A trial of ECX chemotherapy for cancer of unknown primary (CUP-ONE)

Cancer type:

Cancer of unknown primary (CUP)




Phase 2

This trial looked at epirubicin, cisplatin and capecitabine for cancer of unknown primary. It also looked at testing new ways to find out where the cancer started. It was supported by Cancer Research UK.

This trial was open for people to join between 2010 and 2014. The trial team first reported results at a conference in 2014, and reported further results in 2019.

More about this trial

Cancers are named according to where in the body they start. This is called the primary site. If cancer spreads to another part of the body, this is called secondary cancer. 

Sometimes people have secondary cancers in one or more parts of the body, but doctors are unable to find the primary cancer. This is called cancer of unknown primary (CUP) or unknown primary cancer. 

Doctors often use chemotherapy to treat cancer of unknown primary. In this trial, they looked at a combination of 3 chemotherapy drugs called epirubicin, cisplatin and capecitabine. This combination is known as ECX.

The aims of this trial were to find out:

  • how well ECX works for cancer of unknown primary
  • more about new ways of testing cancer tissue removed during a biopsy 

Summary of results

The trial team concluded that ECX chemotherapy worked for cancer of unknown primary and didn’t cause too many serious side effects.

About this trial
This trial was for people with a type of cancer of unknown primary (CUP) called a carcinoma Open a glossary item. They all had cancer that had spread to one or more parts of the body such as the liver, lungs, bones or brain. They hadn’t had treatment before. 

Everyone taking part had the same treatment – a combination of the chemotherapy drugs epirubicin, cisplatin and capecitabine (ECX). They had up to 8 cycles of treatment Open a glossary item.

The research team looked at how many people’s cancer had responded to treatment. They found that the cancer had:

  • gone away or got smaller in 17 people (31%)
  • stayed the same or continued to grow in 34 people (62%)

They weren’t able to assess how well the treatment worked in 4 people (7%).

They also looked at how long it was before the cancer started to grow, and it was nearly 7 months. And when they looked at how long people lived for, they found it was just over 10 months.

The trial team are now analysing all the information they gathered about changes in cells and genetic material. This may take some time, but we will update this page once the results are available.

Side effects
Everyone taking part had at least 1 side effect. Some were mild or short lived, but just under half (46%) had at least one side effect that was more serious. 

The most common of these side effects included:

  • feeling or being sick
  • diarrhoea
  • extreme tiredness (fatigue)

We have more information about the side effects of ECX in our Cancer Drugs section.

The trial team concluded that ECX chemotherapy worked for some people with CUP, and didn’t cause too many serious side effects. 

Where this information comes from    
We have based this summary on information from the research team. The information they sent us has been reviewed by independent specialists (peer reviewed Open a glossary item) and published in a medical journal. The figures we quote above were provided by the trial team who did the research. We have not analysed the data ourselves.

Recruitment start:

Recruitment end:

How to join a clinical trial

Please note: In order to join a trial you will need to discuss it with your doctor, unless otherwise specified.

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Chief Investigator

Dr Harpreet Wasan

Supported by

Cancer Research UK
Experimental Cancer Medicine Centre (ECMC)
NIHR Clinical Research Network: Cancer

Other information

This is Cancer Research UK trial number CRUK/08/006.

If you have questions about the trial please contact our cancer information nurses

Freephone 0808 800 4040

Last review date

CRUK internal database number:

Oracle 823

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Charlie took part in a trial to try new treatments

A picture of Charlie

“I think it’s really important that people keep signing up to these type of trials to push research forward.”

Last reviewed:

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