An autoimmune-based, paraneoplastic neurologic syndrome following checkpoint inhibition and concurrent radiotherapy for merkel cell carcinoma: case report

Sherry, Alexander D.; Bezzerides, Michael; Khattab, Mohamed H.; Luo, Guangcheng; Ancell, Kristin K.; Kirschner, Austin N.

doi:10.1007/s00066-020-01582-3

Cited by 4 publications

(2 citation statements)

References 39 publications

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“…On the other hand, i.e., from the point of view of toxicity, it is well-known that combining RT with IT, as well as with other drugs, may give rise to unexpected events, such as the bystander effect, radiation recall phenomena, or even life-threatening autoimmune paraneoplastic disorders [ 48 , 49 , 50 ]. In our small cohort, we did not report any significant higher-than-expected toxicity.…”

Section: Discussionmentioning

confidence: 99%

Introducing Radiotherapy in Metastatic Merkel Cell Carcinoma Patients with Limited Progression on Avelumab: An Effective Step against Primary and Secondary Immune Resistance?

Ferini¹,

Zagardo²,

Critelli

et al. 2023

JPM

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Purpose: To investigate the ability of radiotherapy (RT) to prolong progression-free survival (PFS) and to report treatment-related toxicities among oligoprogressive metastatic Merkel cell carcinoma (mMCC) patients on avelumab. Methods: We retrospectively collected clinical data on mMCC patients who underwent radiotherapy for limited progression on avelumab. Patients were categorized as primary or secondary immune refractory depending on the time of onset of resistance to immunotherapy (at the first or subsequent follow-up visits after avelumab initiation). Pre- and post-RT PFS were calculated. Overall survival (OS) from the first progression treated with RT was also reported. Radiological responses and toxicities were evaluated according to the irRECIST criteria and RTOG scoring system, respectively. Results: Eight patients, including five females, with a median age of 75 years, met our inclusion criteria. The median gross tumor and clinical target volumes at first progression on avelumab were 29.85 cc and 236.7 cc, respectively. The treatment sites included lymph node, skin, brain, and spine metastases. Four patients received more than one course of RT. Most patients were treated with palliative radiation doses (mainly 30 Gy in 3 Gy/day fractions). Two patients were treated with stereotactic RT. Five/eight patients were primary immune refractory. The objective response rate at the first post-RT assessment was 75%, whereas no local failure was reported. The median pre-RT PFS was 3 months. The pre-RT PFS was 37.5% at 6 months and 12.5% at 1 year. The median post-RT PFS was not reached. The post-RT PFS was 60% at 6 months and 1 year. The post-RT OS was 85.7% at 1 year and 64.3% at 2 years. No relevant treatment-related toxicity was observed. After a median follow-up of 18.5 months, 6/8 patients are still alive and continuing on avelumab therapy. Conclusions: Adding radiotherapy to mMCC patients with limited progression on avelumab seems to be safe and effective in prolonging the successful use of immunotherapy, regardless of the type of immune refractoriness.

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Section: Discussionmentioning

confidence: 99%

Introducing Radiotherapy in Metastatic Merkel Cell Carcinoma Patients with Limited Progression on Avelumab: An Effective Step against Primary and Secondary Immune Resistance?

Ferini¹,

Zagardo²,

Critelli

et al. 2023

JPM

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“…For the setting of metastatic disease, the S2k guideline recommends immunotherapy targeting PD-1/PD-L1 as superior to chemotherapy. While potential for a benefit from combinations of radiotherapy and immunotherapy in MCC is seen, the very limited clinical data did not justify a change of the previous recommendation that radiotherapy can be integrated into multimodal concepts on an individual basis [ 16 , 17 ].…”

Section: Role Of Radiotherapy In the Management Of Macroscopic Tumor ...mentioning

confidence: 99%

The role of radiotherapy in the updated German S2k guideline for management of Merkel cell carcinoma

Vordermark

Höller²

2023

Strahlenther Onkol

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Merkel cell carcinoma (MCC) is a radiosensitive tumor and the role of radiotherapy in the management of this disease was newly defined in the recently published update of the S2k guideline on Merkel cell carcinoma of the Association of Scientific Medical Societies in Germany (AWMF). While adjuvant radiotherapy of the tumor bed is broadly recommended, irradiation of the regional nodal region can be performed in patients with negative sentinel lymph nodes and high-risk factors. In patients with positive sentinel lymph nodes, it is an alternative to completion lymphadenectomy. The standard dose for adjuvant radiotherapy remains 50 Gy.

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Multiple drugs

2020

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An autoimmune-based, paraneoplastic neurologic syndrome following checkpoint inhibition and concurrent radiotherapy for merkel cell carcinoma: case report

Cited by 4 publications

References 39 publications

Introducing Radiotherapy in Metastatic Merkel Cell Carcinoma Patients with Limited Progression on Avelumab: An Effective Step against Primary and Secondary Immune Resistance?

Introducing Radiotherapy in Metastatic Merkel Cell Carcinoma Patients with Limited Progression on Avelumab: An Effective Step against Primary and Secondary Immune Resistance?

The role of radiotherapy in the updated German S2k guideline for management of Merkel cell carcinoma

Multiple drugs

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