicin, and mitomycin (FAM) is often recommended for empiric management of patients with adenocarcinoma of unknown primary. This recommendation is based on the activity of FAM for adenocarcinomas of specific known sites of origin. A literature search disclosed no reports of the efficacy of FAM in this clinical entity. We report on 45 patients with biopsy-proven adenocarcinoma in whom investigation revealed no primary site and who were treated in a phase II trial with FAM. Of 43 evaluable patients, four achieved a complete tumor response, and nine obtained a partial response for an overall rate of 30%. The median survival for all patients was > 10 months. The median survival for patients whose tumors were unresponsive to FAM was 6 months, and median survival was .gtoreq. 14 months in patients with stable disease or FAM-responsive tumors. A phase III trial comparing no therapy or 5-FU with FAM is warranted. For patients not treated in an investigative setting, FAM compares favorably with reported series using other regimens.