Funded by Cancer Australia and the Victorian Cancer Agency, this project is a prospective cohort study to create a national information resource that can improve the understanding of the molecular biology, clinical, quality of life and psychosocial characteristics of patients with Cancer of Unknown Primary (CUP). The SUPER study is active in 11 metropolitan and regional sites across Australia and aims to recruit a minimum of 350 participants.
CUP is a metastatic cancer where a primary tissue of origin (ToO) evades detection despite extensive clinical investigation. CUP is typically treated with empiric chemotherapy, which provides limited survival benefit for most patients. To resolve the likely ToO and to enable site specific therapy, we’ve involved gene-expression profiling by developing a ToO test (known as SUPERDx) and combined it with a variant mutational profiling test (known as Comprehensive Cancer Panel) to identify targeted treatments. The clinical utility of these tests is being evaluated by measuring the impact that identifying clinically actionable mutations has on clinical decision-making and how this information influences the clinical care of CUP patients.
The project also seeks to establish reliable estimates for quality of life and psychosocial needs across the CUP illness trajectory and to identify similarities and differences between CUP and advanced cancer patients with a known primary at baseline. Preliminary analysis of this data has identified significant differences in experience between CUP and non-CUP patients suggesting CUP patients require more psychosocial support and specific interventions to manage diagnostic uncertainty.
The long-term objective is to build a consumer representative group that will advocate for CUP patients in driving improvements in the provision of care. We have a consumer reference group consisting of three patients and two caregivers that meet regularly to provide input and feedback on research proposals, input into grant applications and liaise with similar groups from other countries to facilitate knowledge exchange.
There’s a lack of evidence on the patterns of care for CUP patients; however, Australian studies in Veteran’s Affairs clients have shown that patients with CUP have a higher use of GP consultations, palliative care, hospitalisations and emergency department visits three months before and after diagnosis, compared with metastatic cancer of the known primary site.
There’s a need to understand both the cost of treating CUP and whether treatment and treatment alternatives, including those that are molecularly guided, are cost effective. Furthermore, a comparison with advanced cancers with known primaries provides a useful reference to understand whether there is an additional burden of CUP.
We will undertake a health economic analysis that aims to:
Quantify the costs and timing of resources typically used in the diagnostic work-up of patients with CUP versus advanced cancers of known primaries.
Determine the cost-effectiveness of genomic sequencing for CUP patients versus no sequencing (usual care).