STEP 4: Treatment

Treatment options: Treatment should be individualised according to the clinicopathological subset and the suspected primary site.

Patients in the specific-CUP subset who have good-prognosis CUP should be treated the same as patients with equivalent known primary tumours with metastatic disease.

For patients with a non-specific subset of CUP, but who have a favourable prognosis, a two-drug chemotherapy regimen should be considered.

CUP patients identified in the poor-prognosis non-specific group can be considered for treatment with low-toxicity, palliative, chemotherapy regimens and/or best supportive care.

Palliative care: Early referral can improve quality of life and, in some cases, survival. Palliative care interventions should be considered for all patients diagnosed with CUP.


The lead clinician should discuss:

  • treatment options with the patient/carer including the intent of treatment and expected outcomes
  • advance care planning where appropriate
  • the treatment plan with the patient’s GP.

For detailed information see the ESMO Guidelines for Cancers of Unknown Primary Site.