Treatment of Inoperable Stage III or Stage IV (Metastatic) Merkel Cell Carcinoma — First-Line Approach
Clinical Scenario
This protocol applies to patients with Merkel cell carcinoma (MCC) that has progressed to inoperable stage III or stage IV (metastatic) disease, where curative surgery is no longer feasible. Despite advances in diagnosis and treatment, inoperable stage III and IV MCC remain incurable, making selection of the appropriate first-line systemic strategy critical.
First-Line Treatment — Partial Overview
For eligible patients, enrolment in a clinical trial is the preferred approach. Where a trial is not available, the recommended alternative involves immunotherapy — specifically agents targeting the PD-1/PD-L1 pathway — combined with best supportive care.
The complete regimen, agent selection guidance, sequencing, and supporting evidence are available in the full structured protocol below.
References
DOI: 10.1016/j.esmoop.2024.102977
Despite the recent advances in diagnosis and treatment, inoperable stage III and IV MCC remain incurable.
Administration of immunotherapy in the first-/second-line settings is recommended (if there is no contraindication for immunotherapy).
Immunotherapeutic agents, such as avelumab (III, A; ESMO-MCBS v1.1 score: 4; FDA and EMA approved), pembrolizumab (III, A; ESMO-MCBS v1.1 score: 3; FDA approved, not EMA approved), retifanlimab (III, A; FDA and EMA approved) and nivolumab (III, A; not EMA or FDA approved), are recommended as first- and second-line treatments if no contraindications exist.
In cases of inoperable/disseminated disease, first-line treatment with an anti-PD-(L)1 antibody is suggested as it is more effective and safer than ChT.
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