Version June 2024
This algorithm outlines the treatment approach for patients with metastatic MCC who are eligible for systemic therapy. The selection of agent(s) depends on availability of and access to treatment, disease-related symptoms, patient performance status, and comorbidities. Clinical trials are encouraged, where available. Patients who are ineligible for systemic therapy may be offered alternative treatment approaches and/or best supportive care. Refer to UpToDate content on treatment of metastatic MCC.
Palliative treatment with radiation therapy or surgical resection can be offered at any time to patients with symptomatic tumors or those at risk of organ damage (eg, spinal cord damage or superior vena cava obstruction).MCC: Merkel cell carcinoma; ICI: immune checkpoint inhibitor.
* Multiple clinical factors influence eligibility for ICIs including medical comorbidities, history of autoimmune disease, and use of immunosuppressive therapy or glucocorticoids. Refer to UpToDate content on systemic treatment of metastatic melanoma with molecular alterations.
¶ Pembrolizumab and avelumab are preferred because they can induce durable responses, are typically well tolerated, and are approved for the treatment of MCC. For patients with widely metastatic, symptomatic disease burden, some UpToDate experts offer a brief course (up to two cycles) of chemotherapy to decrease tumor burden prior to initiating ICI therapy.
Δ Nivolumab plus ipilimumab can induce responses in patients with metastatic MCC refractory to single-agent immunotherapy. However, we do not use this combination as initial therapy because it has similar efficacy and is more toxic compared with single-agent immunotherapy.
◊ Chemotherapy has a high response rate and can rapidly reduce tumor burden. However, responses are not durable, the impact on overall survival is uncertain, and patients are at risk for significant treatment-related toxicity (including death).
§ Includes peptide receptor radionuclide radiotherapy and somatostatin analogues (octreotide, lanreotide).آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
