Merkel Cell Carcinoma: Changing Practice Patterns and Impact on Recurrence-Free and Overall Survival at a Single Institution and Nationally

Abstract

Background Merkel cell carcinoma (MCC) is an aggressive neuroendocrine carcinoma of the skin. Our report describes the evolution of management and characteristics associated with recurrence, disease-specific survival (DSS) and overall survival (OS) in the treatment of MCC. Methods A single institution retrospective review of MCC and SEER data to determine factors associated with RFS, DSS, and OS using a multivariable Cox regression on inverse-probability weighted cohorts. Results One hundred fifty-nine patients were identified with a median age of 75. Of these, 96% were Caucasian and 60% male. Fifty-eight out of 159 (36%) of all patients were deceased with 21/58 (36%) dead from MCC with a median follow-up of 3.1 years. Institutionally, trends over time demonstrated an increased use of immunotherapy with a concomitant decrease in chemotherapy and decreased use of radiotherapy alone. Institutionally and nationally, there has been increased surgical nodal staging. Institutionally, factors associated with shorter DSS included advanced age, active cigarette smoker (p = 0.002), cT2 disease (p = 0.007), and MCC with unknown primary (p < 0.001). Institutionally, factors associated with shorter OS included ages ≥ 75 years (p < 0.001), an immunocompromised state (p < 0.001), truncal primary site (p = 0.002), and cT2 disease (HR 9.59, p < 0.001). Conclusion Changing practice patterns in MCC management have been driven by the adoption of immunotherapy. Our study highlights that competing risks of mortality in MCC patients likely prevents OS from being an accurate surrogate outcome measure to understand factors associated with DSS.

Prognostic Value of Radiotherapy and Chemotherapy in Stage I–III Merkel Cell Carcinoma

“…Although advanced age at diagnosis is known to be an independent prognostic factor associated with worse survival, different median or mean values for age at diagnosis have been reported in the literature (7,(19)(20)(21)(22). Results from the RCS analysis in the current study indicated that an age of 75 years was an appropriate inflection point for subsequent analysis (Figure 2), which was consistent with prior large sample size studies (23,24). In the multivariate analysis, advanced age at diagnosis was further proven to be an independent risk factor for the whole cohort as well as in the subgroup analysis.…”

“…To date, accumulating evidence has shown encouraging results for immunotherapy in the treatment of MCC (23,31). In 2016, Kaufman et al conducted a single arm, phase II trial evaluating the efficiency of avelumab in CT-refractory metastatic MCC patients.…”