Avelumab and Other Recent Advances in Merkel Cell Carcinoma

Abstract

Merkel cell carcinoma (MCC) is a rare but aggressive form of skin cancer that occurs in the elderly, is associated with UV radiation and immunosuppression. Initial treatment consists of wide excision with adjuvant radiation. Although the tumor is sensitive to chemotherapy, long-term survival is unusual and there had been no US FDA-approved drugs prior to 2017. The recognition that MCC is associated with the Merkel cell polyomavirus occurs more commonly in immune-compromised patients and tumors express PD-L1 suggested testing immunotherapy. A study of an anti-PD-L1 antibody, avelumab, in chemotherapy-refractory MCC demonstrated a response rate of 31.8% resulting in FDA approval in March 2017 and EMA in September 2017. This review will discuss the disease, role of avelumab and other emerging treatment strategies for MCC.

Personalized treatment concepts in extraocular cancer

“…Old age, ultraviolet light exposure, immunocompromised status, and exposure to human polyomavirus are associated with the pathogenesis of the disease. 51 , 52 …”

“…Avelumab, a anti-PD-L1 antibody, was approved in 2017 by the FDA and EMA for metastatic MCC (mMCC) treatment. 51 JAVELIN Merkel 200, a cohort of this single-arm phase II trial enrolled 88 patients with mMCC or disease progression after prior chemotherapy, published in 2018(56). All patients received avelumab 10 ​mg/kg intravenously every two weeks.…”

An Updated Review of the Biomarkers of Response to Immune Checkpoint Inhibitors in Merkel Cell Carcinoma: Merkel Cell Carcinoma and Immunotherapy

“…Chemotherapy was the standard of care for patients with MCC until anti-PD-L1 antibody avelumab was approved in 2017 by the FDA and European Medicines Agency (EMA) [36,[53][54][55].…”

Burden of Disease, Early Diagnosis, and Treatment of Merkel Cell Carcinoma in Latin America

“…One such immuno-oncologic agent, the checkpoint inhibitor, avelumab, is a fully humanized monoclonal IgG1 antibody that binds to the programmed death ligand-1. 61 , 62 A phase II multicenter trial with avelumab in patients who were previously treated with systemic agents demonstrated an objective response in 32% of patients and 52% were alive at 1 year. This compares with a median survival of 5.7 months in patients with advanced disease who receive second-line chemotherapy.…”