Difference between revisions of "Merkel cell carcinoma"
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Warner-admin (talk | contribs) m (Text replacement - "'''dosing details in manuscript have been reviewed'''" to "'''dosing details in manuscript have been reviewed by our editors'''") |
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[[#top|Back to Top]] | [[#top|Back to Top]] | ||
</div> | </div> | ||
− | {| | + | {{#lst:Editorial board transclusions|derm}} |
− | + | ''For placebo or observational studies in this condition, please visit [[Merkel cell carcinoma - null regimens|this page]].'' | |
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{{TOC limit|limit=3}} | {{TOC limit|limit=3}} | ||
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=Guidelines= | =Guidelines= | ||
+ | '''Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.''' | ||
==Alberta Health Services== | ==Alberta Health Services== | ||
− | *2019: [https://www.albertahealthservices.ca/assets/info/hp/cancer/if-hp-cancer-guide-cu004-merkel-cell.pdf Merkel Cell Carcinoma] | + | *2019: [https://www.albertahealthservices.ca/assets/info/hp/cancer/if-hp-cancer-guide-cu004-merkel-cell.pdf Merkel Cell Carcinoma] [https://pubmed.ncbi.nlm.nih.gov/31084721 PubMed] |
− | ==[https://www.nccn.org/ NCCN]== | + | |
− | *[https://www. | + | ==NCCN== |
+ | *[https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1444 NCCN Guidelines - Merkel Cell Carcinoma] | ||
+ | **'''2018:''' Bichakjian et al. [https://doi.org/10.6004/Jnccn.2018.0055 Merkel Cell Carcinoma, Version 1.2018, NCCN Clinical Practice Guidelines in Oncology.] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9440150/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/29891526/ PubMed] | ||
+ | **'''2014:''' Bichakjian et al. [https://doi.org/10.6004/Jnccn.2014.0041 Merkel cell carcinoma, version 1.2014.] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9441108/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/24616545/ PubMed] | ||
+ | **'''2009:''' Miller et al. [https://doi.org/10.6004/Jnccn.2009.0024 Merkel cell carcinoma.] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9444710/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/19401064/ PubMed] | ||
+ | **'''2006:''' Miller et al. [https://doi.org/10.6004/Jnccn.2006.0060 Merkel cell carcinoma.] [https://pubmed.ncbi.nlm.nih.gov/16884672/ PubMed] | ||
+ | **'''2004:''' No authors listed. [https://doi.org/10.6004/Jnccn.2004.0007 Merkel cell carcinoma. Clinical practice guidelines in oncology.] [https://pubmed.ncbi.nlm.nih.gov/19777698/ PubMed] | ||
+ | |||
+ | ==SITC== | ||
+ | *'''2022:''' Silk et al. [https://doi.org/10.1136/jitc-2021-004434 Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of nonmelanoma skin cancer] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9341183/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/35902131 PubMed] | ||
=Metastatic or advanced disease, first-line therapy= | =Metastatic or advanced disease, first-line therapy= | ||
==Pembrolizumab monotherapy {{#subobject:515cc4|Regimen=1}}== | ==Pembrolizumab monotherapy {{#subobject:515cc4|Regimen=1}}== | ||
− | + | <div class="toccolours" style="background-color:#eeeeee"> | |
− | |||
===Regimen {{#subobject:0b8a79|Variant=1}}=== | ===Regimen {{#subobject:0b8a79|Variant=1}}=== | ||
{| class="wikitable sortable" style="width: 80%; text-align:center;" | {| class="wikitable sortable" style="width: 80%; text-align:center;" | ||
!style="width: 25%"|Study | !style="width: 25%"|Study | ||
− | !style="width: 25%"| | + | !style="width: 25%"|Dates of enrollment |
!style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]] | !style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
!style="width: 25%"|[[Levels_of_Evidence#Efficacy|Efficacy]] | !style="width: 25%"|[[Levels_of_Evidence#Efficacy|Efficacy]] | ||
|- | |- | ||
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4927341/ Nghiem et al. 2016 (KEYNOTE-017)] | |[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4927341/ Nghiem et al. 2016 (KEYNOTE-017)] | ||
− | |2015 | + | <!-- {| class="wikitable" style="margin:auto; color:white; background-color:#1B4F26" |
+ | |'''[https://www.esmo.org/guidelines/esmo-mcbs/esmo-mcbs-scorecards/scorecard-326-1 <span style="color:white;">ESMO-MCBS (3)</span>]''' | ||
+ | |- | ||
+ | |} --> | ||
+ | |2015-01 to 2015-12 | ||
|style="background-color:#91cf61"|Phase 2 (RT) | |style="background-color:#91cf61"|Phase 2 (RT) | ||
|ORR: 58% (95% CI 43-72%)<sup>1</sup> | |ORR: 58% (95% CI 43-72%)<sup>1</sup> | ||
Line 41: | Line 48: | ||
|} | |} | ||
''<sup>1</sup>Reported efficacy is based on the 2021 update.'' | ''<sup>1</sup>Reported efficacy is based on the 2021 update.'' | ||
+ | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Immunotherapy==== | ====Immunotherapy==== | ||
*[[Pembrolizumab (Keytruda)]] 2 mg/kg IV once on day 1 | *[[Pembrolizumab (Keytruda)]] 2 mg/kg IV once on day 1 | ||
− | |||
'''21-day cycle for up to 35 cycles (2 years) or until CR''' | '''21-day cycle for up to 35 cycles (2 years) or until CR''' | ||
− | + | </div></div> | |
===References=== | ===References=== | ||
− | # '''KEYNOTE-017:''' Nghiem PT, Bhatia S, Lipson EJ, Kudchadkar RR, Miller NJ, Annamalai L, Berry S, Chartash EK, Daud A, Fling SP, Friedlander PA, Kluger HM, Kohrt HE, Lundgren L, Margolin K, Mitchell A, Olencki T, Pardoll DM, Reddy SA, Shantha EM, Sharfman WH, Sharon E, Shemanski LR, Shinohara MM, Sunshine JC, Taube JM, Thompson JA, Townson SM, Yearley JH, Topalian SL, Cheever MA. PD-1 blockade with pembrolizumab in advanced Merkel-cell carcinoma. N Engl J Med. 2016 Jun 30;374(26):2542-52. Epub 2016 Apr 19. [https://doi.org/10.1056/NEJMoa1603702 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4927341/ link to PMC article] ''' | + | # '''KEYNOTE-017:''' Nghiem PT, Bhatia S, Lipson EJ, Kudchadkar RR, Miller NJ, Annamalai L, Berry S, Chartash EK, Daud A, Fling SP, Friedlander PA, Kluger HM, Kohrt HE, Lundgren L, Margolin K, Mitchell A, Olencki T, Pardoll DM, Reddy SA, Shantha EM, Sharfman WH, Sharon E, Shemanski LR, Shinohara MM, Sunshine JC, Taube JM, Thompson JA, Townson SM, Yearley JH, Topalian SL, Cheever MA. PD-1 blockade with pembrolizumab in advanced Merkel-cell carcinoma. N Engl J Med. 2016 Jun 30;374(26):2542-52. Epub 2016 Apr 19. [https://doi.org/10.1056/NEJMoa1603702 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4927341/ link to PMC article] '''dosing details in manuscript have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/27093365/ PubMed] [https://clinicaltrials.gov/study/NCT02267603 NCT02267603] |
##'''Update:''' Nghiem P, Bhatia S, Lipson EJ, Sharfman WH, Kudchadkar RR, Brohl AS, Friedlander PA, Daud A, Kluger HM, Reddy SA, Boulmay BC, Riker AI, Burgess MA, Hanks BA, Olencki T, Margolin K, Lundgren LM, Soni A, Ramchurren N, Church C, Park SY, Shinohara MM, Salim B, Taube JM, Bird SR, Ibrahim N, Fling SP, Homet Moreno B, Sharon E, Cheever MA, Topalian SL. Durable Tumor Regression and Overall Survival in Patients With Advanced Merkel Cell Carcinoma Receiving Pembrolizumab as First-Line Therapy. J Clin Oncol. 2019 Mar 20;37(9):693-702. Epub 2019 Feb 6. [https://doi.org/10.1200/jco.18.01896 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6424137/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/30726175/ PubMed] | ##'''Update:''' Nghiem P, Bhatia S, Lipson EJ, Sharfman WH, Kudchadkar RR, Brohl AS, Friedlander PA, Daud A, Kluger HM, Reddy SA, Boulmay BC, Riker AI, Burgess MA, Hanks BA, Olencki T, Margolin K, Lundgren LM, Soni A, Ramchurren N, Church C, Park SY, Shinohara MM, Salim B, Taube JM, Bird SR, Ibrahim N, Fling SP, Homet Moreno B, Sharon E, Cheever MA, Topalian SL. Durable Tumor Regression and Overall Survival in Patients With Advanced Merkel Cell Carcinoma Receiving Pembrolizumab as First-Line Therapy. J Clin Oncol. 2019 Mar 20;37(9):693-702. Epub 2019 Feb 6. [https://doi.org/10.1200/jco.18.01896 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6424137/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/30726175/ PubMed] | ||
##'''Update:''' Nghiem P, Bhatia S, Lipson EJ, Sharfman WH, Kudchadkar RR, Brohl AS, Friedlander PA, Daud A, Kluger HM, Reddy SA, Boulmay BC, Riker A, Burgess MA, Hanks BA, Olencki T, Kendra K, Church C, Akaike T, Ramchurren N, Shinohara MM, Salim B, Taube JM, Jensen E, Kalabis M, Fling SP, Homet Moreno B, Sharon E, Cheever MA, Topalian SL. Three-year survival, correlates and salvage therapies in patients receiving first-line pembrolizumab for advanced Merkel cell carcinoma. J Immunother Cancer. 2021 Apr;9(4):e002478. [https://doi.org/10.1136/jitc-2021-002478 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/pmc8061836/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/33879601/ PubMed] | ##'''Update:''' Nghiem P, Bhatia S, Lipson EJ, Sharfman WH, Kudchadkar RR, Brohl AS, Friedlander PA, Daud A, Kluger HM, Reddy SA, Boulmay BC, Riker A, Burgess MA, Hanks BA, Olencki T, Kendra K, Church C, Akaike T, Ramchurren N, Shinohara MM, Salim B, Taube JM, Jensen E, Kalabis M, Fling SP, Homet Moreno B, Sharon E, Cheever MA, Topalian SL. Three-year survival, correlates and salvage therapies in patients receiving first-line pembrolizumab for advanced Merkel cell carcinoma. J Immunother Cancer. 2021 Apr;9(4):e002478. [https://doi.org/10.1136/jitc-2021-002478 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/pmc8061836/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/33879601/ PubMed] | ||
+ | |||
+ | ==Retifanlimab monotherapy {{#subobject:gb33c4|Regimen=1}}== | ||
+ | <div class="toccolours" style="background-color:#eeeeee"> | ||
+ | ===Regimen {{#subobject:0bhy234|Variant=1}}=== | ||
+ | {| class="wikitable sortable" style="width: 60%; text-align:center;" | ||
+ | !style="width: 33%"|Study | ||
+ | !style="width: 33%"|Dates of enrollment | ||
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
+ | |- | ||
+ | |[https://clinicaltrials.gov/study/NCT03599713 Awaiting publication (POD1UM-201)] | ||
+ | |2019-2022 | ||
+ | | style="background-color:#91cf61" |Phase 2 (RT) | ||
+ | |- | ||
+ | |} | ||
+ | <div class="toccolours" style="background-color:#b3e2cd"> | ||
+ | ====Immunotherapy==== | ||
+ | *[[Retifanlimab (Zynyz)]] 500 mg IV over 30 minutes once on day 1 | ||
+ | '''28-day cycle for up to 24 cycles (2 years)''' | ||
+ | </div></div> | ||
+ | ===References=== | ||
+ | #'''POD1UM-201:''' [https://clinicaltrials.gov/study/NCT03599713 NCT03599713] | ||
=Metastatic or advanced disease, subsequent lines of therapy= | =Metastatic or advanced disease, subsequent lines of therapy= | ||
==Avelumab monotherapy {{#subobject:41b46c|Regimen=1}}== | ==Avelumab monotherapy {{#subobject:41b46c|Regimen=1}}== | ||
− | + | <div class="toccolours" style="background-color:#eeeeee"> | |
===Regimen {{#subobject:bcebae|Variant=1}}=== | ===Regimen {{#subobject:bcebae|Variant=1}}=== | ||
{| class="wikitable sortable" style="width: 80%; text-align:center;" | {| class="wikitable sortable" style="width: 80%; text-align:center;" | ||
!style="width: 25%"|Study | !style="width: 25%"|Study | ||
− | !style="width: 25%"| | + | !style="width: 25%"|Dates of enrollment |
!style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]] | !style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
!style="width: 25%"|[[Levels_of_Evidence#Efficacy|Efficacy]] | !style="width: 25%"|[[Levels_of_Evidence#Efficacy|Efficacy]] | ||
|- | |- | ||
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5587154/ Kaufman et al. 2016 (JAVELIN Merkel 200)] | |[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5587154/ Kaufman et al. 2016 (JAVELIN Merkel 200)] | ||
− | |2014-2015 | + | <!-- {| class="wikitable" style="margin:auto; color:white; background-color:#1B4F26" |
+ | |'''[https://www.esmo.org/guidelines/esmo-mcbs/esmo-mcbs-scorecards/scorecard-248-1 <span style="color:white;">ESMO-MCBS (4)</span>]''' | ||
+ | |- | ||
+ | |} --> | ||
+ | |2014-07-25 to 2015-09-03 | ||
|style="background-color:#91cf61"|Phase 2 (RT) | |style="background-color:#91cf61"|Phase 2 (RT) | ||
|33% (95% CI: 23–44)<sup>1</sup> | |33% (95% CI: 23–44)<sup>1</sup> | ||
Line 68: | Line 100: | ||
|} | |} | ||
''<sup>1</sup>Reported efficacy is based on the 2020 update.'' | ''<sup>1</sup>Reported efficacy is based on the 2020 update.'' | ||
+ | <div class="toccolours" style="background-color:#fdcdac"> | ||
====Prior treatment criteria==== | ====Prior treatment criteria==== | ||
*Failure of at least one previous line of chemotherapy for metastatic disease. | *Failure of at least one previous line of chemotherapy for metastatic disease. | ||
+ | </div> | ||
+ | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Immunotherapy==== | ====Immunotherapy==== | ||
*[[Avelumab (Bavencio)]] 10 mg/kg IV over 60 minutes once on day 1 | *[[Avelumab (Bavencio)]] 10 mg/kg IV over 60 minutes once on day 1 | ||
− | |||
====Supportive therapy==== | ====Supportive therapy==== | ||
− | *[[:Category:Antihistamines|H1-antihistamine]], such as [[Diphenhydramine (Benadryl)|diphenhydramine]] (dose & route not given) once on day 1, 30 to 60 minutes prior to | + | *[[:Category:Antihistamines|H1-antihistamine]], such as [[Diphenhydramine (Benadryl)|diphenhydramine]] (dose & route not given) once on day 1, 30 to 60 minutes prior to avelumab |
− | *[[Acetaminophen (Tylenol)|Paracetamol/acetaminophen]] (dose not given) once on day 1, 30 to 60 minutes prior to | + | *[[Acetaminophen (Tylenol)|Paracetamol/acetaminophen]] (dose not given) once on day 1, 30 to 60 minutes prior to avelumab |
*The Bavencio package insert suggests "Premedicate with acetaminophen and an antihistamine for the first 4 infusions and subsequently as needed." | *The Bavencio package insert suggests "Premedicate with acetaminophen and an antihistamine for the first 4 infusions and subsequently as needed." | ||
− | |||
'''14-day cycles''' | '''14-day cycles''' | ||
− | + | </div></div> | |
===References=== | ===References=== | ||
− | <!-- # '''Abstract:''' Howard Kaufman, Jeffery Scott Russell, Omid Hamid, Shailender Bhatia, Patrick Terheyden, Sandra P. D'Angelo, Kent C. Shih, Celeste Lebbe, Gerald P Linette, Michele Milella, Isaac Brownell, Karl D. Lewis, Jochen H. Lorch, Kevin M. Chin, Lisa Mahnke, Anja von Heydebreck, Jean-Marie Cuillerot, Paul Nghiem. Avelumab (MSB0010718C; anti-PD-L1) in patients with metastatic Merkel cell carcinoma previously treated with chemotherapy: Results of the phase 2 JAVELIN Merkel 200 trial. 2016 ASCO Annual Meeting abstract 9508. | + | <!-- # '''Abstract:''' Howard Kaufman, Jeffery Scott Russell, Omid Hamid, Shailender Bhatia, Patrick Terheyden, Sandra P. D'Angelo, Kent C. Shih, Celeste Lebbe, Gerald P Linette, Michele Milella, Isaac Brownell, Karl D. Lewis, Jochen H. Lorch, Kevin M. Chin, Lisa Mahnke, Anja von Heydebreck, Jean-Marie Cuillerot, Paul Nghiem. Avelumab (MSB0010718C; anti-PD-L1) in patients with metastatic Merkel cell carcinoma previously treated with chemotherapy: Results of the phase 2 JAVELIN Merkel 200 trial. 2016 ASCO Annual Meeting abstract 9508. --> |
− | # '''JAVELIN Merkel 200:''' Kaufman HL, Russell J, Hamid O, Bhatia S, Terheyden P, D'Angelo SP, Shih KC, Lebbé C, Linette GP, Milella M, Brownell I, Lewis KD, Lorch JH, Chin K, Mahnke L, von Heydebreck A, Cuillerot JM, Nghiem P. Avelumab in patients with chemotherapy-refractory metastatic Merkel cell carcinoma: a multicentre, single-group, open-label, phase 2 trial. Lancet Oncol. 2016 Oct;17(10):1374-1385. [ | + | # '''JAVELIN Merkel 200:''' Kaufman HL, Russell J, Hamid O, Bhatia S, Terheyden P, D'Angelo SP, Shih KC, Lebbé C, Linette GP, Milella M, Brownell I, Lewis KD, Lorch JH, Chin K, Mahnke L, von Heydebreck A, Cuillerot JM, Nghiem P. Avelumab in patients with chemotherapy-refractory metastatic Merkel cell carcinoma: a multicentre, single-group, open-label, phase 2 trial. Lancet Oncol. 2016 Oct;17(10):1374-1385. Epub 2016 Sep 1. [https://doi.org/10.1016/s1470-2045(16)30364-3 link to original article] '''dosing details in manuscript have been reviewed by our editors''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5587154/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/27592805/ PubMed] content property of [https://hemonc.org HemOnc.org] [https://clinicaltrials.gov/study/NCT02155647 NCT02155647] |
− | ## '''Update:''' Kaufman HL, Russell JS, Hamid O, Bhatia S, Terheyden P, D'Angelo SP, Shih KC, Lebbé C, Milella M, Brownell I, Lewis KD, Lorch JH, von Heydebreck A, Hennessy M, Nghiem P. Updated efficacy of avelumab in patients with previously treated metastatic Merkel cell carcinoma after ≥1 year of follow-up: JAVELIN Merkel 200, a phase 2 clinical trial. J Immunother Cancer. 2018 Jan 19;6(1):7. [https:// | + | ## '''Update:''' Kaufman HL, Russell JS, Hamid O, Bhatia S, Terheyden P, D'Angelo SP, Shih KC, Lebbé C, Milella M, Brownell I, Lewis KD, Lorch JH, von Heydebreck A, Hennessy M, Nghiem P. Updated efficacy of avelumab in patients with previously treated metastatic Merkel cell carcinoma after ≥1 year of follow-up: JAVELIN Merkel 200, a phase 2 clinical trial. J Immunother Cancer. 2018 Jan 19;6(1):7. [https://doi.org/10.1186/s40425-017-0310-x link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774167/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/29347993/ PubMed] |
− | ## '''Update:''' D'Angelo SP, Russell J, Lebbé C, Chmielowski B, Gambichler T, Grob JJ, Kiecker F, Rabinowits G, Terheyden P, Zwiener I, Bajars M, Hennessy M, Kaufman HL. Efficacy and safety of first-line avelumab treatment in patients with stage IV metastatic Merkel cell carcinoma: a preplanned interim analysis of a clinical trial. JAMA Oncol. 2018 Sep 1;4(9):e180077. Epub 2018 Sep 13. [https:// | + | ## '''Update:''' D'Angelo SP, Russell J, Lebbé C, Chmielowski B, Gambichler T, Grob JJ, Kiecker F, Rabinowits G, Terheyden P, Zwiener I, Bajars M, Hennessy M, Kaufman HL. Efficacy and safety of first-line avelumab treatment in patients with stage IV metastatic Merkel cell carcinoma: a preplanned interim analysis of a clinical trial. JAMA Oncol. 2018 Sep 1;4(9):e180077. Epub 2018 Sep 13. [https://doi.org/10.1001/jamaoncol.2018.0077 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885245/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/29566106/ PubMed] |
##'''Update:''' D'Angelo SP, Bhatia S, Brohl AS, Hamid O, Mehnert JM, Terheyden P, Shih KC, Brownell I, Lebbé C, Lewis KD, Linette GP, Milella M, Georges S, Shah P, Ellers-Lenz B, Bajars M, Güzel G, Nghiem PT. Avelumab in patients with previously treated metastatic Merkel cell carcinoma: long-term data and biomarker analyses from the single-arm phase 2 JAVELIN Merkel 200 trial. J Immunother Cancer. 2020 May;8(1):e000674. [https://doi.org/10.1136/jitc-2020-000674 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/pmc7239697/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/32414862/ PubMed] | ##'''Update:''' D'Angelo SP, Bhatia S, Brohl AS, Hamid O, Mehnert JM, Terheyden P, Shih KC, Brownell I, Lebbé C, Lewis KD, Linette GP, Milella M, Georges S, Shah P, Ellers-Lenz B, Bajars M, Güzel G, Nghiem PT. Avelumab in patients with previously treated metastatic Merkel cell carcinoma: long-term data and biomarker analyses from the single-arm phase 2 JAVELIN Merkel 200 trial. J Immunother Cancer. 2020 May;8(1):e000674. [https://doi.org/10.1136/jitc-2020-000674 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/pmc7239697/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/32414862/ PubMed] | ||
− | + | ##'''Update:''' D'Angelo SP, Bhatia S, Brohl AS, Hamid O, Mehnert JM, Terheyden P, Shih KC, Brownell I, Lebbé C, Lewis KD, Linette GP, Milella M, Xiong H, Guezel G, Nghiem PT. Avelumab in patients with previously treated metastatic Merkel cell carcinoma (JAVELIN Merkel 200): updated overall survival data after >5 years of follow-up. ESMO Open. 2021 Dec;6(6):100290. Epub 2021 Oct 26. [https://doi.org/10.1016/j.esmoop.2021.100290 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/pmc8564559/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/34715570/ PubMed] | |
[[Category:Merkel cell carcinoma regimens]] | [[Category:Merkel cell carcinoma regimens]] | ||
[[Category:Disease-specific pages]] | [[Category:Disease-specific pages]] | ||
− | [[Category: | + | [[Category:Non-melanoma skin cancers]] |
Latest revision as of 12:22, 15 July 2024
Section editor | |
---|---|
Elizabeth Buchbinder, MD Dana-Farber Cancer Institute Boston, MA, USA |
For placebo or observational studies in this condition, please visit this page.
3 regimens on this page
3 variants on this page
|
Guidelines
Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.
Alberta Health Services
- 2019: Merkel Cell Carcinoma PubMed
NCCN
- NCCN Guidelines - Merkel Cell Carcinoma
- 2018: Bichakjian et al. Merkel Cell Carcinoma, Version 1.2018, NCCN Clinical Practice Guidelines in Oncology. link to PMC article PubMed
- 2014: Bichakjian et al. Merkel cell carcinoma, version 1.2014. link to PMC article PubMed
- 2009: Miller et al. Merkel cell carcinoma. link to PMC article PubMed
- 2006: Miller et al. Merkel cell carcinoma. PubMed
- 2004: No authors listed. Merkel cell carcinoma. Clinical practice guidelines in oncology. PubMed
SITC
- 2022: Silk et al. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of nonmelanoma skin cancer link to PMC article PubMed
Metastatic or advanced disease, first-line therapy
Pembrolizumab monotherapy
Regimen
Study | Dates of enrollment | Evidence | Efficacy |
---|---|---|---|
Nghiem et al. 2016 (KEYNOTE-017) | 2015-01 to 2015-12 | Phase 2 (RT) | ORR: 58% (95% CI 43-72%)1 |
1Reported efficacy is based on the 2021 update.
Immunotherapy
- Pembrolizumab (Keytruda) 2 mg/kg IV once on day 1
21-day cycle for up to 35 cycles (2 years) or until CR
References
- KEYNOTE-017: Nghiem PT, Bhatia S, Lipson EJ, Kudchadkar RR, Miller NJ, Annamalai L, Berry S, Chartash EK, Daud A, Fling SP, Friedlander PA, Kluger HM, Kohrt HE, Lundgren L, Margolin K, Mitchell A, Olencki T, Pardoll DM, Reddy SA, Shantha EM, Sharfman WH, Sharon E, Shemanski LR, Shinohara MM, Sunshine JC, Taube JM, Thompson JA, Townson SM, Yearley JH, Topalian SL, Cheever MA. PD-1 blockade with pembrolizumab in advanced Merkel-cell carcinoma. N Engl J Med. 2016 Jun 30;374(26):2542-52. Epub 2016 Apr 19. link to original article link to PMC article dosing details in manuscript have been reviewed by our editors PubMed NCT02267603
- Update: Nghiem P, Bhatia S, Lipson EJ, Sharfman WH, Kudchadkar RR, Brohl AS, Friedlander PA, Daud A, Kluger HM, Reddy SA, Boulmay BC, Riker AI, Burgess MA, Hanks BA, Olencki T, Margolin K, Lundgren LM, Soni A, Ramchurren N, Church C, Park SY, Shinohara MM, Salim B, Taube JM, Bird SR, Ibrahim N, Fling SP, Homet Moreno B, Sharon E, Cheever MA, Topalian SL. Durable Tumor Regression and Overall Survival in Patients With Advanced Merkel Cell Carcinoma Receiving Pembrolizumab as First-Line Therapy. J Clin Oncol. 2019 Mar 20;37(9):693-702. Epub 2019 Feb 6. link to original article link to PMC article PubMed
- Update: Nghiem P, Bhatia S, Lipson EJ, Sharfman WH, Kudchadkar RR, Brohl AS, Friedlander PA, Daud A, Kluger HM, Reddy SA, Boulmay BC, Riker A, Burgess MA, Hanks BA, Olencki T, Kendra K, Church C, Akaike T, Ramchurren N, Shinohara MM, Salim B, Taube JM, Jensen E, Kalabis M, Fling SP, Homet Moreno B, Sharon E, Cheever MA, Topalian SL. Three-year survival, correlates and salvage therapies in patients receiving first-line pembrolizumab for advanced Merkel cell carcinoma. J Immunother Cancer. 2021 Apr;9(4):e002478. link to original article link to PMC article PubMed
Retifanlimab monotherapy
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Awaiting publication (POD1UM-201) | 2019-2022 | Phase 2 (RT) |
Immunotherapy
- Retifanlimab (Zynyz) 500 mg IV over 30 minutes once on day 1
28-day cycle for up to 24 cycles (2 years)
References
- POD1UM-201: NCT03599713
Metastatic or advanced disease, subsequent lines of therapy
Avelumab monotherapy
Regimen
Study | Dates of enrollment | Evidence | Efficacy |
---|---|---|---|
Kaufman et al. 2016 (JAVELIN Merkel 200) | 2014-07-25 to 2015-09-03 | Phase 2 (RT) | 33% (95% CI: 23–44)1 |
1Reported efficacy is based on the 2020 update.
Prior treatment criteria
- Failure of at least one previous line of chemotherapy for metastatic disease.
Immunotherapy
- Avelumab (Bavencio) 10 mg/kg IV over 60 minutes once on day 1
Supportive therapy
- H1-antihistamine, such as diphenhydramine (dose & route not given) once on day 1, 30 to 60 minutes prior to avelumab
- Paracetamol/acetaminophen (dose not given) once on day 1, 30 to 60 minutes prior to avelumab
- The Bavencio package insert suggests "Premedicate with acetaminophen and an antihistamine for the first 4 infusions and subsequently as needed."
14-day cycles
References
- JAVELIN Merkel 200: Kaufman HL, Russell J, Hamid O, Bhatia S, Terheyden P, D'Angelo SP, Shih KC, Lebbé C, Linette GP, Milella M, Brownell I, Lewis KD, Lorch JH, Chin K, Mahnke L, von Heydebreck A, Cuillerot JM, Nghiem P. Avelumab in patients with chemotherapy-refractory metastatic Merkel cell carcinoma: a multicentre, single-group, open-label, phase 2 trial. Lancet Oncol. 2016 Oct;17(10):1374-1385. Epub 2016 Sep 1. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article PubMed content property of HemOnc.org NCT02155647
- Update: Kaufman HL, Russell JS, Hamid O, Bhatia S, Terheyden P, D'Angelo SP, Shih KC, Lebbé C, Milella M, Brownell I, Lewis KD, Lorch JH, von Heydebreck A, Hennessy M, Nghiem P. Updated efficacy of avelumab in patients with previously treated metastatic Merkel cell carcinoma after ≥1 year of follow-up: JAVELIN Merkel 200, a phase 2 clinical trial. J Immunother Cancer. 2018 Jan 19;6(1):7. link to original article link to PMC article PubMed
- Update: D'Angelo SP, Russell J, Lebbé C, Chmielowski B, Gambichler T, Grob JJ, Kiecker F, Rabinowits G, Terheyden P, Zwiener I, Bajars M, Hennessy M, Kaufman HL. Efficacy and safety of first-line avelumab treatment in patients with stage IV metastatic Merkel cell carcinoma: a preplanned interim analysis of a clinical trial. JAMA Oncol. 2018 Sep 1;4(9):e180077. Epub 2018 Sep 13. link to original article link to PMC article PubMed
- Update: D'Angelo SP, Bhatia S, Brohl AS, Hamid O, Mehnert JM, Terheyden P, Shih KC, Brownell I, Lebbé C, Lewis KD, Linette GP, Milella M, Georges S, Shah P, Ellers-Lenz B, Bajars M, Güzel G, Nghiem PT. Avelumab in patients with previously treated metastatic Merkel cell carcinoma: long-term data and biomarker analyses from the single-arm phase 2 JAVELIN Merkel 200 trial. J Immunother Cancer. 2020 May;8(1):e000674. link to original article link to PMC article PubMed
- Update: D'Angelo SP, Bhatia S, Brohl AS, Hamid O, Mehnert JM, Terheyden P, Shih KC, Brownell I, Lebbé C, Lewis KD, Linette GP, Milella M, Xiong H, Guezel G, Nghiem PT. Avelumab in patients with previously treated metastatic Merkel cell carcinoma (JAVELIN Merkel 200): updated overall survival data after >5 years of follow-up. ESMO Open. 2021 Dec;6(6):100290. Epub 2021 Oct 26. link to original article link to PMC article PubMed