scholarly journals Two Clinical Cases of Metastatic Merkel Cell Carcinoma Illustrating Avelumab Tolerability in Elderly Patients

2021 ◽  
Vol 42 (06) ◽  
pp. 599-602
Author(s):  
Bridget Josephs ◽  
Sanjeev Sewak
Keyword(s):  
Elderly Patients ◽  
Cell Carcinoma ◽  
Merkel Cell Carcinoma ◽  
Palliative Radiotherapy ◽  
Merkel Cell ◽  
Phase Ii Trials ◽  
Durable Response ◽  
Old Patients ◽  
New Class ◽  
Sustained Responses

AbstractWe present two cases of primary cutaneous Merkel cell carcinoma in a 80-year and a 95-year old patient. Both patients had a wide local excision, but early recurrences occurred. Case 1 required palliative radiotherapy. He did not receive chemotherapy but case 2 did. They then proceeded to have immunotherapy with sustained responses lasting greater than 2 and 3 years. This report highlights an important new class of drug for the treatment of advanced Merkel cell carcinoma. Furthermore, our case report demonstrates that avelumab immunotherapy can be safely delivered to elderly patients, including 80- and 95-year-old patients. This report parallels the high and durable response rates to avelumab (including complete responses) that were shown in the JAVELIN phase II trials.

scholarly journals An Unusual Presentation of Merkel Cell Carcinoma in a HIV Patient: A Case Report and Literature Review

2019 ◽  
Vol 7 ◽  
pp. 232470961983669
Author(s):  
Preethi Ramachandran ◽  
Burak Erdinc ◽  
Vladimir Gotlieb
Keyword(s):  
Cell Carcinoma ◽  
Merkel Cell Carcinoma ◽  
Target Therapy ◽  
Palliative Radiotherapy ◽  
Unusual Presentation ◽  
Merkel Cell ◽  
Advanced Stages ◽  
Subcutaneous Mass ◽  
Aggressive Tumors ◽  
Head Neck

Merkel cell carcinoma (MCC) is a rare, rapidly growing, aggressive neuroendocrine skin cancer that generally arises on sun-exposed areas of body such as head, neck, upper limbs, and shoulders of people with light complexity. Typically, MCC presents as shiny, flesh-colored or bluish-red, intracutaneous nodule, possibly with ulceration or crusting. In most of the cases, there is an association with Merkel cell polyomavirus. Even though these are very aggressive tumors, early detection and treatment has always given favorable outcome. There seems to be no consensus in definite prognostic markers, and advanced stages have the worst outcome even with treatment. There has been a recent trend in using PD-I/PD-L1 target therapy rather than chemotherapy in these cancers and have shown to improve survival by many months. In this article, we report a very unusual presentation of MCC first found on left frontoparietal skull as an 8-cm diameter fixed, subcutaneous mass without any typical features of MCC and was found to have metastatic spread to lung and liver. The patient was treated with palliative radiotherapy to brain and chemotherapy with cisplatin/etoposide with addition of immunotherapy later.

scholarly journals Clinical Features and Prognosis of Merkel Cell Carcinoma in Elderly Patients

2020 ◽  
Vol 26 ◽  
Author(s):  
YiJun Xia ◽  
DongSheng Cao ◽  
Jun Zhao ◽  
BangZhong Zhu ◽  
Juan Xie
Keyword(s):  
Elderly Patients ◽  
Cell Carcinoma ◽  
Clinical Features ◽  
Merkel Cell Carcinoma ◽  
Merkel Cell

scholarly journals Challenges of New Approaches in Metastatic Merkel Cell Carcinoma

2020 ◽  
Vol 13 (2) ◽  
pp. 501-507
Author(s):  
Ana Monteiro ◽  
Emanuel Gouveia ◽  
Daniela Garcez ◽  
Sara Donato ◽  
Diogo Martins-Branco ◽  
...  
Keyword(s):  
Cell Carcinoma ◽  
Merkel Cell Carcinoma ◽  
Checkpoint Inhibitors ◽  
Progression Free Survival ◽  
Merkel Cell ◽  
Durable Response ◽  
Immune Mediated ◽  
Metastatic Setting ◽  
Life Threatening ◽  
The One

Merkel cell carcinoma is a rare and aggressive cutaneous tumor, and the use of checkpoint inhibitors immunotherapy is a recent indication in its metastatic setting, both first and second line. However, the widespread use of immunotherapy is associated with an increase of acute and late immune-mediated adverse events. We present a case of an elderly fit patient with metastatic Merkel cell carcinoma treated with pembrolizumab who developed diabetic ketoacidosis, a severe immune-mediated adverse event. A multidisciplinary approach was crucial to overcome the life-threatening event. Even with early treatment stop, the patient had a significant and durable response to the treatment for 15 months. Meanwhile, a progressive pan-cerebellar syndrome emerged, possible due to a paraneoplastic syndrome with a negative onco-neuronal antibody panel, although an autoimmune etiology associated with immunotherapy could not be excluded. Unfortunately, the situation was irreversible and refractory to immunomodulatory treatment. Despite the unpredictable toxicity, it is important to note the efficacy profile, with a progression-free survival of 15 months, which is higher than the one reported in reference clinical trials in this setting.

scholarly journals Favorable Response to Treatment with Avelumab in an HIV-Positive Patient with Advanced Merkel Cell Carcinoma Previously Refractory to Chemotherapy

2018 ◽  
Vol 11 (2) ◽  
pp. 467-475 ◽  
Author(s):  
Mohammed U. Al Homsi ◽  
Mai Mostafa ◽  
Khaled Fahim
Keyword(s):  
Cell Carcinoma ◽  
Merkel Cell Carcinoma ◽  
Stage Iv ◽  
Positive Patient ◽  
Response To Treatment ◽  
Exclusion Criterion ◽  
Hiv Positive ◽  
Cancer Type ◽  
Merkel Cell ◽  
Durable Response

Avelumab is indicated for the management of Merkel cell carcinoma, a rare and aggressive neuroendocrine skin cancer. Its regulatory approval followed the positive outcome of a Phase 2 trial on 88 patients with stage IV disease, which excluded patients with immunodeficiency due to HIV, a risk factor for this cancer type. We report a positive and sustained response to avelumab in an HIV-positive patient with stage IV Merkel cell carcinoma refractory to previous chemotherapy (cisplatin/etoposide) and radiotherapy. Five cycles of avelumab 10 mg/m2 resulted in the resolution of tumor activity visualized using PET-CT scanning in all affected lymph nodes. The only major side effect associated with avelumab was thyroiditis and mild hypothyroidism, a known adverse effect of this treatment, which was well controlled by L-thyroxine treatment. Treatment is ongoing and the positive response has been sustained during 5 further cycles of treatment up to date. This apparently durable response is consistent with the earlier clinical trial experience with avelumab, but seen here in a patient with HIV-associated immunodeficiency as a predisposing factor (an exclusion criterion from the previous trial). Further clinical trials with avelumab in a broader patient population with Merkel cell carcinoma are warranted.

scholarly journals An Unusual Clinical Presentation of Merkel Cell Carcinoma: A Case Report

2010 ◽  
Vol 2010 ◽  
pp. 1-3 ◽  
Author(s):  
Deba P. Sarma ◽  
Dawn E. Heagley ◽  
Julianne Chalupa ◽  
Meredith Cox ◽  
James M. Shehan
Keyword(s):  
Elderly Patients ◽  
Cell Carcinoma ◽  
Merkel Cell Carcinoma ◽  
Clinical Presentation ◽  
Benign Lesion ◽  
Excisional Biopsy ◽  
The Sun ◽  
Merkel Cell ◽  
Exposed Skin

Introduction. Merkel cell carcinoma is a rare, aggressive neuroendocrine cell carcinoma arising in the sun-exposed skin of elderly patients. Most of these tumors are located in the dermis. An unusual clinical presentation of such a tumor in the subcutis, if not biopsied, may be easily mistaken as a benign lesion.Case Presentation. An 83-year-old white woman presented with a several-month history of a painless 7 mm subcutaneous mass that was initially thought to be a lipoma. A conservative follow-up was planned. At the insistence of the patient, an excisional biopsy of the mass was performed revealing a subcutaneous Merkel cell carcinoma. The tumor cells stained positively for CK 20, chromogranin, and synaptophysin. No other primary or metastatic tumors found after a thorough work-up. The patient was treated with local irradiation. She remains disease free at her six-month follow-up visit.Conclusion. When a new growth is encountered in the sun-exposed skin of elderly patients, a biopsy is warranted even if the lesion clinically appears benign.

scholarly journals Talimogene laherparepvec induces durable response of regionally advanced Merkel cell carcinoma in 4 consecutive patients

2019 ◽  
Vol 5 (9) ◽  
pp. 782-786 ◽  
Author(s):  
Brian C. Westbrook ◽  
T. Graham Norwood ◽  
Nina L.J. Terry ◽  
Svetlana B. McKee ◽  
Robert M. Conry
Keyword(s):  
Cell Carcinoma ◽  
Merkel Cell Carcinoma ◽  
Merkel Cell ◽  
Talimogene Laherparepvec ◽  
Durable Response

Lymph Nodal Merkel Cell Carcinoma; Primary or Metastatic Disease? A Clinical Case

2002 ◽  
Vol 88 (5) ◽  
pp. 424-426 ◽  
Author(s):  
Giuseppe Fotia ◽  
Roberto Barni ◽  
Cristiana Bellan ◽  
Alessandro Neri
Keyword(s):  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Merkel Cell Carcinoma ◽  
Pulmonary Metastases ◽  
Histopathological Examination ◽  
Palliative Radiotherapy ◽  
Merkel Cell ◽  
Neoplastic Tissue ◽  
Regional Lymph Nodes

We report a case of Merkel cell carcinoma (MCC) presenting in the lymph nodes in the absence of a primary cutaneous site. The MCC was treated by palliative radiotherapy, which controlled the disease locally. Eight months after diagnosis a mass appeared on the ipsilateral knee; histopathological examination of this lesion confirmed the diagnosis of MCC. The patient died two months later due to the development of pulmonary metastases. Interestingly, the neoplastic tissue was confined to the regional lymph nodes for several months before the primary site appeared. Primary lymph nodal MCC is rare and the diagnosis is difficult. In our opinion the only way to make a diagnosis of primary lymph nodal MCC is by appropriate clinical follow-up.

scholarly journals Retrospective Multicenter Analysis of the Outcome of a Re-Induction with Immune Checkpoint Inhibitors in Advanced Merkel Cell Carcinoma

2020 ◽  
Vol 2 (11) ◽  
pp. 2202-2207 ◽  
Author(s):  
H. M. Stege ◽  
F. Bradfisch ◽  
M. I. Fleischer ◽  
P. Mohr ◽  
S. Ugurel ◽  
...  
Keyword(s):  
Adverse Events ◽  
Tumor Progression ◽  
Cell Carcinoma ◽  
Merkel Cell Carcinoma ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Tumor Response ◽  
Checkpoint Inhibitors ◽  
Merkel Cell ◽  
Durable Response

AbstractSignificant progress has been made in the treatment of advanced Merkel cell carcinoma (MCC) by establishing immune checkpoint inhibitors (ICI). Tumor progression, durable response, or adverse events may lead to ICI discontinuation in MCC patients. If in these patients tumor progression occurs, the question remains if re-induction with ICI achieves renewed tumor response. This retrospective multicenter study evaluated patients in with re-induction of anti-PD-1/anti-PD-L1 therapy for advanced MCC. Clinical data were extracted at treatment initiation, tumor response, treatment cessation, and subsequent tumor response to re-induction. Eight patients from seven centers (mean age 67.8 years) were included. The median duration of initial therapy with anti-PD-1/anti-PD-L1 was 9.6 months (2–21 months). Two patients achieved complete response (CR), four patients partial response (PR), one patient stable disease (SD), while in one patient progressive disease (PD) occurred as best overall response (BOR) to ICI. Reason for discontinuation of ICI was PD in three patients and severe adverse events in five patients. Following a median anti-PD-1/anti-PD-L1 therapy-free interval of 9.5 months (3–18 months), re-induction with ICI therapy was initiated. Five of eight patients (62.5%) achieved an objective response upon re-induction, while in three patients, no response could be observed. Notably, adverse events, which had led to the discontinuation of the first ICI treatment line, were not observed upon re-induction. The initial response to immune checkpoint inhibitors seems to be an important marker for successful re-induction. Interestingly, adverse events leading to treatment discontinuation were not observed during re-induction.

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