Clinical impact of immunotherapy in Merkel cell carcinoma patients: A systematic review and meta-analysis

Garza-Dávila, Valeria Fernanda; Valdespino-Valdes, Jorge; Barrera, Francisco J.; Ocampo‐Candiani, Jorge; Garza‐Rodríguez, Verónica

doi:10.1016/j.jaad.2021.04.024

Cited by 7 publications

(5 citation statements)

References 36 publications

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“…Recent advances in immunotherapy for the treatment of metastatic melanoma have prompted its application in MCC. Results of a previous meta-analysis demonstrated that immunotherapy was safe and effective in reducing the tumor diameter with a durable response rate (22). At present, immune checkpoint inhibitors (ICIs) exhibit no clear advantage as an adjuvant therapy and programmed cell death protein-1/programmed cell death-ligand 1 inhibitors are still considered first-line treatment options for advanced MCC (16).…”

Section: Discussionmentioning

confidence: 99%

Wide local excision for Merkel cell carcinoma of the lower extremity: A case report

Zhang

Sun

2022

Exp Ther Med

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Primary Merkel cell carcinoma (MCC) is rare and wide local excision is the primary method of treatment. However, no consensus has been reached on the best surgical approach and research is currently limited. The choice of surgical method depends on the experience of the surgeon and the situation of the patient. In the present study, the clinical data of a single case of primary MCC that was treated with wide local excision in June 2019 were retrospectively analyzed and the associated literature was reviewed. The patient underwent complete resection of the tumor, which extended 2 cm from the outer edge of the nodule and reached the subcutaneous fat layer. The wound was closed with a tension-relieving suture. The stitches were removed 15 days following surgery and the wound had healed adequately. No recurrence occurred during 30 months of follow-up. However, further multi-center prospective randomized clinical trials are required for further investigation.

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Section: Discussionmentioning

confidence: 99%

Wide local excision for Merkel cell carcinoma of the lower extremity: A case report

Zhang

Sun

2022

Exp Ther Med

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“…Survival from MCC is much lower than for melanoma (50% at 5-years for local and < 14% for metastatic disease [ 96 ]), although immunotherapy trials are reporting improved outcomes [ 97 – 99 ]; the costs of treatment are likely to increase if these therapies are widely adopted.…”

Section: Harms Of Exposure To Uv Radiationmentioning

confidence: 99%

The effects of exposure to solar radiation on human health

Neale

Lucas

Byrne

et al. 2023

Photochem Photobiol Sci

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This assessment by the Environmental Effects Assessment Panel (EEAP) of the Montreal Protocol under the United Nations Environment Programme (UNEP) evaluates the effects of ultraviolet (UV) radiation on human health within the context of the Montreal Protocol and its Amendments. We assess work published since our last comprehensive assessment in 2018. Over the last four years gains have been made in knowledge of the links between sun exposure and health outcomes, mechanisms, and estimates of disease burden, including economic impacts. Of particular note, there is new information about the way in which exposure to UV radiation modulates the immune system, causing both harms and benefits for health. The burden of skin cancer remains high, with many lives lost to melanoma and many more people treated for keratinocyte cancer, but it has been estimated that the Montreal Protocol will prevent 11 million cases of melanoma and 432 million cases of keratinocyte cancer that would otherwise have occurred in the United States in people born between 1890 and 2100. While the incidence of skin cancer continues to rise, rates have stabilised in younger populations in some countries. Mortality has also plateaued, partly due to the use of systemic therapies for advanced disease. However, these therapies are very expensive, contributing to the extremely high economic burden of skin cancer, and emphasising the importance and comparative cost-effectiveness of prevention. Photodermatoses, inflammatory skin conditions induced by exposure to UV radiation, can have a marked detrimental impact on the quality of life of sufferers. More information is emerging about their potential link with commonly used drugs, particularly anti-hypertensives. The eyes are also harmed by over-exposure to UV radiation. The incidence of cataract and pterygium is continuing to rise, and there is now evidence of a link between intraocular melanoma and sun exposure. It has been estimated that the Montreal Protocol will prevent 63 million cases of cataract that would otherwise have occurred in the United States in people born between 1890 and 2100. Despite the clearly established harms, exposure to UV radiation also has benefits for human health. While the best recognised benefit is production of vitamin D, beneficial effects mediated by factors other than vitamin D are emerging. For both sun exposure and vitamin D, there is increasingly convincing evidence of a positive role in diseases related to immune function, including both autoimmune diseases and infection. With its influence on the intensity of UV radiation and global warming, the Montreal Protocol has, and will have, both direct and indirect effects on human health, potentially changing the balance of the risks and benefits of spending time outdoors. Graphical abstract

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“…The ORRs were 41.02% (32 of 78) and 41.66% (20 of 48) for MCPyV-positive and -negative tumors, respectively, with no difference in response (OR, 1.10; 95% CI, 0.52–2.33) ( 77 ).…”

Section: MCCmentioning

confidence: 99%

Classic and new strategies for the treatment of advanced melanoma and non-melanoma skin cancer

et al. 2023

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Advanced melanoma and non-melanoma skin cancers (NMSCs) are burdened with a dismal prognosis. To improve the survival of these patients, studies on immunotherapy and target therapies in melanoma and NMSCs are rapidly increasing. BRAF and MEK inhibitors improve clinical outcomes, and anti-PD1 therapy demonstrates better results than chemotherapy or anti-CTLA4 therapy in terms of the survival of patients with advanced melanoma. In recent years, the combination therapy of nivolumab plus ipilimumab has gained ground in studies for its survival and response rate benefits in patients with advanced melanoma. In addition, neoadjuvant treatment for stages III and IV melanoma, either as monotherapy or combination therapy, has recently been discussed. Another promising strategy evaluated in recent studies is the triple combination of anti-PD-1/PD-L1 immunotherapy and anti-BRAF plus anti-MEK targeted therapy. On the contrary, in advanced and metastatic BCC, successful therapeutic strategies, such as vismodegib and sonidegib, are based on the inhibition of aberrant activation of the Hedgehog signaling pathway. In these patients, anti-PD-1 therapy with cemiplimab should be reserved as the second-line therapy in case of disease progression or poor response. In patients with locally advanced or metastatic SCC, who are not candidates for surgery or radiotherapy, anti-PD1 agents such as cemiplimab, pembrolizumab, and cosibelimab (CK-301) have shown significant results in terms of response rate. PD-1/PD-L1 inhibitors, such as avelumab, have also been used in Merkel carcinoma, achieving responses in half of the patients with advanced disease. The latest prospect emerging for MCC is the locoregional approach involving the injection of drugs that can stimulate the immune system. Two of the most promising molecules used in combination with immunotherapy are cavrotolimod (a Toll-like receptor 9 agonist) and a Toll-like receptor 7/8 agonist. Another area of study is cellular immunotherapy with natural killer cells stimulated with an IL-15 analog or CD4/CD8 cells stimulated with tumor neoantigens. Neoadjuvant treatment with cemiplimab in CSCCs and nivolumab in MCCs has shown promising results. Despite the successes of these new drugs, the new challenges ahead will be to select patients who will benefit from these treatments based on biomarkers and parameters of the tumor microenvironment.

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Clinical impact of immunotherapy in Merkel cell carcinoma patients: A systematic review and meta-analysis

Cited by 7 publications

References 36 publications

Wide local excision for Merkel cell carcinoma of the lower extremity: A case report

Wide local excision for Merkel cell carcinoma of the lower extremity: A case report

The effects of exposure to solar radiation on human health

Classic and new strategies for the treatment of advanced melanoma and non-melanoma skin cancer

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