For patients with a non-specific subset of CUP, but who have a favourable prognosis, a two-drug chemotherapy regimen as per the NCCN or ESMO guidelines should be considered (Culine et al. 2003, Gross-Goupil et al. 2012, Hainsworth et al. 2010).

Patients with localised disease may be suitable for local therapies such as high-dose (ablative) radiotherapy (Janssen et al. 2014) or surgical excision.

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 (Fizazi et al. 2015).

Using palliative radiotherapy to relieve local symptoms should also be considered where appropriate (Rich & Mendenhall 2016, Tey et al. 2017). In addition, other palliative procedures to assist in symptom control may also be considered in specific situations such as video-assisted thoracoscopic surgery pleurodesis or PleurX (if available) for interventional pain relief.

Timeframe for commencing treatment

Timeframes for diagnosis should be informed by evidence-based guidelines (where they exist) while recognising that shorter timelines for appropriate consultations and treatment can reduce patient distress.

Treatment of CUP should begin within two weeks of the decision to treat (four weeks from referral).