Merkel cell carcinoma: Epidemiology, prognosis, therapy and unmet medical needs

Abstract

Merkel cell carcinoma (MCC) is a rare skin cancer that is associated with Merkel cell polyomavirus infection in most cases. Incidence rates of MCC have increased in past decades. Risk factors for MCC include ultraviolet light exposure, immunosuppression and advanced age. MCC is an aggressive malignancy with frequent recurrences and a high mortality rate, although patient outcomes are generally more favourable if the patient is referred for treatment at an early stage. Although advances have been made recently in the MCC field, large gaps remain with regard to definitive biomarkers and prognostic indicators. Although MCC is chemosensitive, responses in advanced stages are mostly of short duration, and the associated clinical benefit on overall survival is unclear. Recent nonrandomised phase 2 clinical trials with anti-PD-L1/PD-1 antibodies have demonstrated safety and efficacy; however, there are still no approved treatments for patients with metastatic MCC. Patients with advanced disease are encouraged to participate in clinical trials for treatment, indicating the largely unmet need for durable, safe treatment within this population.

Nonprogression with Avelumab Treatment Associated with Gains in Quality of Life in Metastatic Merkel Cell Carcinoma

“…Mean FACT-M scores were lower than reported in a previous study of patients with stage IV melanoma [24,44]. This could be due to the fact that MCC is in general a more aggressive tumor than melanoma [6]. However, differences between the two studies at baseline could also be impacted by other characteristics of the underlying populations; such as type of treatment or patient age.…”

Merkel cell carcinoma cardiac metastasis causing cardiac tamponade

“…Sentinel lymph node biopsy is recommended for those with clinically and radiographically node-negative disease 16. There are data to suggest that adjuvant radiotherapy reduces the local recurrence rate of MCC 17. There is no convincing data to suggest any survival benefit with adjuvant chemotherapy 17…”

Merkel Cells and Merkel Cell Carcinoma of Genitourinary System Tumor with Aggressive Behavior and Poor Prognosis

“…head, neck and extremities of elderly persons. [25][26][27]. This highly aggressive malignancy occures most often in the white population [28,29].…”

“…Risk group includes the elderly people with immunosuppression from organ transplant and HIV infection [27,30]. MCC presents as a firm, painless, red-violet, rapidly enlarging, cutaneous nodule ( Figure 4) [25,27,31]. Ethiology of MCC is linked to the presence of clonally integrated Merkel cell polyomavirus (MCPyV) and/or mutagenesis from ultraviolet [UV] light exposure [32].…”

“…CK-20 is specific, highly sensitive marker for MCC [positive in 89 to 100% of cases [35]. Mortality of the cancer is estimated to be between 33% and 46% [27,36] and the rate of mortality is higher than in patients with melanoma [27,37]. MCC is the second most common cause of death after melanoma [37,38].…”