Favorable Response After Only One Cycle of Peptide Receptor Radionuclide Therapy With 177Lu-DOTATATE in a Patient With Metastatic Merkel Cell Carcinoma

Moghadam, Soroush Zarehparvar; Divband, Ghasemali; Shakeri, Sepideh; Aryana, Kamran

doi:10.1097/rlu.0000000000002669

Cited by 10 publications

(11 citation statements)

References 10 publications

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“…The median PFS as not reached in the Lutathera arm at time of primary analysis and was 8.4 months (95% CI 5.8 to 9.1 months) for patients treated with the SSA alone. The single center experience at the Erasmus Medical Center included 1214 patients with SSTR-positive neuroendocrine tumors, including MCC [ 124 ], with single patient reports suggesting potential treatment response with Lutathera for patients with MCC [ 125 ]. The GoTHAM trial is a phase Ib/II trial investigating the safety and antitumor activity of Lutathera or RT in addition to avelumab for patients with metastatic MCC.…”

Section: Treatmentmentioning

confidence: 99%

Merkel Cell Carcinoma of the Head and Neck: Epidemiology, Pathogenesis, Current State of Treatment and Future Directions

Yusuf

McKenzie

Rattani

et al. 2021

Cancers

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Merkel cell carcinoma (MCC) is a rare, cutaneous neuroendocrine malignancy with increasing incidence. The skin of the head and neck is a common subsite for MCC with distinctions in management from other anatomic areas. Given the rapid pace of developments regarding MCC pathogenesis (Merkel cell polyoma virus (MCPyV)-positive or virus-negative, cell of origin), diagnosis, staging and treatment, and up to date recommendations are critical for optimizing outcomes. This review aims to summarize currently available literature for MCC of the head and neck. The authors reviewed current literature, including international guidelines regarding MCC pathogenesis, epidemiology, diagnosis, staging, and treatment. Subsequently recommendations were derived including the importance of baseline imaging, MCPyV serology testing, primary site surgery, nodal evaluation, radiotherapy, and the increasing role of immune modulating agents in MCC. MCPyV serology testing is increasingly important with potential distinctions in treatment response and surveillance between virus-positive and virus-negative MCC. Surgical management continues to balance optimizing local control with minimal morbidity. Similarly, radiotherapy continues to have importance in the adjuvant, definitive, and palliative setting for MCC of the head and neck. Immunotherapy has changed the paradigm for advanced MCC, with increasing work focusing on optimizing outcomes for non-responders and high-risk patients, including those with immunosuppression.

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Section: Treatmentmentioning

confidence: 99%

Merkel Cell Carcinoma of the Head and Neck: Epidemiology, Pathogenesis, Current State of Treatment and Future Directions

Yusuf

McKenzie

Rattani

et al. 2021

Cancers

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“…The National Comprehensive Cancer Network guidelines have implemented the use of PRRT for neuroendocrine tumors but not yet for MCC (17). To date, there have been only a few reported cases of successful PRRT in mMCC (5)(6)(7) and no cases of combined PRRT and immunotherapy. Recently, the GoTHAM trial (NCT04261855) was launched; it is investigating the efficacy of firstline avelumab plus PRRT for the treatment of mMCC.…”

Section: Discussionmentioning

confidence: 99%

“…PRRT led to significantly prolonged survival compared with treatment with somatostatin analogs in patients with neuroendocrine tumors of the midgut (4). PRRT for mMCC exhibited a promising response in a few case reports (5)(6)(7). Here, we report the case of a patient with mMCC who progressed on multiple lines of ICI and subsequently responded well to combined therapy with ipilimumab plus nivolumab ICI and somatostatin PRRT.…”

mentioning

confidence: 94%

Response to Combined Peptide Receptor Radionuclide Therapy and Checkpoint Immunotherapy with Ipilimumab Plus Nivolumab in Metastatic Merkel Cell Carcinoma

et al. 2021

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For patients with Merkel cell carcinoma (MCC) who are refractory to immune checkpoint inhibition (ICI), treatment options are limited. Few cases of MCCs have been reported to show responses to peptide receptor radionuclide therapy (PRRT). A combination of PRRT and ICI has not been reported in MCC to date. A patient with metastatic MCC, who was resistant to first-line avelumab and acquired resistance to ipilimumab/nivolumab (IPI/NIVO) with additional radiotherapy, presented with multiple distant metastases. After confirmation of SSTR expression, treatment was continued with an additional 4 doses of IPI/NIVO combined with 2 cycles of PRRT. Treatment was well tolerated, with transient hemotoxicity and mild nausea. Restaging after 3 mo demonstrated an exceptional response. This case demonstrates the feasibility of combined treatment with IPI/NIVO and PRRT as an option for MCC patients progressing under ICI. Prospective evidence confirming the additive value of combining ICI and radionuclide therapy in a larger cohort is needed.

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“…Peptide receptor radionuclide therapy (PRRT) with (177) Lu-DOTATATE could be a potentially active therapy in MCC. Several case reports described objective responses in metastatic MCC patients ( 99 , 100 ), and a phase II trial is currently ongoing (NCT04276597).…”

Section: Future Directions For Advanced Diseasementioning

confidence: 99%

Merkel Cell Carcinoma: An Immunotherapy Fairy-Tale?

et al. 2021

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Merkel cell carcinoma (MCC) is a rare, highly aggressive, neuroendocrine cutaneous tumor. The incidence of MCC is growing worldwide, and the disease-related mortality is about three-fold higher than melanoma. Since a few years ago, very little has been known about this disease, and chemotherapy has been the standard of care. Nowadays, new discoveries about the pathophysiology of this neoplasm and the introduction of immunotherapy allowed to completely rewrite the history of these patients. In this review, we provide a summary of the most important changes in the management of Merkel cell carcinoma, with a focus on immunotherapy and a landscape of future treatment strategies.

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Favorable Response After Only One Cycle of Peptide Receptor Radionuclide Therapy With 177Lu-DOTATATE in a Patient With Metastatic Merkel Cell Carcinoma

Cited by 10 publications

References 10 publications

Merkel Cell Carcinoma of the Head and Neck: Epidemiology, Pathogenesis, Current State of Treatment and Future Directions

Merkel Cell Carcinoma of the Head and Neck: Epidemiology, Pathogenesis, Current State of Treatment and Future Directions

Response to Combined Peptide Receptor Radionuclide Therapy and Checkpoint Immunotherapy with Ipilimumab Plus Nivolumab in Metastatic Merkel Cell Carcinoma

Merkel Cell Carcinoma: An Immunotherapy Fairy-Tale?

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