Merkel cell cancer medical therapy: Difference between revisions
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=== '''Adjuvant immunotherapy''' === | === '''Adjuvant immunotherapy''' === | ||
* Using new medications like monoclonal antibodies in patients with merkel cell cancer shows promising results especially if the patients have metastasis.<ref name="pmid27592805">{{cite journal |vauthors=Kaufman HL, Russell J, Hamid O, Bhatia S, Terheyden P, D'Angelo SP, Shih KC, Lebbé C, Linette GP, Milella M, Brownell I, Lewis KD, Lorch JH, Chin K, Mahnke L, von Heydebreck A, Cuillerot JM, Nghiem P |title=Avelumab in patients with chemotherapy-refractory metastatic Merkel cell carcinoma: a multicentre, single-group, open-label, phase 2 trial |journal=Lancet Oncol. |volume=17 |issue=10 |pages=1374–1385 |date=October 2016 |pmid=27592805 |pmc=5587154 |doi=10.1016/S1470-2045(16)30364-3 |url=}}</ref><ref name="pmid29478343">{{cite journal |vauthors=Gaiser MR, Bongiorno M, Brownell I |title=PD-L1 inhibition with avelumab for metastatic Merkel cell carcinoma |journal=Expert Rev Clin Pharmacol |volume=11 |issue=4 |pages=345–359 |date=April 2018 |pmid=29478343 |doi=10.1080/17512433.2018.1445966 |url=}}</ref> | * Using new medications like monoclonal antibodies in patients with merkel cell cancer shows promising results especially if the patients have metastasis.<ref name="pmid27592805">{{cite journal |vauthors=Kaufman HL, Russell J, Hamid O, Bhatia S, Terheyden P, D'Angelo SP, Shih KC, Lebbé C, Linette GP, Milella M, Brownell I, Lewis KD, Lorch JH, Chin K, Mahnke L, von Heydebreck A, Cuillerot JM, Nghiem P |title=Avelumab in patients with chemotherapy-refractory metastatic Merkel cell carcinoma: a multicentre, single-group, open-label, phase 2 trial |journal=Lancet Oncol. |volume=17 |issue=10 |pages=1374–1385 |date=October 2016 |pmid=27592805 |pmc=5587154 |doi=10.1016/S1470-2045(16)30364-3 |url=}}</ref><ref name="pmid29478343">{{cite journal |vauthors=Gaiser MR, Bongiorno M, Brownell I |title=PD-L1 inhibition with avelumab for metastatic Merkel cell carcinoma |journal=Expert Rev Clin Pharmacol |volume=11 |issue=4 |pages=345–359 |date=April 2018 |pmid=29478343 |doi=10.1080/17512433.2018.1445966 |url=}}</ref><ref name="pmid294783432">{{cite journal |vauthors=Gaiser MR, Bongiorno M, Brownell I |title=PD-L1 inhibition with avelumab for metastatic Merkel cell carcinoma |journal=Expert Rev Clin Pharmacol |volume=11 |issue=4 |pages=345–359 |date=April 2018 |pmid=29478343 |doi=10.1080/17512433.2018.1445966 |url=}}</ref> | ||
* Preferred regimen (1): Avelumab(PD-L1 inhibition ) | * Preferred regimen (1): Avelumab(PD-L1 inhibition ) | ||
* Preferred regimen (2): Nivolumab | * Preferred regimen (2): Nivolumab | ||
Revision as of 00:59, 23 January 2019
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Merkel cell cancer Microchapters |
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Merkel cell cancer medical therapy On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ahmad Al Maradni, M.D. [2]
Overview
The predominant therapy for Merkel cell cancer is surgical resection. Adjunctive chemoradiation may also be required in more advanced disease.
Medical Therapy
- Merkel cell cancer that has metastasized may respond, at least partially, to treatment with chemotherapy and/or radiation.
Radiation
- Merkel cell cancer is radiosensitive carcinoma.
- Radiation is an alternative treatment and used can be alone in patients with merkel cell cancer who are not suitable for surgery.[1]
- Radiotherapy has a curative rate of 75 to 85 percent.[2]
- Systemic relapse after radiotherapy is one f the cause of death in patients with merkel cell cancer.[3]
- Adjuvant radiotherapy is effective in reducing the rate of recurrence and increasing the 5-year survival of patients with merkel cell cancer.
- Preferred dosage: 60 to 66 Gy
Chemotherapy or chemoradiotherapy
- Patients with merkel cell carcinoma who are having a metastatic disease may get beneficial results with chemotherapy.[4]
- Chemotherapy usually does not cure the disease, but it can be effective in shrinking the tumor size if the tumor is either too large to be resectable or is located within in critical or difficult regions.
- Contraindications in using chemotherapy is immunosuppression which are of a great concern.
- Preferred regimen (1): Carboplatin a weekly regimen IV: Target AUC 4.5 on day 1 of weeks 1, 4, 7, and 10
- Preferred regimen (2): Etoposide IV concentrations >0.4 mg/mL
Adjuvant immunotherapy
- Using new medications like monoclonal antibodies in patients with merkel cell cancer shows promising results especially if the patients have metastasis.[5][6][7]
- Preferred regimen (1): Avelumab(PD-L1 inhibition )
- Preferred regimen (2): Nivolumab
- Preferred regimen (3): Pembrolizumab
References
- ↑ Pape E, Rezvoy N, Penel N, Salleron J, Martinot V, Guerreschi P, Dziwniel V, Darras S, Mirabel X, Mortier L (November 2011). "Radiotherapy alone for Merkel cell carcinoma: a comparative and retrospective study of 25 patients". J. Am. Acad. Dermatol. 65 (5): 983–90. doi:10.1016/j.jaad.2010.07.043. PMID 21641081.
- ↑ Harrington C, Kwan W (October 2014). "Outcomes of Merkel cell carcinoma treated with radiotherapy without radical surgical excision". Ann. Surg. Oncol. 21 (11): 3401–5. doi:10.1245/s10434-014-3757-8. PMID 25001091.
- ↑ Veness M, Foote M, Gebski V, Poulsen M (November 2010). "The role of radiotherapy alone in patients with merkel cell carcinoma: reporting the Australian experience of 43 patients". Int. J. Radiat. Oncol. Biol. Phys. 78 (3): 703–9. doi:10.1016/j.ijrobp.2009.08.011. PMID 19939581.
- ↑ Poulsen MG, Rischin D, Porter I, Walpole E, Harvey J, Hamilton C, Keller J, Tripcony L (January 2006). "Does chemotherapy improve survival in high-risk stage I and II Merkel cell carcinoma of the skin?". Int. J. Radiat. Oncol. Biol. Phys. 64 (1): 114–9. doi:10.1016/j.ijrobp.2005.04.042. PMID 16125873.
- ↑ Kaufman HL, Russell J, Hamid O, Bhatia S, Terheyden P, D'Angelo SP, Shih KC, Lebbé C, Linette GP, Milella M, Brownell I, Lewis KD, Lorch JH, Chin K, Mahnke L, von Heydebreck A, Cuillerot JM, Nghiem P (October 2016). "Avelumab in patients with chemotherapy-refractory metastatic Merkel cell carcinoma: a multicentre, single-group, open-label, phase 2 trial". Lancet Oncol. 17 (10): 1374–1385. doi:10.1016/S1470-2045(16)30364-3. PMC 5587154. PMID 27592805.
- ↑ Gaiser MR, Bongiorno M, Brownell I (April 2018). "PD-L1 inhibition with avelumab for metastatic Merkel cell carcinoma". Expert Rev Clin Pharmacol. 11 (4): 345–359. doi:10.1080/17512433.2018.1445966. PMID 29478343.
- ↑ Gaiser MR, Bongiorno M, Brownell I (April 2018). "PD-L1 inhibition with avelumab for metastatic Merkel cell carcinoma". Expert Rev Clin Pharmacol. 11 (4): 345–359. doi:10.1080/17512433.2018.1445966. PMID 29478343.