Current Treatment Options in Oncology

, Volume 14, Issue 2, pp 249–263

Emerging and Mechanism-Based Therapies for Recurrent or Metastatic Merkel Cell Carcinoma

  • Natalie J. Miller
  • Shailender Bhatia
  • Upendra Parvathaneni
  • Jayasri G. Iyer
  • Paul Nghiem
Skin Cancer (W Sharfman, Section Editor)

DOI: 10.1007/s11864-013-0225-9

Cite this article as:
Miller, N.J., Bhatia, S., Parvathaneni, U. et al. Curr. Treat. Options in Oncol. (2013) 14: 249. doi:10.1007/s11864-013-0225-9

Opinion statement

Merkel cell carcinoma (MCC) is a rare but aggressive neuroendocrine skin cancer with a disease-specific mortality of approximately 40 %. The association of MCC with a recently discovered polyomavirus, combined with the increased incidence and mortality of MCC among immunocompromised patients, highlight the importance of the immune system in controlling this cancer. Initial management of MCC is summarized within the NCCN guidelines and in recently published reviews. The high rate of recurrent and metastatic disease progression in MCC, however, presents a major challenge in a cancer that lacks mechanism-based, disease-specific therapies. Traditional treatment approaches have focused on cytotoxic chemotherapy that, despite frequent initial efficacy, rarely provides durable responses and has high morbidity among the elderly. In addition, the immunosuppressive nature of chemotherapy is of concern when treating a virus-associated cancer for which survival is unusually tightly linked to immune function. With a median survival of 9.6 months after development of an initial metastasis (n = 179, described herein), and no FDA-approved agents for this cancer, there is an urgent need for more effective treatments. We review diverse management options for patients with advanced MCC, with a focus on emerging and mechanism-based therapies, some of which specifically target persistently expressed viral antigens. These treatments include single-dose radiation and novel immunotherapies, some of which are in clinical trials. Due to their encouraging efficacy, low toxicity, and lack of immune suppression, these therapies may offer viable alternatives to traditional cytotoxic chemotherapy.

Keywords

Merkel cell carcinoma Skin cancer Immunotherapy Merkel cell polyomavirus Pazopanib Octreotide Somatostatin Neuroendocrine carcinoma Adoptive T cell therapy Single-dose radiation therapy PD-1 Survival 

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Natalie J. Miller
    • 1
  • Shailender Bhatia
    • 2
    • 4
    • 5
  • Upendra Parvathaneni
    • 3
  • Jayasri G. Iyer
    • 1
  • Paul Nghiem
    • 1
    • 4
    • 5
  1. 1.Departments of Medicine/Dermatology, PathologyUniversity of WashingtonSeattleUSA
  2. 2.Department of Medicine/Medical OncologyUniversity of WashingtonSeattleUSA
  3. 3.Department of Radiation OncologyUniversity of WashingtonSeattleUSA
  4. 4.Fred Hutchinson Cancer Research CenterSeattleUSA
  5. 5.Seattle Cancer Care AllianceSeattleUSA

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