Options mapped

Cancer of unknown primary (CUP): options by country

Treatment options for Cancer of unknown primary (CUP) mapped across 5 countries — covering chemotherapy, clinical trials, immunotherapy and radiation — each linking to its regulator, HTA, or guideline source, with questions to bring to your care team. Options, not recommendations.

Options mappedRare diseaseLast checked June 2026

Beyond approved care

In clinical trials & emerging options

Options that are not — or not yet — an approved standard where you live: studies, clinical trials, off-label use, and early evidence that your own oncologist may not raise. Each is labeled by how strong the evidence is. A listing here is information to research and discuss with your team; it does not mean a treatment is proven, safe for you, or available today.

In clinical trials

Site-directed therapy based on molecular tissue of origin, molecular targeted therapy, immunological therapy including checkpoint-inhibitor context, cytotoxic chemotherapy including platinum doublets with taxane or gemcitabine, clinical trials, palliative care/hospice for poor performance status or relapsing diseaseClinical trialClinical trialInvestigationalUnited States · Potential actionable targets in fetched source include MSI-H/dMMR, TMB-H, PD-1/PD-L1 expression, HER2 expression, NTRK/RET/EGFR pathogenic variants, BRAF V600E, ROS1 fusion, MET amplification, and homologous recombination repair deficiency/MSI; Newly diagnosed unfavorable CUP; biomarker-selected tumor-agnostic contexts; unfavorable CUP not eligible for molecular targeted therapy or immunotherapy. · NCI states cytotoxic chemotherapy can be palliative and that small studies underpin drug choices, with no randomized trials showing benefit over best supportive care. Do not infer cure, superiority, or individual eligibility from the category list. Confidence/conflicts: High for NCI treatment-category framework and biomarker caveats; individual FDA label details should be verified separately for each biomarker/drug. National Cancer Institute — national cancer agency evidence summary
CUP team/MDT investigation, PET-CT in selected settings, chemotherapy when considered for confirmed CUP, clinical trials, chemotherapy directed at specific treatable syndromes, radical local treatment for selected presentations, palliative/supportive careClinical trialClinical trialReported in a clinical trialUnited Kingdom · NICE recommends selected immunohistochemistry and points to NHS genomic testing information; no specific treatment biomarker approval extracted in this finding; MUO/provisional CUP/confirmed CUP; confirmed CUP systemic treatment; specific treatable syndromes; selected radical-treatment presentations; poor-prognosis presentations. · NICE CG104 is a diagnostic and management guideline, not a drug-specific technology appraisal. It does not state that a particular chemotherapy regimen is universally preferred for all CUP. Confidence/conflicts: High for NICE pathway and systemic-treatment principles; low for any specific drug/regimen because the guideline does not make a universal regimen claim. National Institute for Health and Care Excellence (NICE) — clinical guideline
Chemotherapy, immunotherapy, targeted cancer drugs, radiotherapy, surgery, clinical trials, treatment to control symptoms including pain medicines, anti-sickness drugs, steroids, bone-strengthening drugs such as denosumabClinical trialClinical trialReported in a clinical trialUnited Kingdom · Molecular or gene-expression profiling may identify proteins or gene changes relevant to targeted therapy; no specific biomarker-drug approval extracted in this finding; CUP general treatment decision-making; symptom-control and palliative contexts; selected surgery/radiotherapy contexts. · The page states treatment depends on where the cancer is, spread, likely origin, microscopy, health/fitness, and personal wishes. Do not represent any listed category as suitable for all CUP cases. Confidence/conflicts: High for treatment category mapping and caveats; NICE should be used for formal England/Wales guideline claims. Cancer Research UK — UK cancer information / treatment decision support
Pembrolizumab; cisplatin, cyclophosphamide, doxorubicin, epirubicin, fluorouracil, vincristine; gene panel array and blood sample collectionClinical trial · NCT03752333Clinical trialTrial only (registry)United Kingdom · Genomic testing/gene panel context; no specific treatment biomarker extracted for pembrolizumab record in this finding; CUP pembrolizumab trial; metastatic cancer of unknown site chemotherapy; genomic testing in CUP. · The chemotherapy record is old with unknown status; the genomic-testing study is diagnostic/evidence-generation, not treatment. NICE pathway guidance should be used for formal UK management claims. Confidence/conflicts: High for UK registry support; medium for current treatment access because two records are completed/old and genomic testing is not direct treatment. ClinicalTrials.gov — clinical-trial registry
Alectinib, vismodegib, ipatasertib, olaparib, erlotinib, bevacizumab, vemurafenib, cobimetinib, trastuzumab SC, pertuzumab, atezolizumab, entrectinib, ivosidenib, pemigatinib, carboplatin, paclitaxel, cisplatin, gemcitabineClinical trial · NCT03498521Clinical trialTrial only (registry)Japan · Molecularly selected/actionable-target context implied by assigned targeted therapies; exact biomarker assignment is protocol-specific and not fully extracted in this finding; Cancer of unknown primary site in a phase 2 targeted/immunotherapy versus platinum-based chemotherapy study. · The study is completed. The long intervention list reflects trial arms/protocol options, not a menu of approved CUP treatments in each country. Confidence/conflicts: High for multi-country trial-site support; no country approval or reimbursement claim is made. reimbursement not established in this jurisdiction trial-registry listing only — does not establish approval, reimbursement, or eligibility ClinicalTrials.gov — clinical-trial registry
Gemcitabine plus docetaxel; Cancer Type ID test versus empiric strategy; FOLFOXIRI versus cisplatin for grade 3 poorly differentiated neuroendocrine carcinoma of gastroenteropancreatic and unknown primary; paclitaxel/carboplatin with or without cetuximab; nivolumab plus ipilimumab; belinostat/carboplatin/paclitaxel versus carboplatin/paclitaxel; PIPAC registry including CUPClinical trial · NCT02590055Clinical trialTrial only (registry)Korea · CUP chemotherapy; CUP molecular-analysis strategy; metastatic grade 3 poorly differentiated neuroendocrine carcinoma of unknown/GEP primary; second-line CUP; peritoneal malignancy/PIPAC registry including CUP. · Several records are old, completed, or unknown status; some are broad neuroendocrine or peritoneal registry contexts rather than all-CUP treatment studies. Verify local current access separately. Confidence/conflicts: High for registry support; low-to-medium for current access because several records are old/unknown and none are regulator sources. ClinicalTrials.gov — clinical-trial registry
PaCIFiC-CUP DNA methylation classifier, 18F-FAPI PET, tissue-of-origin ORIGIN-PanCA profiling, pucotenlimab plus MRG002, molecularly selected targeted agents/ICIs including FGFR/IDH1/HER2/PARP/BRAF/MEK/EGFR/NTRK categories, tislelizumab plus chemotherapy, elective mucosal irradiation, PD-1 inhibitor plus nab-paclitaxel plus bevacizumabClinical trial · NCT06140992Clinical trialTrial only (registry)China · DNA methylation classification context; HER2-positive for pucotenlimab + MRG002; molecular characteristics in digestive/unknown-primary trial; gene mutation/immune evasion context in tislelizumab plus chemotherapy record; CUP classification/diagnostic workup; cancer of unknown primary site; HER2-positive CUP; unknown primary cancer within digestive cancers; bone metastases of unknown primary; head-and-neck cancer of unknown primary; CUP systemic therapy trial context. · Several studies are diagnostic/profiling rather than direct treatment; several have unknown or not-yet-recruiting status. Trial records are not the same as approved or reimbursed treatment. Confidence/conflicts: High for China-site registry support; no NMPA approval or current access claim is made. ClinicalTrials.gov — clinical-trial registry

A clinical-trial listing or early report shows an option is being studied — not that it works, that it is safe for any one person, or that a site is enrolling today. Whether any of these fits is a conversation for your oncology team and the trial team. Last checked June 2026.

What this page does

Maps options by country

It maps sourced options by country alongside diagnosis wording, stage, test results, specialists, and trial-search terms.

What it does not do

Does not choose treatment

It does not rank treatments, recommend a choice, or decide clinical fit.

Where it comes from

Built on trusted sources

Every option links to a trusted regulator, HTA, or guideline source, and the list grows as new sources pass verification.

Information to gather before the next visit

Has pathology and molecular profiling identified an actionable target or likely tissue of origin?
Is the goal site-directed therapy, tumor-agnostic targeted/immunotherapy, palliative chemotherapy, trial enrollment, or symptom control?
Does performance status support systemic therapy, or should supportive/palliative options be prioritized?
Has the case been classified as MUO, provisional CUP, or confirmed CUP after specialist review?

Trial-search terms to discuss

Cancer of unknown primary (CUP) clinical trial