2019: Volume 2, Issue 3
Past Issues
Full-Text 
PDFPalliative Systemic Treatment of Advanced Merkel Cell Carcinoma in the Pre-Immunotherapy Era: A Retrospective, Single-Center Analysis of Patients with An Orphan Neuroendocrine Malignancy
Patrick Schöffski*, Gitte Moors, Paul Clement, Herlinde Dumez, Oliver Bechter
Department of General Medical Oncology, Laboratory of Experimental Oncology, Leuven Cancer Institute, University Hospitals Leuven, KU Leuven, Belgium
Corresponding author: Patrick Schöffski, Department of General Medical Oncology, Laboratory of Experimental Oncology, Leuven Cancer Institute, University Hospitals Leuven, KU Leuven, Belgium.
Received: May 28, 2019
Published: June 27, 2019
ABSTRACT
Objectives: To evaluate the efficacy of systemic treatments in patients with advanced Merkel cell carcinoma (MCC) prior to the introduction of immune checkpoint modulation.
Methods: Fifty-nine patients were treated at the University Hospitals Leuven between 1999 and 2012. Seventeen had advanced disease incurable by radiotherapy and/or surgery, received one or multiple systemic treatments and were included in this retrospective analysis.
Results: MCC is a chemotherapy-sensitive tumour with an objective response rate of 63% to first-line chemotherapy. The combination of cisplatin or carboplatin with etoposide was the most frequently used regimen (n=13) with responses seen in 69% of patients. The median progression-free survival after first-line chemotherapy was 8 months. Eight patients received second line chemotherapy with gemcitabine, taxanes or vinca alkaloids with a response rate of 25%. The median overall survival since start of first line chemotherapy was 13 months.
Conclusions: A considerable proportion of patients with MCC fails local treatments and requires systemic therapy. Advanced MCC is a chemotherapy-sensitive disease with high response rates. The poor overall survival achieved with chemotherapy supports the need for novel systemic strategies, such as the routine implementation of immunologic treatment approaches. Immune checkpoint modulation is complementary to chemotherapy, and should be further developed as single agent, in sequence or in combination with other biological or cytotoxic therapy.
Keywords: Merkel cell carcinoma, Chemotherapy, Prognosis
