Materiały źródłowe

• #1 Merkel Cell Carcinoma Diagnosis & Treatment | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/merkel-cell-carcinoma/diagnosis-treatment-msk

  Memorial Sloan Kettering Cancer Center has the largest single-center experience with Merkel cell carcinoma of anywhere in the world. Our team includes practice-leading experts in surgery, pathology, radiation oncology, and medical oncology who use advanced diagnostic techniques and provide state-of-the-art surgical procedures and other therapies to treat Merkel cell carcinoma. […] Merkel cell carcinoma is frequently curable with surgical and nonsurgical therapies, particularly if caught early. Treatments are often highly individualized, depending on a patients general health, as well as the tumors location, size, depth, and degree of spread. […] Patients with Merkel cell carcinoma are usually first treated with surgery. Patients with more advanced disease may receive additional treatments such as radiation and drug therapy after or instead of surgery.

• #2 Treatment for Merkel Cell Carcinoma | Fred Hutchinson Cancer Center

  https://www.fredhutch.org/en/diseases/merkel-cell-carcinoma/treatment.html

  Fred Hutchinson Cancer Center has one of the most active Merkel cell carcinoma (MCC) clinical and research programs in the world, led by Paul T. Nghiem, MD, PhD, a dermatologist and scientist at the forefront of MCC care. Our experts offer comprehensive MCC treatment at the Multidisciplinary Skin Oncology Clinic, including advanced therapies and new options available only through clinical studies. […] We have dermatologists, surgeons, medical oncologists, radiation oncologists and nurses who specialize in MCC; the most advanced diagnostic, treatment and recovery programs; and extensive support. […] Fred Hutch patients have access to advanced therapies being explored in clinical studies for MCC conducted here and at UW Medicine. […] We view treatment as a collaborative effort. Your Fred Hutch physicians will explain all your options and recommend a treatment plan based on the location, size and stage of your cancer and your overall health.

• #3 Treating Merkel Cell Carcinoma Based on the Extent of the Cancer | American Cancer Society

  https://www.cancer.org/cancer/types/merkel-cell-skin-cancer/treating/common-treatments-by-extent.html

  Treatment of Merkel cell carcinoma (MCC) depends on how far the cancer has spread, so having the right tests done to determine if the cancer has spread and if so, how much (such as a sentinel lymph node biopsy or imaging tests like CT, MRI, or PET/CT scans), is very important. […] Other factors, such as where the tumor is and your age, personal preferences, and overall health, might also affect your treatment options. […] This is why it’s important to have a team of doctors experienced in treating this cancer, who can discuss which treatment options are likely to be best for you. […] Once Merkel cell cancer has been diagnosed with a biopsy, if there is no obvious spread to a different part of the body, a sentinel lymph biopsy (SLNB) and wide excision are typically done, most often during the same operation.

• #4 Merkel cell carcinoma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/merkel-cell-carcinoma/diagnosis-treatment/drc-20351036

  Treatment for Merkel cell carcinoma most often involves surgery to remove the cancer. If the cancer has spread beyond the skin, treatment may involve medicines or radiation. […] A surgeon removes the cancer along with a border of skin that doesn’t have cancer. For cancer that has spread to lymph nodes near the skin cancer, the surgeon removes those lymph nodes. This is called a lymph node dissection. […] Surgery most often involves a scalpel to cut away the cancer. Sometimes, a surgeon may use a procedure called Mohs surgery. […] Mohs surgery involves cutting away thin layers of skin. The surgeon uses a microscope to look at each layer for cancer. The process keeps going until there’s no more cancer. The goal of Mohs surgery is to remove all the cancer without harming the healthy skin around it.

• #5 Merkel Cell Carcinoma: Symptoms, Causes, Stages & Treatment

  https://my.clevelandclinic.org/health/diseases/17971-merkel-cell-carcinoma

  Treatments for Merkel cell carcinoma depend on the cancer stage. Early-stage Merkel cell carcinoma (stages 0 to II [2]) responds better to treatments than late-stage (stages III and IIIV [3 and 4]) cancers. […] Healthcare providers surgically remove Merkel cell carcinoma tumors. Surgical options include: Mohs surgery to remove the tumor and skin layers while preserving as much healthy tissue as possible. Wide local excision to remove the tumor and some surrounding healthy tissue. Lymph node dissection to surgically remove lymph nodes that have metastatic cancer cells. […] After surgery, you may need reconstructive surgery or a skin graft to repair and heal the treated area. You may also get cancer treatments to kill any lingering cancer cells in your body, such as: Chemotherapy. Immunotherapy. Radiation therapy.

• #6 Merkel Cell Carcinoma Diagnosis & Treatment | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/merkel-cell-carcinoma/diagnosis-treatment-msk

  Surgery to remove the primary tumor is the most common initial treatment for Merkel cell carcinoma. The surgeon typically removes a safety margin of up to 1 inch of normal skin around the tumor to ensure that all cancer cells have been removed. […] Surgical removal of the tumor is usually done at the same time as a sentinel lymph node biopsy, which determines if the cancer has spread to nearby lymph nodes. […] If the biopsy indicates that the cancer has spread to the sentinel lymph node, most patients are offered radiation therapy. Spread to lymph nodes is found in more than one-third of patients. […] Localized radiation therapy can be used to destroy any remaining cancer cells following surgery. Radiation can also be used to treat the area surrounding lymph nodes. […] A variety of drugs can be used to treat Merkel cell carcinoma. Chemotherapy was traditionally used, but in recent years, immunotherapy has emerged as the most effective strategy to treat patients with more advanced Merkel cell carcinoma. Immunotherapy is most often used for Merkel cell carcinoma in combination with surgery, radiation therapy, or both. […] Research studies are ongoing to determine if immunotherapy may be helpful in reducing the risk that the cancer will return in people with earlier stages of Merkel cell carcinoma.

• #7 Skin Cancer – Merkel Cell Carcinoma Treatment & Management: Approach Considerations, Pharmacologic Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/870538-treatment

  The primary tumor should be excised with 1-2 cm margins. […] In patients with regional lymph node involvement, radical lymphadenectomy is recommended. […] Adjuvant radiation therapy may be considered in patients with multiple affected lymph nodes of extracapsular extension. […] In unresectable metastatic Merkel cell carcinoma, monochemotherapy or polychemotherapy achieve high remission rates; however, responses are usually short-lived. […] Treatment within clinical trials is regarded as a standard of care in disseminated Merkel cell carcinoma. […] A study by Bishop et al indicated that treatment for Merkel cell carcinoma of the head and neck that includes radiation therapy provides effective local and regional control of the disease. […] A study by Chen et al of 4815 patients with Merkel cell carcinoma of the head and neck indicated that postoperative adjuvant therapy with chemoradiotherapy offers greater improvement in the overall survival rate than does postoperative radiotherapy alone in patients with male sex, tumor size of at least 3 cm, and positive margins.

• #8 Merkel cell carcinoma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/merkel-cell-carcinoma/diagnosis-treatment/drc-20351036

  Treatment for Merkel cell carcinoma most often involves surgery to remove the cancer. If the cancer has spread beyond the skin, treatment may involve medicines or radiation. […] A surgeon removes the cancer along with a border of skin that doesn’t have cancer. For cancer that has spread to lymph nodes near the skin cancer, the surgeon removes those lymph nodes. This is called a lymph node dissection. […] Surgery most often involves a scalpel to cut away the cancer. Sometimes, a surgeon may use a procedure called Mohs surgery. […] Mohs surgery involves cutting away thin layers of skin. The surgeon uses a microscope to look at each layer for cancer. The process keeps going until there’s no more cancer. The goal of Mohs surgery is to remove all the cancer without harming the healthy skin around it.

• #9 Merkel Cell Carcinoma Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/skin/hp/merkel-cell-treatment-pdq

  There are two competing philosophies about the most appropriate method of treating MCC. In the first philosophy, MCC is treated like other nonmelanoma skin cancers, with an emphasis on treating local-regional disease with surgery and radiation therapy, as appropriate. In the second philosophy, MCC is treated according to its biological features. This approach makes it analogous to small cell lung cancer, which is assumed to be a systemic disease, and leads to a more routine recommendation of systematic adjuvant chemotherapy. […] […] Given the propensity of MCC to recur locally (sometimes with satellite lesions and/or in-transit metastases), wide local excision to reduce the risk of local recurrence has been recommended for patients with clinical stage I or stage II disease. […] […] In some case series, local-regional recurrence rates are high when pathological nodal staging is omitted. Surgical nodal staging in clinically negative patients has identified positive nodes in at least 25% to 35% of patients. […]

• #10 Diagnosis and treatment of Merkel cell carcinoma: European consensus-based interdisciplinary guideline – Update 2022. – Melanoma Institute Australia

  https://melanoma.org.au/paper/diagnosis-and-treatment-of-merkel-cell-carcinoma-european-consensus-based-interdisciplinary-guideline-update-2022/

  Merkel cell carcinoma (MCC) is a rare skin cancer, accounting for less than 1% of all cutaneous malignancies. […] For localised MCC, first-line treatment is surgical excision with postoperative margin assessment followed by adjuvant radiation therapy (RT). […] Sentinel lymph node biopsy is recommended in all patients with MCC without clinically detectable lymph nodes or distant metastasis. […] Adjuvant RT alone, eventually combined with complete lymph nodes dissection is proposed in case of micrometastatic nodal involvement. […] In case of macroscopic nodal involvement, the standard of care is complete lymph nodes dissection potentially followed by post-operative RT. […] Immunotherapy with anti-PD-(L)1 antibodies should be offered as first-line systemic treatment in advanced MCC. […] Chemotherapy can be used when patients fail to respond or are intolerant for anti-PD-(L)1 immunotherapy or clinical trials.

• #11 Treatments for Merkel cell carcinoma | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/skin-non-melanoma/treatment/merkel-cell-carcinoma

  A lymph node dissection removes lymph nodes that may contain cancer. It is done when the doctor can feel enlarged lymph nodes or the sentinel lymph node biopsy shows that the sentinel lymph node contains cancer. A lymph node dissection is done after the main tumour has been removed. […] Radiation therapy uses high-energy rays or particles to destroy cancer cells. It is often directed toward nearby lymph nodes or the area where lymph nodes were removed. You may have radiation therapy to: destroy any remaining cancer cells left behind after surgery and reduce the risk of the cancer recurring (called adjuvant therapy), treat the cancer if surgery can’t be done, treat Merkel cell carcinoma that has come back after surgery, relieve symptoms of advanced Merkel cell carcinoma (called palliative therapy).

• #12 Merkel Cell Carcinoma of the Skin – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482329/

  If the disease is limited to locoregional lymph nodes, a complete lymph node dissection should be performed and/or radiotherapy to the nodal basin. […] Those with metastatic disease are best managed through a multidisciplinary tumor board. NCCN guidelines recommend a clinical trial if available. Alternatively, systemic therapy, radiation therapy, and/or surgery may be considered alone or in combination. Currently available systemic agents include cytotoxic chemotherapy and immunotherapy. Unfortunately, because of the aggressive nature of the disease, cytotoxic chemotherapy has been shown to provide patients with only three months of progression-free survival. However, immune-based therapies have demonstrated promising results in clinical trials. Specifically, pembrolizumab, nivolumab, and avelumab are anti-PD-1 and PD-L1 antibodies that function to restore active T cell response against the tumor. One study showed a median progression-free survival of nine months with pembrolizumab therapy in patients with MCC. […] Patients with a diagnosis of MCC require a multidisciplinary approach and require close follow-up with their dermatologist. Fortunately, clinical trials utilizing immunomodulating agents such as anti-PD-1 and PD-L1 antibodies have shown great promise in providing improved progression-free survival.

• #13 Merkel Cell Carcinoma: Symptoms, Causes, Stages & Treatment

  https://my.clevelandclinic.org/health/diseases/17971-merkel-cell-carcinoma

  Treatments for Merkel cell carcinoma depend on the cancer stage. Early-stage Merkel cell carcinoma (stages 0 to II [2]) responds better to treatments than late-stage (stages III and IIIV [3 and 4]) cancers. […] Healthcare providers surgically remove Merkel cell carcinoma tumors. Surgical options include: Mohs surgery to remove the tumor and skin layers while preserving as much healthy tissue as possible. Wide local excision to remove the tumor and some surrounding healthy tissue. Lymph node dissection to surgically remove lymph nodes that have metastatic cancer cells. […] After surgery, you may need reconstructive surgery or a skin graft to repair and heal the treated area. You may also get cancer treatments to kill any lingering cancer cells in your body, such as: Chemotherapy. Immunotherapy. Radiation therapy.

• #14 Merkel cell carcinoma | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/neuroendocrine-tumours-nets/types/merkel-cell-skin-cancer

  Radiotherapy uses high energy x-rays to kill cancer cells. You might have it after surgery to kill any MCC cells that might have been left behind. This is called adjuvant treatment. It lowers the risk of the cancer coming back. You usually have it once a day, Monday to Friday, for over 5 weeks. […] You may also have radiotherapy on its own as your main treatment if you cant have surgery for any reason. […] Treatment for MCC that has spread to other parts of the body wont get rid of the cancer. But it can control your symptoms and help you feel better. Treatment you might have includes: […] Immunotherapy uses our immune system to fight cancer. It works by helping the immune system to recognise and attack cancer cells. […] You might have a type of immunotherapy called avelumab (Bavencio). You have avelumab as a drip into your bloodstream every 2 weeks. You usually have treatment for as long as it helps you, and as long as you are not experiencing too many side effects.

• #15 Merkel Cell Carcinoma Treatment

  https://www.skincancer.org/skin-cancer-information/merkel-cell-carcinoma/mcc-treatment/

  Merkel cell carcinoma is rare and dangerous but treatable, especially when found at an early stage. […] Because MCC is such an uncommon form of skin cancer, it is best to seek treatment at an academic center with physicians who have specialized expertise in caring for people with this particular disease. A multi-disciplinary team experienced in the care of MCC is recommended. Dermatologists, surgeons, medical oncologists and radiation oncologists need to confer to determine the best plan for a given case. […] While treatment options for MCC depend on the stage of the disease and the overall health of the patient, treatment includes surgical removal of the primary tumor along with: Radiation, Immunotherapy, Chemotherapy. […] MCC is highly responsive to radiation, a localized treatment that uses high-energy rays such as X-rays or particles such as electrons to penetrate the tumors and destroy them or keep them from growing.

• #16 Merkel Cell Carcinoma of the Skin – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482329/

  Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine tumor of the skin with increasing incidence. […] Treatment consists of wide local excision with or without adjuvant radiotherapy for the local disease. New therapies for metastatic MCC have shown promise and include immune-based therapies. […] Treatment of Merkel cell carcinoma consists of wide local excision of the primary tumor with 1-2 cm margins to investing fascia of muscle or pericranium when feasible. Mohs micrographic surgery may be considered provided it does not interfere with SLNB. Adjuvant radiation therapy to the primary tumor site may be beneficial and should be considered in specific cases; it may be appropriate for low-risk patients with a small primary tumor (less than 1 cm) and no other adverse risk factors (such as immunosuppression or lymphovascular invasion).

• #17 Skin Cancer – Merkel Cell Carcinoma Treatment & Management: Approach Considerations, Pharmacologic Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/870538-treatment

  For patients with operable disease, most agree that surgery is the treatment of choice. […] Aggressive wide local excision is the treatment of choice for the primary tumor. […] Merkel cell carcinoma (MCC) is a radiosensitive tumor, and radiotherapy is currently used as an adjuvant. […] Most clinical studies demonstrate better local control rates with adjuvant radiotherapy after surgery. […] Adjuvant radiation therapy to the primary site and regional nodes is generally recommended in addition to neck dissection. […] Chemotherapy is generally not currently advocated for stage II disease. […] The development of distant metastases portends a poor prognosis, with a mean life expectancy of 5 months. […] Many types of chemotherapeutic agents have been used with brief success in treating stage III disease, with no increase in the survival rate. […] The role of radiation therapy in disseminated disease is to achieve palliation. […] The role of adjuvant chemotherapy remains unresolved. […] Palliative chemotherapy is often used for unresectable or recurrent disease.

• #18 Merkel cell carcinoma | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/neuroendocrine-tumours-nets/types/merkel-cell-skin-cancer

  Radiotherapy uses high energy x-rays to kill cancer cells. You might have it after surgery to kill any MCC cells that might have been left behind. This is called adjuvant treatment. It lowers the risk of the cancer coming back. You usually have it once a day, Monday to Friday, for over 5 weeks. […] You may also have radiotherapy on its own as your main treatment if you cant have surgery for any reason. […] Treatment for MCC that has spread to other parts of the body wont get rid of the cancer. But it can control your symptoms and help you feel better. Treatment you might have includes: […] Immunotherapy uses our immune system to fight cancer. It works by helping the immune system to recognise and attack cancer cells. […] You might have a type of immunotherapy called avelumab (Bavencio). You have avelumab as a drip into your bloodstream every 2 weeks. You usually have treatment for as long as it helps you, and as long as you are not experiencing too many side effects.

• #19 Merkel Cell Carcinoma

  https://neuroendocrine.org.au/what-are-nets/merkel-cell-carcinoma/

  Treatment options for Metastatic Disease (cancer that has spread around the body): […] National Comprehensive Cancer Network (NCCN) guidelines recommend patients with MCC which has spread around the body, to have systemic therapy (treat cancer cells wherever they may be) using chemotherapy or immunotherapy or combination of therapies such as systemic, resection and / or RT. Where possible, due to the advances in MCC treatments, patients should be considered for participation in clinical trials. […] Chemotherapy is currently recommended in metastatic MCC for a palliative role (to control symptoms caused by MCC) and used when there has been failure of Immunotherapy to work, or if the patient has other health issues where Immunotherapy shouldnt be used. […] Radiation Therapy is given when there is spread to reduce the symptoms (such as pain) in bone metastases or large lymph nodes. It can also help in altering the immune response. This is because MCC is very sensitive to RT and can reduce the size of the cancer, relieving symptoms and has very limited side effects at the doses needed.

• #20 Merkel Cell Carcinoma Diagnosis & Treatment | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/merkel-cell-carcinoma/diagnosis-treatment-msk

  Surgery to remove the primary tumor is the most common initial treatment for Merkel cell carcinoma. The surgeon typically removes a safety margin of up to 1 inch of normal skin around the tumor to ensure that all cancer cells have been removed. […] Surgical removal of the tumor is usually done at the same time as a sentinel lymph node biopsy, which determines if the cancer has spread to nearby lymph nodes. […] If the biopsy indicates that the cancer has spread to the sentinel lymph node, most patients are offered radiation therapy. Spread to lymph nodes is found in more than one-third of patients. […] Localized radiation therapy can be used to destroy any remaining cancer cells following surgery. Radiation can also be used to treat the area surrounding lymph nodes. […] A variety of drugs can be used to treat Merkel cell carcinoma. Chemotherapy was traditionally used, but in recent years, immunotherapy has emerged as the most effective strategy to treat patients with more advanced Merkel cell carcinoma. Immunotherapy is most often used for Merkel cell carcinoma in combination with surgery, radiation therapy, or both. […] Research studies are ongoing to determine if immunotherapy may be helpful in reducing the risk that the cancer will return in people with earlier stages of Merkel cell carcinoma.

• #21 Merkel Cell Carcinoma – EyeWiki

  https://eyewiki.org/Merkel_Cell_Carcinoma

  Management consists mainly of surgical excision and pathologic nodal staging. Mohs micrographic surgery or frozen sections are used for histopathologic confirmation of disease free margins. For other areas of the body, suggested margins are 1-2 cm, an area that is often not practical for periocular lesions. Rather, for eyelid Merkel cell carcinomas, a more conservative approach with surgical margins as small as 5 mm is acceptable, although the exact recommended margins remain controversial and vary based on patient and tumor characteristics. […] NCCN guidelines recommend adjunctive radiotherapy for all stages of MCC, ideally within 4-6 weeks of surgical excision. Data regarding survival benefit with the use of post-op adjuvant radiation vs surgical excision alone is conflicting; however, most studies agree that adjuvant radiotherapy significantly lowers 5-year risk of local recurrence compared to surgery alone.

• #22 Merkel cell carcinoma | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/neuroendocrine-tumours-nets/types/merkel-cell-skin-cancer

  Radiotherapy uses high energy x-rays to kill cancer cells. You might have it after surgery to kill any MCC cells that might have been left behind. This is called adjuvant treatment. It lowers the risk of the cancer coming back. You usually have it once a day, Monday to Friday, for over 5 weeks. […] You may also have radiotherapy on its own as your main treatment if you cant have surgery for any reason. […] Treatment for MCC that has spread to other parts of the body wont get rid of the cancer. But it can control your symptoms and help you feel better. Treatment you might have includes: […] Immunotherapy uses our immune system to fight cancer. It works by helping the immune system to recognise and attack cancer cells. […] You might have a type of immunotherapy called avelumab (Bavencio). You have avelumab as a drip into your bloodstream every 2 weeks. You usually have treatment for as long as it helps you, and as long as you are not experiencing too many side effects.

• #23 Skin cancer types: Merkel cell carcinoma diagnosis & treatment

  https://www.aad.org/public/diseases/skin-cancer/types/common/merkel-cell/treatment

  To lower the risk of the cancer returning after surgery, doctors often recommend having another type of treatment. Called adjuvant therapy, this helps to kill any remaining cancer cells. Radiation therapy is often the treatment given after surgery for MCC. […] If you have MCC in stage I, II, or III that surgery cannot remove, you may receive only radiation treatments. […] Immunotherapy: When MCC spreads, doctors often recommend this type of treatment. These medications can target and destroy cancer cells. […] For patients with advanced (has spread) MCC, the results from this type of treatment have been encouraging. […] Avelumab is first drug ever approved to treat to treat MCC. Its currently approved for patients in stage IV who are 12 years of age or older. […] Clinical trial: Other medications known as immunotherapies are being tested in clinical trials for MCC. For some patients diagnosed with MCC, joining a clinical trial may a treatment option.

• #24 Immunotherapy for Merkel cell carcinoma: a turning point in patient care | Journal for ImmunoTherapy of Cancer

  https://jitc.bmj.com/content/6/1/23

  Merkel Cell carcinoma (MCC) is a rare but aggressive cancer, with an estimated disease-associated mortality as high as 46%. MCC has proven to be an immunologically responsive disease and the advent of immune checkpoint inhibitors has changed the treatment landscape for patients with advanced MCC. […] In patients with primary, or localized MCC, which accounts for 6570% of patients at diagnosis, typically undergo surgical resection followed by adjuvant radiotherapy to prevent recurrence at the primary site and involved regional lymphatics. […] Study data do not support the routine use of adjuvant systemic chemotherapy for high-risk resected MCC and, therefore, adjuvant chemotherapy is not included in the NCCN guidelines. […] Until recently, chemotherapy has been a mainstay of therapy for patients with advanced MCC.

• #25 Treatment for Merkel Cell Carcinoma | Fred Hutchinson Cancer Center

  https://www.fredhutch.org/en/diseases/merkel-cell-carcinoma/treatment.html

  If your cancer has spread to distant parts of your body (stage IV), you are likely to need systemic therapy. […] The most promising emerging option for MCC is a class of drugs called immune checkpoint inhibitors (ICIs). […] In March 2017, the U.S. Food and Drug Administration approved the first treatment for metastatic MCC: the ICI avelumab (Bavencio). […] Many patients not only did well, without evidence of active cancer, but also had very good quality of life while receiving this therapy. […] In general, chemotherapy is reserved for late stages of MCC, when immune therapies are not an option.

• #26 Merkel Cell Carcinoma Treatment

  https://www.skincancer.org/skin-cancer-information/merkel-cell-carcinoma/mcc-treatment/

  If the cancer has reached an advanced stage, treatments including immunotherapy, chemotherapies and participation in a clinical trial may be recommended as potential options. […] Immunotherapies boost the body’s ability to fight cancers by using synthetic versions of immune system proteins, or by enabling the release of cells that attack tumors. These therapies are effective when used alone or in combinations. […] In 2017, researchers achieved promising success in treating advanced stage MCC with a revolutionary immunotherapy treatment known as checkpoint blockade therapy. […] Avelumab (Bavencio®) was the first immune checkpoint inhibitor approved by the FDA (in 2017) for the treatment of adults and pediatric patients age 12 and older with metastatic MCC. […] The 2018 National Comprehensive Cancer Network (NCCN) guidelines list immunotherapy agents as preferred treatment options for patients with advanced MCC. Chemotherapy is now generally recommended for patients who are not eligible for immunotherapy or those who did not respond to immunotherapy. […] Doctors can use chemotherapy in a “palliative” manner temporarily to decrease pain and improve comfort and mobility for patients.

• #27 Treating Merkel Cell Carcinoma Based on the Extent of the Cancer | American Cancer Society

  https://www.cancer.org/cancer/types/merkel-cell-skin-cancer/treating/common-treatments-by-extent.html

  After the biopsy, the main tumor on the skin is treated with surgery (usually wide local excision) to try to remove all of the cancer. […] If it’s not clear that the cancer can be removed completely, immunotherapy might be tried first to try to shrink it and make surgery easier. […] A few weeks after surgery, radiation therapy is often given to the area where the tumor was removed, especially if there is a higher risk of the cancer coming back. […] Options might include lymph node dissection to remove them, radiation therapy, or lymph node dissection followed by radiation therapy. […] Treatment options might include surgery, radiation therapy, immunotherapy, chemotherapy, or some combination of these. […] Treatment with one of the immunotherapy drugs known as checkpoint inhibitors can often shrink MCC tumors.

• #28 Immunotherapeutic Advances in the Treatment of Merkel Cell Carcinoma – touchONCOLOGY

  https://touchoncology.com/dermatological-cancers/journal-articles/immunotherapeutic-advances-in-the-treatment-of-merkel-cell-carcinoma/

  Currently, the National Comprehensive Cancer Network (NCCN) 1.2023 guidelines recommend avelumab, nivolumab or pembrolizumab for disseminated MCC, while the recently approved agent retifanlimab is recommended for patients not amenable to surgery or RT. […] Avelumab, a PD-L1-blocking antibody, has shown safety and efficacy in the setting of metastatic MCC (mMCC). […] Pembrolizumab is another PD-1 receptor-targeting monoclonal antibody that has been shown to be safe and effective in mMMC. […] Nivolumab monotherapy has been explored as a neoadjuvant and adjuvant therapy in MCC. […] The combination of ipilimumab and nivolumab immunotherapy has been demonstrated to be effective in the management of advanced MCC. […] Retifanlimab-dlwr, an anti-PD-1 monoclonal antibody, received accelerated approval for patients with metastatic or recurrent locally advanced MCC earlier this year. […] In the realm of the treatment of MCC, immunotherapy has emerged as a promising strategy, leveraging the body’s immune system to combat and eliminate cancer cells.

• #29 Immunotherapeutic Advances in the Treatment of Merkel Cell Carcinoma – touchONCOLOGY

  https://touchoncology.com/dermatological-cancers/journal-articles/immunotherapeutic-advances-in-the-treatment-of-merkel-cell-carcinoma/

  Currently, the National Comprehensive Cancer Network (NCCN) 1.2023 guidelines recommend avelumab, nivolumab or pembrolizumab for disseminated MCC, while the recently approved agent retifanlimab is recommended for patients not amenable to surgery or RT. […] Avelumab, a PD-L1-blocking antibody, has shown safety and efficacy in the setting of metastatic MCC (mMCC). […] Pembrolizumab is another PD-1 receptor-targeting monoclonal antibody that has been shown to be safe and effective in mMMC. […] Nivolumab monotherapy has been explored as a neoadjuvant and adjuvant therapy in MCC. […] The combination of ipilimumab and nivolumab immunotherapy has been demonstrated to be effective in the management of advanced MCC. […] Retifanlimab-dlwr, an anti-PD-1 monoclonal antibody, received accelerated approval for patients with metastatic or recurrent locally advanced MCC earlier this year. […] In the realm of the treatment of MCC, immunotherapy has emerged as a promising strategy, leveraging the body’s immune system to combat and eliminate cancer cells.

• #30 Immunotherapeutic Advances in the Treatment of Merkel Cell Carcinoma – touchONCOLOGY

  https://touchoncology.com/dermatological-cancers/journal-articles/immunotherapeutic-advances-in-the-treatment-of-merkel-cell-carcinoma/

  Currently, the National Comprehensive Cancer Network (NCCN) 1.2023 guidelines recommend avelumab, nivolumab or pembrolizumab for disseminated MCC, while the recently approved agent retifanlimab is recommended for patients not amenable to surgery or RT. […] Avelumab, a PD-L1-blocking antibody, has shown safety and efficacy in the setting of metastatic MCC (mMCC). […] Pembrolizumab is another PD-1 receptor-targeting monoclonal antibody that has been shown to be safe and effective in mMMC. […] Nivolumab monotherapy has been explored as a neoadjuvant and adjuvant therapy in MCC. […] The combination of ipilimumab and nivolumab immunotherapy has been demonstrated to be effective in the management of advanced MCC. […] Retifanlimab-dlwr, an anti-PD-1 monoclonal antibody, received accelerated approval for patients with metastatic or recurrent locally advanced MCC earlier this year. […] In the realm of the treatment of MCC, immunotherapy has emerged as a promising strategy, leveraging the body’s immune system to combat and eliminate cancer cells.

• #31 Immunotherapy for Merkel cell carcinoma: a turning point in patient care | Journal for ImmunoTherapy of Cancer

  https://jitc.bmj.com/content/6/1/23

  The success of immune checkpoint inhibitors in several cancer types and the immune susceptibility of MCC has renewed hope for developing more effective treatment options for patients with MCC. […] Pembrolizumab was the first immune checkpoint inhibitor to demonstrate objective tumor regressions in patients with MCC. […] In March 2017, a PD-L1 monoclonal antibody, avelumab, became the first FDA-approved treatment for MCC. […] Nivolumab is another monoclonal PD-1 antibody with clinical activity in advanced MCC. […] Immunomodulatory therapies have had a profound impact on the cancer treatment landscape, and MCC is no exception. […] The results of the trials described above led to the inclusion of avelumab, pembrolizumab and nivolumab in the January 2018 NCCN guidelines as preferred treatment options for patients with disseminated disease. […] These findings require validation in larger patient cohorts, but suggest that immune checkpoint blockade may be most efficacious when used in the first-line setting. […] The neoadjuvant setting also provides an opportunity for administration of immune checkpoint inhibition.

• #32 The biology and treatment of Merkel cell carcinoma: current understanding and research priorities | Nature Reviews Clinical Oncology

  https://www.nature.com/articles/s41571-018-0103-2

  Surgical excision with 12 cm margins, typically followed by radiotherapy, are the mainstays of the management of primary MCCs. […] Systemic therapies for patients with MCC have traditionally included chemotherapy, such as platinum-based drugs, taxanes, anthracyclines and etoposide. […] In the past 2 years, the anti-PD-L1 antibody avelumab has been approved as a therapy for patients with metastatic MCC by the FDA, the European Medicines Agency (EMA), Swissmedic and the Japanese Ministry of Health, Labor and Welfare. […] Several immunotherapies that act through mechanisms other than inhibition of PD-1 or PD-L1 are currently under investigation for MCC. […] Alternatives to ICI are needed for patients with advanced-stage MCC who are immunosuppressed (and thus ineligible) or who do not respond to ICI.

• #33 Merkel Cell Carcinoma Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/skin/hp/merkel-cell-treatment-pdq

  Treatment options for stage III MCC include the following: Margin-negative local excision, attempting to maintain function. Sentinel lymph node procedure, possibly followed by more definitive regional node surgery if positive node(s) are found. […] […] Treatment options for stage IV MCC include the following: Single-agent immunotherapy. Palliation with chemotherapy and/or surgery and/or radiation therapy as clinically appropriate. […] […] For patients with distant disease, several single-agent immunotherapies have elicited durable responses and are the recommended first-line systemic therapy option for most patients. […] […] Recommendations and outcomes of various treatments for patients with MCC are included in many large case series and several single-arm phase II clinical trials. Patients should strongly consider enrolling in clinical trials. […]

• #34 Merkel Cell Carcinoma Treatment (PDQ®): Treatment – Health Professional Information [NCI] | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.merkel-cell-carcinoma-treatment-pdq%C2%AE-treatment-health-professional-information-nci.ncicdr0000062884

  Approximately 70% to 80% of MCC cases in the United States are caused by Merkel cell polyomavirus (MCPyV). Within virus-positive MCCs, the viral oncoproteins (T antigens) are constitutively expressed and promote growth. […] Several single-agent immune checkpoint inhibitors have shown improved survival and tolerability in patients with advanced MCC, compared with the chemotherapy that was used in historical controls. Therefore, immune checkpoint inhibitors are considered the recommended first-line treatment for most patients. […] Avelumab is a human antiprogrammed death ligand-1 (PD-L1) monoclonal antibody. […] Pembrolizumab is a humanized IgG4 antiprogrammed cell death-1 (PD-1) monoclonal antibody. […] Retifanlimab is an antiPD-1 monoclonal antibody. […] Single-agent immunotherapy is the preferred initial systemic therapy for patients with metastatic disease. Chemotherapy may be considered for patients with stage IV disease who have a good performance status and are either ineligible for or have disease progression while receiving immunotherapy.

• #35 Merkel Cell Carcinoma Treatment

  https://www.skincancer.org/skin-cancer-information/merkel-cell-carcinoma/mcc-treatment/

  If the cancer has reached an advanced stage, treatments including immunotherapy, chemotherapies and participation in a clinical trial may be recommended as potential options. […] Immunotherapies boost the body’s ability to fight cancers by using synthetic versions of immune system proteins, or by enabling the release of cells that attack tumors. These therapies are effective when used alone or in combinations. […] In 2017, researchers achieved promising success in treating advanced stage MCC with a revolutionary immunotherapy treatment known as checkpoint blockade therapy. […] Avelumab (Bavencio®) was the first immune checkpoint inhibitor approved by the FDA (in 2017) for the treatment of adults and pediatric patients age 12 and older with metastatic MCC. […] The 2018 National Comprehensive Cancer Network (NCCN) guidelines list immunotherapy agents as preferred treatment options for patients with advanced MCC. Chemotherapy is now generally recommended for patients who are not eligible for immunotherapy or those who did not respond to immunotherapy. […] Doctors can use chemotherapy in a “palliative” manner temporarily to decrease pain and improve comfort and mobility for patients.

• #36 Chemotherapy for Merkel Cell Carcinoma | American Cancer Society

  https://www.cancer.org/cancer/types/merkel-cell-skin-cancer/treating/chemotherapy.html

  Chemotherapy (chemo) for Merkel cell carcinoma uses anti-cancer drugs that are most often given into a vein (IV) or given by mouth. These drugs travel through the bloodstream to all parts of the body. This makes chemo useful for treating cancers that have spread to other organs. […] Chemo is most likely to be helpful for Merkel cell cancer that has spread to other parts of the body. In the past, chemo was often the main treatment for MCC that had spread. But newer immunotherapy drugs tend to work better, so they are now more likely to be the first treatment for advanced cancers. […] Chemo might still be used in some situations to treat advanced MCC, such as: If a person can’t have immunotherapy for some reason. If the cancer is no longer responding to immunotherapy. […] The most common chemo drugs for MCCs that have spread include: Cisplatin, Carboplatin, Etoposide, Topotecan.

• #37 Chemotherapy for Merkel Cell Carcinoma | American Cancer Society

  https://www.cancer.org/cancer/types/merkel-cell-skin-cancer/treating/chemotherapy.html

  Chemotherapy (chemo) for Merkel cell carcinoma uses anti-cancer drugs that are most often given into a vein (IV) or given by mouth. These drugs travel through the bloodstream to all parts of the body. This makes chemo useful for treating cancers that have spread to other organs. […] Chemo is most likely to be helpful for Merkel cell cancer that has spread to other parts of the body. In the past, chemo was often the main treatment for MCC that had spread. But newer immunotherapy drugs tend to work better, so they are now more likely to be the first treatment for advanced cancers. […] Chemo might still be used in some situations to treat advanced MCC, such as: If a person can’t have immunotherapy for some reason. If the cancer is no longer responding to immunotherapy. […] The most common chemo drugs for MCCs that have spread include: Cisplatin, Carboplatin, Etoposide, Topotecan.

• #38 Merkel Cell Carcinoma Treatment

  https://www.skincancer.org/skin-cancer-information/merkel-cell-carcinoma/mcc-treatment/

  If the cancer has reached an advanced stage, treatments including immunotherapy, chemotherapies and participation in a clinical trial may be recommended as potential options. […] Immunotherapies boost the body’s ability to fight cancers by using synthetic versions of immune system proteins, or by enabling the release of cells that attack tumors. These therapies are effective when used alone or in combinations. […] In 2017, researchers achieved promising success in treating advanced stage MCC with a revolutionary immunotherapy treatment known as checkpoint blockade therapy. […] Avelumab (Bavencio®) was the first immune checkpoint inhibitor approved by the FDA (in 2017) for the treatment of adults and pediatric patients age 12 and older with metastatic MCC. […] The 2018 National Comprehensive Cancer Network (NCCN) guidelines list immunotherapy agents as preferred treatment options for patients with advanced MCC. Chemotherapy is now generally recommended for patients who are not eligible for immunotherapy or those who did not respond to immunotherapy. […] Doctors can use chemotherapy in a “palliative” manner temporarily to decrease pain and improve comfort and mobility for patients.

• #39 Chemotherapy for Merkel Cell Carcinoma | American Cancer Society

  https://www.cancer.org/cancer/types/merkel-cell-skin-cancer/treating/chemotherapy.html

  Chemotherapy (chemo) for Merkel cell carcinoma uses anti-cancer drugs that are most often given into a vein (IV) or given by mouth. These drugs travel through the bloodstream to all parts of the body. This makes chemo useful for treating cancers that have spread to other organs. […] Chemo is most likely to be helpful for Merkel cell cancer that has spread to other parts of the body. In the past, chemo was often the main treatment for MCC that had spread. But newer immunotherapy drugs tend to work better, so they are now more likely to be the first treatment for advanced cancers. […] Chemo might still be used in some situations to treat advanced MCC, such as: If a person can’t have immunotherapy for some reason. If the cancer is no longer responding to immunotherapy. […] The most common chemo drugs for MCCs that have spread include: Cisplatin, Carboplatin, Etoposide, Topotecan.

• #40 Chemotherapy for Merkel Cell Carcinoma | American Cancer Society

  https://www.cancer.org/cancer/types/merkel-cell-skin-cancer/treating/chemotherapy.html

  Most often, either cisplatin or carboplatin is used, often along with etoposide. Topotecan by itself tends to have fewer serious side effects, so it might be a better option for some people who are older or have other serious health problems. […] These drugs are given into a vein (IV), usually once every few weeks. They can often shrink MCC tumors for a time (or at least slow their growth and spread) and help relieve some symptoms. But after a while the cancer tends to start growing again. […] Chemo drugs can cause side effects. These depend on the type and dose of the drugs given and how long they are used. Common side effects can include: Hair loss, Mouth sores, Loss of appetite, Nausea and vomiting, Diarrhea or constipation, Increased risk of infection (from having too few white blood cells), Easy bruising or bleeding (from having too few blood platelets), Fatigue (from having too few red blood cells).

• #41 Merkel cell carcinoma | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/neuroendocrine-tumours-nets/types/merkel-cell-skin-cancer

  Chemotherapy uses cytotoxic drugs to kill cancer cells. For MCC, you usually have a combination of chemotherapy drugs such as: carboplatin or cisplatin, etoposide, cyclophosphamide, vincristine, doxorubicin. […] Clinical trials have looked at other immunotherapies including the drugs: nivolumab, pembrolizumab, ipilimumab. […] Your doctor might offer you one of these drugs as part of a clinical trial. Or they might offer you a different drug. […] Doctors are always trying to improve treatments and reduce the side effects. As part of your treatment, your doctor might ask you to take part in a clinical trial. This might be to test a new treatment or to look at different combinations of existing treatments.

• #42 Chemotherapy for Merkel Cell Carcinoma | American Cancer Society

  https://www.cancer.org/cancer/types/merkel-cell-skin-cancer/treating/chemotherapy.html

  Most often, either cisplatin or carboplatin is used, often along with etoposide. Topotecan by itself tends to have fewer serious side effects, so it might be a better option for some people who are older or have other serious health problems. […] These drugs are given into a vein (IV), usually once every few weeks. They can often shrink MCC tumors for a time (or at least slow their growth and spread) and help relieve some symptoms. But after a while the cancer tends to start growing again. […] Chemo drugs can cause side effects. These depend on the type and dose of the drugs given and how long they are used. Common side effects can include: Hair loss, Mouth sores, Loss of appetite, Nausea and vomiting, Diarrhea or constipation, Increased risk of infection (from having too few white blood cells), Easy bruising or bleeding (from having too few blood platelets), Fatigue (from having too few red blood cells).

• #43 Merkel Cell Carcinoma Treatment – NCI

  https://www.cancer.gov/types/skin/patient/merkel-cell-treatment-pdq

  There are different types of treatment for people with Merkel cell carcinoma. […] The following types of treatment are used: Surgery, Radiation therapy, Chemotherapy, Immunotherapy. […] Treatment of stage I and stage II Merkel cell carcinoma may include: surgery to remove the tumor, such as wide local excision with or without lymph node dissection, radiation therapy after surgery. […] Treatment of stage III Merkel cell carcinoma may include: wide local excision with or without lymph node dissection, radiation therapy, chemotherapy and immunotherapy with an immune checkpoint inhibitor (pembrolizumab), for tumors that cannot be removed by surgery. […] Treatment of stage IV Merkel cell carcinoma may include: immunotherapy with an immune checkpoint inhibitor (avelumab, pembrolizumab, or retifanlimab), chemotherapy, surgery, or radiation therapy as palliative treatment to relieve symptoms and improve quality of life.

• #44 Merkel Cell Carcinoma Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/skin/hp/merkel-cell-treatment-pdq

  Approximately 70% to 80% of MCC cases in the United States are caused by Merkel cell polyomavirus (MCPyV). Within virus-positive MCCs, the viral oncoproteins (T antigens) are constitutively expressed and promote growth. […] […] Single-agent immunotherapy is the preferred initial systemic therapy for patients with metastatic disease. Chemotherapy may be considered for patients with stage IV disease who have a good performance status and are either ineligible for or have disease progression while receiving immunotherapy. […] […] Treatment options for stage I and stage II MCC include the following: Margin-negative local excision, attempting to maintain function. Surgical nodal evaluation, typically by SLN procedure initially, may be considered for patients with significant risk of nodal disease. […]

• #45 Merkel Cell Carcinoma of the Skin – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482329/

  Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine tumor of the skin with increasing incidence. […] Treatment consists of wide local excision with or without adjuvant radiotherapy for the local disease. New therapies for metastatic MCC have shown promise and include immune-based therapies. […] Treatment of Merkel cell carcinoma consists of wide local excision of the primary tumor with 1-2 cm margins to investing fascia of muscle or pericranium when feasible. Mohs micrographic surgery may be considered provided it does not interfere with SLNB. Adjuvant radiation therapy to the primary tumor site may be beneficial and should be considered in specific cases; it may be appropriate for low-risk patients with a small primary tumor (less than 1 cm) and no other adverse risk factors (such as immunosuppression or lymphovascular invasion).

• #46 Merkel Cell Carcinoma Treatment – NCI

  https://www.cancer.gov/types/skin/patient/merkel-cell-treatment-pdq

  There are different types of treatment for people with Merkel cell carcinoma. […] The following types of treatment are used: Surgery, Radiation therapy, Chemotherapy, Immunotherapy. […] Treatment of stage I and stage II Merkel cell carcinoma may include: surgery to remove the tumor, such as wide local excision with or without lymph node dissection, radiation therapy after surgery. […] Treatment of stage III Merkel cell carcinoma may include: wide local excision with or without lymph node dissection, radiation therapy, chemotherapy and immunotherapy with an immune checkpoint inhibitor (pembrolizumab), for tumors that cannot be removed by surgery. […] Treatment of stage IV Merkel cell carcinoma may include: immunotherapy with an immune checkpoint inhibitor (avelumab, pembrolizumab, or retifanlimab), chemotherapy, surgery, or radiation therapy as palliative treatment to relieve symptoms and improve quality of life.

• #47 Merkel Cell Carcinoma Treatment (PDQ®): Treatment – Patient Information [NCI] | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.merkel-cell-carcinoma-treatment-pdq%C2%AE-treatment-patient-information-nci.ncicdr0000441548

  Treatment of stage I and stage II Merkel cell carcinoma may include the following: Surgery to remove the tumor, such as wide local excision with or without lymph node dissection. […] Treatment of stage III Merkel cell carcinoma may include the following: Wide local excision with or without lymph node dissection, Radiation therapy, Immunotherapy (immune checkpoint inhibitor therapy using pembrolizumab), for tumors that cannot be removed by surgery, A clinical trial of chemotherapy, A clinical trial of immunotherapy (nivolumab). […] Treatment of stage IV Merkel cell carcinoma may include the following: Immunotherapy (immune checkpoint inhibitor therapy using avelumab or pembrolizumab), Chemotherapy, surgery or radiation therapy as palliative treatment to relieve symptoms and improve quality of life.

• #48

  https://compassoncology.navigatingcare.com/library/merkelcell/learn/treatment-of-stage-iii-merkel-cell-carcinoma

  Treatment of stage III Merkel cell carcinoma may include the following: Wide local excision with or without lymph node dissection. […] Radiation therapy. […] Immunotherapy (immune checkpoint inhibitor therapy using pembrolizumab), for tumors that cannot be removed by surgery. […] A clinical trial of chemotherapy. […] A clinical trial of immunotherapy (nivolumab).

• #49 Merkel Cell Carcinoma Treatment – NCI

  https://www.cancer.gov/types/skin/patient/merkel-cell-treatment-pdq

  There are different types of treatment for people with Merkel cell carcinoma. […] The following types of treatment are used: Surgery, Radiation therapy, Chemotherapy, Immunotherapy. […] Treatment of stage I and stage II Merkel cell carcinoma may include: surgery to remove the tumor, such as wide local excision with or without lymph node dissection, radiation therapy after surgery. […] Treatment of stage III Merkel cell carcinoma may include: wide local excision with or without lymph node dissection, radiation therapy, chemotherapy and immunotherapy with an immune checkpoint inhibitor (pembrolizumab), for tumors that cannot be removed by surgery. […] Treatment of stage IV Merkel cell carcinoma may include: immunotherapy with an immune checkpoint inhibitor (avelumab, pembrolizumab, or retifanlimab), chemotherapy, surgery, or radiation therapy as palliative treatment to relieve symptoms and improve quality of life.

• #50 Merkel Cell Carcinoma Treatment (PDQ®): Treatment – Patient Information [NCI] | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.merkel-cell-carcinoma-treatment-pdq%C2%AE-treatment-patient-information-nci.ncicdr0000441548

  Treatment of stage I and stage II Merkel cell carcinoma may include the following: Surgery to remove the tumor, such as wide local excision with or without lymph node dissection. […] Treatment of stage III Merkel cell carcinoma may include the following: Wide local excision with or without lymph node dissection, Radiation therapy, Immunotherapy (immune checkpoint inhibitor therapy using pembrolizumab), for tumors that cannot be removed by surgery, A clinical trial of chemotherapy, A clinical trial of immunotherapy (nivolumab). […] Treatment of stage IV Merkel cell carcinoma may include the following: Immunotherapy (immune checkpoint inhibitor therapy using avelumab or pembrolizumab), Chemotherapy, surgery or radiation therapy as palliative treatment to relieve symptoms and improve quality of life.

• #51 Merkel Cell Carcinoma Treatment (PDQ®): Treatment – Health Professional Information [NCI] | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.merkel-cell-carcinoma-treatment-pdq%C2%AE-treatment-health-professional-information-nci.ncicdr0000062884

  Approximately 70% to 80% of MCC cases in the United States are caused by Merkel cell polyomavirus (MCPyV). Within virus-positive MCCs, the viral oncoproteins (T antigens) are constitutively expressed and promote growth. […] Several single-agent immune checkpoint inhibitors have shown improved survival and tolerability in patients with advanced MCC, compared with the chemotherapy that was used in historical controls. Therefore, immune checkpoint inhibitors are considered the recommended first-line treatment for most patients. […] Avelumab is a human antiprogrammed death ligand-1 (PD-L1) monoclonal antibody. […] Pembrolizumab is a humanized IgG4 antiprogrammed cell death-1 (PD-1) monoclonal antibody. […] Retifanlimab is an antiPD-1 monoclonal antibody. […] Single-agent immunotherapy is the preferred initial systemic therapy for patients with metastatic disease. Chemotherapy may be considered for patients with stage IV disease who have a good performance status and are either ineligible for or have disease progression while receiving immunotherapy.

• #52 Merkel Cell Carcinoma Treatment (PDQ®): Treatment – Patient Information [NCI] | The Children’s Hospital at Montefiore

  https://www.cham.org/health-library/article?id=ncicdr0000441548

  A clinical trial of chemotherapy. […] A clinical trial of immunotherapy (nivolumab). […] Treatment of stage IV Merkel cell carcinoma may include the following: […] Immunotherapy (immune checkpoint inhibitor therapy using avelumab or pembrolizumab). […] Chemotherapy, surgery or radiation therapy as palliative treatment to relieve symptoms and improve quality of life. […] A clinical trial of immunotherapy (nivolumab and ipilimumab). […] Treatment of recurrent Merkel cell carcinoma may include the following: […] Wide local excision to remove a larger area of tissue than was removed in earlier surgery. A lymph node dissection may also be done. […] Radiation therapy after surgery. […] Chemotherapy. […] Radiation therapy and/or surgery as palliative treatment to relieve symptoms and improve quality of life.

• #53 Merkel Cell Carcinoma Treatment – NCI

  https://www.cancer.gov/types/skin/patient/merkel-cell-treatment-pdq

  Treatment of recurrent Merkel cell carcinoma may include: wide local excision to remove a larger area of tissue than was removed in earlier surgery with or without lymph node dissection, radiation therapy after surgery, chemotherapy, immunotherapy with an immune checkpoint inhibitor (avelumab, pembrolizumab, or retifanlimab), radiation therapy and/or surgery as palliative treatment to relieve symptoms and improve quality of life.

• #54 Merkel Cell Carcinoma Treatment (PDQ®): Treatment – Patient Information [NCI] | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.merkel-cell-carcinoma-treatment-pdq%C2%AE-treatment-patient-information-nci.ncicdr0000441548

  Treatment of recurrent Merkel cell carcinoma may include the following: Wide local excision to remove a larger area of tissue than was removed in earlier surgery. A lymph node dissection may also be done, Radiation therapy after surgery, Chemotherapy, Radiation therapy and/or surgery as palliative treatment to relieve symptoms and improve quality of life.

• #55 Advancing Treatment Options for Merkel Cell Carcinoma: A Review of Tumor-Targeted Therapies

  https://www.mdpi.com/1422-0067/25/20/11055

  Advancing Treatment Options for Merkel Cell Carcinoma: A Review of Tumor-Targeted Therapies […] Although rare, Merkel cell carcinoma (MCC) is a highly aggressive and increasingly prevalent neuroendocrine cancer of the skin. While current interventions, including surgical resection, radiation, and immunotherapy have been employed in treating many patients, those who remain unresponsive to treatment are met with sparse alternatives and a grim prognosis. For this reason, it is of interest to expand the repertoire of available therapies for MCC patients who remain resistant to current primary interventions. […] Recently, our improved mechanistic understanding of aberrant cell signaling observed in both MCPyV-positive and -negative MCC has facilitated exploration into several small molecules and inhibitors, among them receptor tyrosine kinase inhibitors (TKIs) and somatostatin analogs (SSAs), both of which have positively improved response rates and reduced tumor volumes upon application to treatment of MCC. The introduction of such targeted therapies into treatment protocols holds promise for more personalized care tailored towards patients of diverse subtypes, thereby improving outcomes and mitigating tumor burden, especially for treatment-resistant individuals.

• #56 Advancing Treatment Options for Merkel Cell Carcinoma: A Review of Tumor-Targeted Therapies

  https://www.mdpi.com/1422-0067/25/20/11055

  Historically, the mainstay of treatment for MCC has included surgery, radiation therapy, and chemotherapy. However, these approaches often yield limited success in the setting of metastatic disease, highlighting the need for novel therapeutic approaches. Great progress has been made with the introduction of immunotherapy in treating MCC. Many patients show durable responses when treated with PD-1 inhibitors, including pembrolizumab, nivolumab, or avelumab. Still, nearly 50% of patients with MCC do not respond to PD-1 checkpoint inhibition. […] Recent advancements in the understanding of the molecular pathogenesis of MCC have led to the exploration into and emergence of targeted therapies, marking a new era in the approach to MCC treatment. These therapies are specifically designed to target molecular pathways or genetic mutations that play a crucial role in MCC, offering a more targeted approach.

• #57 Immunotherapeutic Advances in the Treatment of Merkel Cell Carcinoma – touchONCOLOGY

  https://touchoncology.com/dermatological-cancers/journal-articles/immunotherapeutic-advances-in-the-treatment-of-merkel-cell-carcinoma/

  Currently, the National Comprehensive Cancer Network (NCCN) 1.2023 guidelines recommend avelumab, nivolumab or pembrolizumab for disseminated MCC, while the recently approved agent retifanlimab is recommended for patients not amenable to surgery or RT. […] Avelumab, a PD-L1-blocking antibody, has shown safety and efficacy in the setting of metastatic MCC (mMCC). […] Pembrolizumab is another PD-1 receptor-targeting monoclonal antibody that has been shown to be safe and effective in mMMC. […] Nivolumab monotherapy has been explored as a neoadjuvant and adjuvant therapy in MCC. […] The combination of ipilimumab and nivolumab immunotherapy has been demonstrated to be effective in the management of advanced MCC. […] Retifanlimab-dlwr, an anti-PD-1 monoclonal antibody, received accelerated approval for patients with metastatic or recurrent locally advanced MCC earlier this year. […] In the realm of the treatment of MCC, immunotherapy has emerged as a promising strategy, leveraging the body’s immune system to combat and eliminate cancer cells.

• #58 Advancing Treatment Options for Merkel Cell Carcinoma: A Review of Tumor-Targeted Therapies

  https://www.mdpi.com/1422-0067/25/20/11055

  Ongoing research into molecularly targeted agents, such as tyrosine kinase inhibitors (TKIs) and antiangiogenic drugs, holds promise for expanding the therapeutic options available for MCC. […] The potential for the application of these small-molecule inhibitors in MCC therapy is discussed in the following sections. […] Receptor tyrosine kinases—including VEGFR, PDGFRA, and KIT (CD117)—normally function in the regulation of cell growth and proliferation by translating extracellular signals into activated intracellular messages. […] For this reason, receptor tyrosine kinase inhibitors (TKIs) have been employed in the treatment of various solid cancers, including in the setting of MCC. Specifically, agents such as imatinib, pazopanib, apatinib, lenvatinib, and cabozantinib are TKIs that function as anti-proliferative and antiangiogenic factors to both suppress the metastatic potential of cancer cells and turn off constitutive tyrosine kinase activity.

• #59 Advancing Treatment Options for Merkel Cell Carcinoma: A Review of Tumor-Targeted Therapies

  https://www.mdpi.com/1422-0067/25/20/11055

  The expression of VEGF-A, VEGF-C, VEGF-R2, PDGF-a, and PDGF-B points towards the involvement of angiogenic pathways in MCC. These proteins could be potential targets for antiangiogenic therapies or TKIs that target these pathways. […] Pazopanib targets several of these pathway receptors, including the vascular endothelial growth factor receptor (VEGFR) and platelet-derived growth factor receptor (PDGFR), and has been thought to show promise in preclinical studies due to its potent antitumor and antiangiogenic activity. […] Another group of drugs previously investigated in the treatment of MCC are somatostatin analogs (SSAs). SSAs bind specifically to somatostatin receptors (SSTRs) to prevent tumor-activated endocrine regulators that result in tumor growth, such as insulin, gut hormones, TSH, and growth hormones. […] The use of SSAs has been expanded in clinical treatments of MCC. Octreotide and lanreotide are two SSAs that have been employed in clinical trials to treat patients with MCC.

• #60 Merkel Cell Carcinoma Pipeline Appears Robust With 14+ Key Pharma Companies Actively Working in the Therapeutics Segment | DelveInsight – The Globe and Mail

  https://www.theglobeandmail.com/investing/markets/markets-news/GetNews/32269662/merkel-cell-carcinoma-pipeline-appears-robust-with-14-key-pharma-companies-actively-working-in-the-therapeutics-segment-delveinsight

  DelveInsights Merkel Cell Carcinoma pipeline report depicts a robust space with 14+ active players working to develop 14+ pipeline therapies for Merkel Cell Carcinoma treatment. […] Promising Merkel Cell Carcinoma Therapies such as Avelumab, Pembrolizumab, MLN0128, KRT-232, Retifanlimab, Ipilimumab and others. […] Domatinostat is an orally administered histone deacetylase (HDAC) inhibitor with a unique mode of action that was designed to strengthen the bodys own anti-tumor immune response. Domatinostat opens the tumor microenvironment and encourages infiltration of immune cells into the tumor. To advance the development program, 4SC has also signed a drug supply agreement with Merck KGaA for avelumab (anti-PD-L1 antibody) to conduct a Phase II clinical trial of domatinostat in combination with avelumab in advanced-stage Merkel cell carcinoma (MCC) patients progressing on previous anti-PD-(L)1 monotherapy (MERKLIN 2).

• #61 IFx-Hu2.0 Enters Clinical Trials for Merkel Cell Carcinoma

  https://www.targetedonc.com/view/ifx-hu2-0-enters-clinical-trials-for-merkel-cell-carcinoma

  Trials of IFx-Hu2.0 are initiating, looking to overcome checkpoint inhibitor resistance in Merkel cell carcinoma. […] A phase 1b/2a clinical trial (NCT06940440) evaluating the innate immune agonist IFx-Hu2.0 in patients with noncutaneous Merkel cell carcinoma (MCC) of unknown primary has begun. […] IFx-Hu2.0 is designed to address primary resistance to checkpoint inhibitors (CPIs) like pembrolizumab (Keytruda). […] „Like our planned phase 3 accelerated approval trial, this phase 1b/2a trial will also investigate the ability of IFx-Hu2.0 to increase the antitumor response rate when used alongside [pembrolizumab] in first line treatment of CPI-naive, metastatic MCC.” […] This newly initiated multicenter, open-label study plans to evaluate the safety and feasibility of IFx-Hu2.0 as an adjunct to pembrolizumab for the treatment of adult patients with visceral MCC lesions.

• #62 Immunotherapy for Merkel cell carcinoma: a turning point in patient care | Journal for ImmunoTherapy of Cancer

  https://jitc.bmj.com/content/6/1/23

  The success of immune checkpoint inhibitors in several cancer types and the immune susceptibility of MCC has renewed hope for developing more effective treatment options for patients with MCC. […] Pembrolizumab was the first immune checkpoint inhibitor to demonstrate objective tumor regressions in patients with MCC. […] In March 2017, a PD-L1 monoclonal antibody, avelumab, became the first FDA-approved treatment for MCC. […] Nivolumab is another monoclonal PD-1 antibody with clinical activity in advanced MCC. […] Immunomodulatory therapies have had a profound impact on the cancer treatment landscape, and MCC is no exception. […] The results of the trials described above led to the inclusion of avelumab, pembrolizumab and nivolumab in the January 2018 NCCN guidelines as preferred treatment options for patients with disseminated disease. […] These findings require validation in larger patient cohorts, but suggest that immune checkpoint blockade may be most efficacious when used in the first-line setting. […] The neoadjuvant setting also provides an opportunity for administration of immune checkpoint inhibition.

• #63 Merkel Cell Carcinoma

  https://neuroendocrine.org.au/what-are-nets/merkel-cell-carcinoma/

  Treatments other than Immunotherapy are being studied for MCC patients who dont respond to, or cannot have immunotherapy. […] Immunotherapy is a treatment that uses the patients own immune system to fight cancer. […] Currently immunotherapy is only available and approved for patients with advanced metastatic merkel cell carcinoma, but these treatments are being actively investigated in patients with earlier stage disease. There is currently a study open in Australia investigating this.

• #64 Merkel Cell Carcinoma Patient Support Center

  https://www.skincancer.org/skin-cancer-information/merkel-cell-carcinoma/mcc-patient-support/

  A: First and foremost, while MCC is rare and dangerous, it is treatable. Due to a tremendous amount of work and research by dedicated health-care professionals, MCC treatment options and knowledge have surged. […] The most important thing for you to do is to seek treatment at an academic center with specialized expertise in caring for people with MCC. Dermatologists, surgeons, medical oncologists and radiation oncologists need to confer to determine the best plan for a given case. It is important that they all understand the aggressiveness of MCC and all communicate with each other and you in a concise manner. […] A: “It’s so important, for several reasons. Depending on your sources of data, MCC is three to five times more deadly than melanoma, so it’s a serious diagnosis. And, due to its rarity, a lot of physicians are not familiar with the specific care that’s indicated. Updated information is not in many textbooks because MCC management has been so rapidly evolving over the past five to 10 years. Going to a place that truly offers expert multidisciplinary care is very important.”

• #65 Diagnosis and treatment of Merkel cell carcinoma: European consensus-based interdisciplinary guideline – Update 2022. – Melanoma Institute Australia

  https://melanoma.org.au/paper/diagnosis-and-treatment-of-merkel-cell-carcinoma-european-consensus-based-interdisciplinary-guideline-update-2022/

  Merkel cell carcinoma (MCC) is a rare skin cancer, accounting for less than 1% of all cutaneous malignancies. […] For localised MCC, first-line treatment is surgical excision with postoperative margin assessment followed by adjuvant radiation therapy (RT). […] Sentinel lymph node biopsy is recommended in all patients with MCC without clinically detectable lymph nodes or distant metastasis. […] Adjuvant RT alone, eventually combined with complete lymph nodes dissection is proposed in case of micrometastatic nodal involvement. […] In case of macroscopic nodal involvement, the standard of care is complete lymph nodes dissection potentially followed by post-operative RT. […] Immunotherapy with anti-PD-(L)1 antibodies should be offered as first-line systemic treatment in advanced MCC. […] Chemotherapy can be used when patients fail to respond or are intolerant for anti-PD-(L)1 immunotherapy or clinical trials.

• #66 Merkel Cell Carcinoma: Symptoms, Causes, Stages & Treatment

  https://my.clevelandclinic.org/health/diseases/17971-merkel-cell-carcinoma

  Treatments for Merkel cell carcinoma depend on the cancer stage. Early-stage Merkel cell carcinoma (stages 0 to II [2]) responds better to treatments than late-stage (stages III and IIIV [3 and 4]) cancers. […] Healthcare providers surgically remove Merkel cell carcinoma tumors. Surgical options include: Mohs surgery to remove the tumor and skin layers while preserving as much healthy tissue as possible. Wide local excision to remove the tumor and some surrounding healthy tissue. Lymph node dissection to surgically remove lymph nodes that have metastatic cancer cells. […] After surgery, you may need reconstructive surgery or a skin graft to repair and heal the treated area. You may also get cancer treatments to kill any lingering cancer cells in your body, such as: Chemotherapy. Immunotherapy. Radiation therapy.

• #67 Merkel Cell Carcinoma Treatment Program at Mass General Cancer Center

  https://www.massgeneral.org/cancer-center/treatments-and-services/melanoma/merkel-cell-carcinoma

  A precise, accurate diagnosis is critical to appropriate treatment. […] Our specialists are at the forefront of techniques that improve the identification, evaluation, and monitoring of Merkel cell carcinoma. […] Our surgeons offer the highest degree of clinical expertise. […] Our experienced team carefully chooses the precise radiation technique for you. […] Our medical oncologists offer innovative approaches including immune-stimulating medications known as Immune Checkpoint Inhibitors and chemotherapeutic medications to shrink early tumors. […] We are developing a clinical and translational research program that incorporates basic science to better understand the fundamental biology of MCC, translational research to investigate biomarkers that may predict response to therapy and clinical trials to improve the therapeutic options for patients with the disease. […] Our multidisciplinary team of surgeons, medical oncologists, radiation oncologists, dermatologists and pathologists work together to develop a personalized treatment plan specifically for your stage of disease.

• #68 Treatments for Merkel cell carcinoma | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/skin-non-melanoma/treatment/merkel-cell-carcinoma

  Drug therapy uses drugs such as chemotherapy or immunotherapy to treat stage 4 or recurrent Merkel cell carcinoma. Drug therapy is used to help shrink the cancer, slow the growth and spread of the cancer and to relieve symptoms of advanced cancer. […] Talk to your doctor about clinical trials open to people with skin cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. […] Follow-up care lets your healthcare team keep track of your health for a period of time after treatment ends. This important part of cancer care is often shared among the cancer specialists and your family doctor. They will help you recover from treatment side effects and monitor you for any signs that the cancer has recurred.

• #69

  https://fcs.navigatingcare.com/library/merkelcell/learn/treatment-option-overview

  Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. […] Immunotherapy is a treatment that uses the patients immune system to fight cancer. […] There are two types of immune checkpoint inhibitor therapy: […] Patients may want to think about taking part in a clinical trial. […] For some patients, taking part in a clinical trial may be the best treatment choice. […] Patients who take part in clinical trials also help improve the way cancer will be treated in the future. […] Patients can enter clinical trials before, during, or after starting their cancer treatment. […] Follow-up tests may be needed. […] Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.

• #70 Treatment for Merkel Cell Carcinoma | Fred Hutchinson Cancer Center

  https://www.fredhutch.org/en/diseases/merkel-cell-carcinoma/treatment.html

  Surgery and radiation therapy are the most common treatments for people with early-stage MCC (stage I or II, when the main tumor has not spread to lymph nodes or other parts of the body). […] If you have early-stage disease, you will likely have surgery to remove the tumor. […] To kill remaining cancer cells, surgery is often followed by external-beam radiation therapy to the tumor site and possibly to the lymph nodes in the same region of the body. MCC is very sensitive to radiation therapy. […] Treatment for advanced disease may involve surgery, radiation therapy and also systemic therapy, which treats cancer throughout your body. […] If you have more advanced MCC that has spread to nearby lymph nodes but not to other parts of your body (stage III), you are likely to have surgery to remove the cancer followed by radiation to the main site as well as the regional lymph nodes.

• #71 Merkel Cell Carcinoma Treatment Program at Mass General Cancer Center

  https://www.massgeneral.org/cancer-center/treatments-and-services/melanoma/merkel-cell-carcinoma

  World-renowned specialists and superb resources for diagnosing and staging cancer combined with leading-edge treatment approaches provide personalized care for patients with this rare type of skin cancer. […] Our Merkel Cell Treatment Program is comprised of world-renowned specialists for a rare type of skin cancer. We integrate superb resources for diagnosing and staging cancer with leading-edge treatment approaches to provide personalized care for our patients. […] Patients with Merkel cell carcinoma are staged by history and physical exam, radiographic imaging and sentinel lymph node biopsy. […] We recommend a PET/CT (Positron Emission Tomography/Computed Tomography) or a CT plus an MRI (Magnetic Resonance Imaging) of the brain to look for evidence of distant disease. […] We will develop and coordinate a treatment plan personalized for you and your stage of cancer.

• #72 Treatment For Merkel Cell Carcinoma | Baptist Health Miami Cancer Institute

  https://baptisthealth.net/services/cancer-care/miami-cancer-institute/our-approach/adult-cancers/skin-cancers/merkel-cell-carcinoma/treatment

  Targeted Therapies Our specialists use drugs or other select substances to identify and attack specific types of cancer cells, blocking their growth and spread. […] Immunotherapy Your Miami Cancer Institute cancer specialist may use certain drugs to assist your immune systems ability to identify and attack specific types of cancer cells, blocking their growth and spread. […] Clinical Trials Miami Cancer Institute offers South Florida patients and our communities access to leading-edge, innovative treatments that often result in new therapies not available elsewhere and that can often mean excellent outcomes for patients.

• #73 The biology and treatment of Merkel cell carcinoma: current understanding and research priorities | Nature Reviews Clinical Oncology

  https://www.nature.com/articles/s41571-018-0103-2

  Merkel cell carcinoma (MCC) is a rare and aggressive skin cancer associated with advanced age and immunosuppression. […] Therapeutic options for patients with advanced-stage MCC have historically been limited; however, new immunotherapeutic approaches are enabling durable responses to be achieved in a subset of patients. […] In this Consensus Statement, we review the current state of knowledge of MCC biology and treatment and define key outstanding questions in the areas of basic, translational and clinical MCC research. […] The success of immune checkpoint inhibition (ICI) is a milestone in the management of advanced-stage MCC. […] However, not all patients have durable responses to ICI. […] Therefore, predicting and improving responsiveness to immunotherapy and identifying alternative therapies for patients in whom ICI is contraindicated and/or ineffective are both current research priorities in patients with MCC.

Zobacz więcej