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Jacobs D, Huang H, Olino K, Weiss S, Kluger H, Judson BL, Zhang Y. Assessment of Age, Period, and Birth Cohort Effects and Trends in Merkel Cell Carcinoma Incidence in the United States. JAMA Dermatol 2021; 157:59-65. [PMID: 33146688 DOI: 10.1001/jamadermatol.2020.4102] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Merkel cell carcinoma is an aggressive, cutaneous, neuroendocrine cancer that is increasing in incidence. Understanding why the incidence of Merkel cell carcinoma is increasing through underlying factors, such as age effects, calendar period of diagnosis effects, and birth cohort effects, can help guide resource allocation and design of screening programs. Objectives To evaluate the associations of patient age, calendar period of diagnosis, and birth cohort with the increasing incidence of Merkel cell carcinoma and to provide new incidence projections to 2030. Design, Setting, and Participants A cross-sectional retrospective study with age-period-cohort analysis and incidence projection modeling using data from the Surveillance, Epidemiology, and End Results Program database of 9 registries from 1987 to 2016 was conducted among 3720 patients with Merkel cell carcinoma. Statistical analysis was conducted from October 20, 2019, to July 29, 2020. Exposures Age effects (ie, physiology), period of diagnosis effects (ie, changes in diagnostics and clinical awareness), and birth cohort effects (ie, environmental risk factors) over time were assessed. Main Outcomes and Measures Incidence rates of Merkel cell carcinoma. Results Among the 3720 patients in the study (2200 male patients [59.1%]; median age, 77 years [interquartile range, 68-84 years]), during the period from 2012 to 2016, the age-adjusted Merkel cell carcinoma incidence rate was 0.66 per 100 000 (95% CI, 0.62-0.70), which represented a 3.5-times (95% CI, 3.0-4.2) increase from 1987 to 1991. The incidence of Merkel cell carcinoma increased with patient age across calendar periods and birth cohorts; the highest incidence rate was observed for those aged 85 years or older, with an age-adjusted rate from 2012 to 2016 of 14.6 per 100 000 for men and 5.5 per 100 000 for women. Although the birth cohort effect has continued to increase over time, the calendar period of diagnosis effect has started to plateau. It is projected that there will be 3023 new cases of Merkel cell carcinoma in 2020 and 5130 new cases in 2030, increased from an estimated 1933 cases in 2010. Conclusions and Relevance The slowing down of the period effect (ie, changes in diagnostics and awareness) found in this longitudinal cohort study suggests that part of the initial increased incidence of Merkel cell carcinoma was associated with increased detection. However, the projected increase in incidence rate is likely associated with the aging population and increasing risk factor exposure in more recent birth cohorts.
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Affiliation(s)
| | - Huang Huang
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Kelly Olino
- Yale Cancer Center, New Haven, Connecticut.,Divsion of Surgical Oncology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Sarah Weiss
- Yale Cancer Center, New Haven, Connecticut.,Division of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Harriet Kluger
- Yale Cancer Center, New Haven, Connecticut.,Division of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Benjamin L Judson
- Yale Cancer Center, New Haven, Connecticut.,Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Yawei Zhang
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut.,Department of Surgery, Yale School of Medicine, New Haven, Connecticut
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Grubb AF, Hankollari E. Cerebral metastasis of Merkel cell carcinoma following resection with negative margins and adjuvant external beam radiation: a case report. J Med Case Rep 2021; 15:118. [PMID: 33714267 PMCID: PMC7956125 DOI: 10.1186/s13256-021-02690-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 01/21/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine tumor of the skin. It is associated with advanced age, ultraviolet (UV) radiation, and Merkel cell polyomavirus. It has a predilection for the lymphatic system, but rarely spreads to the central nervous system. CASE PRESENTATION A 71-year-old Caucasian man with a history of rheumatoid arthritis and MCC of the right lower eyelid and cheek presented with left-sided hemineglect and word-finding difficulty. Twenty months earlier he had undergone local excision of a 3 cm lesion with negative margins, negative sentinel lymph node biopsy, and external beam radiation. On presentation he was found to have a 6.3 cm mass in the right frontotemporal region. He underwent prompt resection, with pathological analysis consistent with metastatic MCC. He subsequently underwent stereotactic radiosurgery (SRS) and adjunctive immunotherapy with pembrolizumab. He has since tolerated the therapy well and is currently without neurological symptoms or evidence of recurrence. CONCLUSIONS Cerebral metastasis of MCC is a rare event and should be considered when a patient with a history of MCC presents with neurological symptoms. Optimal treatment regimens of these rare cases are unclear; however, prompt resection, stereotactic radiosurgery, and adjunctive immunotherapy have shown an initial positive response in this patient.
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Affiliation(s)
- Alex F Grubb
- Department of Medicine, Duke University Hospital, 2301 Erwin Road, Durham, NC, 27710, USA.
| | - Elizabeth Hankollari
- Department of Medicine, Duke University Hospital, 2301 Erwin Road, Durham, NC, 27710, USA
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53
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Angeles CV, Sabel MS. Immunotherapy for Merkel cell carcinoma. J Surg Oncol 2021; 123:775-781. [PMID: 33595894 DOI: 10.1002/jso.26319] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/07/2020] [Accepted: 11/17/2020] [Indexed: 12/12/2022]
Abstract
Merkel cell carcinoma (MCC) is an aggressive form of skin cancer which, while chemosensitive, has high rates of relapse and chemoresistance, limiting the impact of chemotherapy. An immunogenic tumor, the management of advanced MCC has changed dramatically with the introduction of checkpoint inhibitors. This review will focus on the impact of immunotherapy in unresectable and metastatic MCC, ongoing research in the adjuvant and neoadjuvant settings, and future directions of immune-based strategies for this challenging cancer.
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Affiliation(s)
| | - Michael S Sabel
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
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54
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Cutaneous Head and Neck Cancers in the High-Risk Immunosuppressed Population. Otolaryngol Clin North Am 2021; 54:397-413. [PMID: 33602516 DOI: 10.1016/j.otc.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The immunosuppressed (IS) population encompasses a diverse cohort of patients to include iatrogenically immunocompromised organ transplant recipients as well as patients with chronic lymphoid malignancies, human immunodeficiency virus/acquired immunodeficiency syndrome, and autoimmune disorders. Cutaneous cancers in this high-risk patient group are clinically distinct from the general immunocompetent population, showing aggressive behavior with associated poor outcomes. This article reviews the pathogenesis, epidemiology, incidence, prognosis, and special considerations required in managing cutaneous cancers in the IS patient population.
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55
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D’Arcy ME, Castenson D, Lynch CF, Kahn AR, Morton LM, Shiels MS, Pfeiffer RM, Engels EA. Risk of Rare Cancers Among Solid Organ Transplant Recipients. J Natl Cancer Inst 2021; 113:199-207. [PMID: 32462187 PMCID: PMC7850530 DOI: 10.1093/jnci/djaa078] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/04/2020] [Accepted: 05/21/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Immunosuppressed solid organ transplant recipients (SOTRs) have elevated rates of certain rare cancers caused by viruses. Evaluating risk of rare cancers among SOTRs may provide etiological clues for additional cancers linked to poor immunity and viral infections. METHODS We performed a cohort study of 262 455 SOTRs (1987-2014) from the US SOTR registry linked to 17 population-based cancer registries. First cancers in SOTRs were categorized using an established classification scheme based on site and histology. Standardized incidence ratios (SIRs) compared risk in SOTRs with the general population. We used Poisson regression to calculate incidence rate ratios according to immune-related SOTR characteristics, including time since transplant (ie, duration of immunosuppression). All statistical tests were 2-sided. RESULTS We examined 694 distinct cancer subtypes, with 33 manifesting statistically significantly elevated SIRs (Bonferroni P < 7.2 × 10-5). All 33 are rare (incidence <6 per 100 000 person-years) and several have known viral etiology (eg, Merkel cell carcinoma: SIR = 24.7, 95% confidence interval [CI] = 20.8 to 29.1). Additional cancers that were increased include squamous cell carcinomas of the lip (SIR range = 18.3-19.8), eye and adnexa (SIR = 13.8, 95% CI = 7.9 to 22.3), salivary gland (SIR = 9.3, 95% CI = 6.1 to 13.5), and nasal cavity and sinuses (SIR = 4.5, 95% CI = 2.8 to 6.8); sebaceous adenocarcinoma (SIR = 34.3, 95% CI = 26.3 to 44.0); malignant fibrous histiocytoma (15.4); and subtypes of bladder, kidney, lung, and colon cancer (SIR range = 3.2-13.3). Incidence of several cancers increased over time since transplant (Ptrend < .05), including squamous cell carcinomas of the lip, salivary gland, and anogenital sites. CONCLUSIONS SOTRs experience elevated rates of several rare cancers. Because some of these cancers exhibit aggressive behavior with poor outcomes, it is important to further characterize the role of immunity and the potential involvement of oncogenic viruses to improve prevention and treatment.
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MESH Headings
- Adolescent
- Adult
- Aged
- Carcinoma, Merkel Cell/epidemiology
- Carcinoma, Merkel Cell/etiology
- Carcinoma, Merkel Cell/pathology
- Carcinoma, Squamous Cell/epidemiology
- Carcinoma, Squamous Cell/etiology
- Carcinoma, Squamous Cell/immunology
- Carcinoma, Squamous Cell/pathology
- Female
- Humans
- Immune Tolerance/immunology
- Immunocompromised Host/immunology
- Immunosuppression Therapy/adverse effects
- Male
- Middle Aged
- Neoplasms/epidemiology
- Neoplasms/etiology
- Neoplasms/immunology
- Neoplasms/pathology
- Organ Transplantation/adverse effects
- Rare Diseases/epidemiology
- Rare Diseases/etiology
- Rare Diseases/immunology
- Rare Diseases/pathology
- Registries
- Risk Factors
- Sarcoma, Kaposi/epidemiology
- Sarcoma, Kaposi/etiology
- Sarcoma, Kaposi/immunology
- Sarcoma, Kaposi/pathology
- Skin Neoplasms
- Transplant Recipients
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Affiliation(s)
- Monica E D’Arcy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | | | - Charles F Lynch
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Amy R Kahn
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, NY, USA
| | - Lindsay M Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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Park SY, Doolittle-Amieva C, Moshiri Y, Akaike T, Parvathaneni U, Bhatia S, Zaba LC, Nghiem P. How we treat Merkel cell carcinoma: within and beyond current guidelines. Future Oncol 2021; 17:1363-1377. [PMID: 33511866 PMCID: PMC7983043 DOI: 10.2217/fon-2020-1036] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Merkel cell carcinoma (MCC) is an aggressive skin cancer associated with a high risk of local recurrence and distant metastasis. Optimal care of this potentially life-threatening cancer is critical but challenging because: physicians are often unfamiliar with its management due to rarity, and MCC management remains controversial, in part because it is rapidly evolving across multiple specialties. While guidelines offer a broad overview of management, they are often not sufficient when making decisions for individual patients. Herein, we present a literature review as well as practical approaches adopted at our institutions for staging, surveillance and therapy of MCC. Each of these areas are discussed in light of how they can be appropriately customized for prevalent but challenging situations. We also provide representative examples of MCC patient scenarios and how they were managed by a multidisciplinary team to identify suitable evidence-based, individualized treatment plans. Merkel cell carcinoma (MCC) is a skin cancer with a high risk of recurrence and distant spread. Optimal care of this cancer is important. However, management is challenging because it is rare and its treatment is continuously evolving across multiple specialties. While treatment guidelines offer a broad overview of management, they are often not detailed enough to provide appropriate patient-specific assistance. Herein, we present a review of recent studies and our suggestions relevant to MCC staging, surveillance and treatment options. Each of these areas are discussed in light of how they can be appropriately customized for challenging situations often encountered by practitioners. We also provide representative examples of MCC patient scenarios and how they were managed by a multidisciplinary team to identify evidence-based, individualized treatment plans.
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Affiliation(s)
- Song Y Park
- Division of Dermatology, University of Washington at South Lake Union, Seattle, WA 98109, USA
| | - Coley Doolittle-Amieva
- Division of Dermatology, University of Washington at South Lake Union, Seattle, WA 98109, USA
| | - Yasman Moshiri
- Division of Dermatology, University of Washington at South Lake Union, Seattle, WA 98109, USA
| | - Tomoko Akaike
- Division of Dermatology, University of Washington at South Lake Union, Seattle, WA 98109, USA
| | - Upendra Parvathaneni
- Department of Radiation Oncology, University of Washington, Seattle, WA 98109, USA
| | - Shailender Bhatia
- Department of Medicine, University of Washington, Seattle, WA 98109, USA
| | - Lisa C Zaba
- Department of Dermatology, Stanford University, Palo Alto, CA 94304, USA
| | - Paul Nghiem
- Division of Dermatology, University of Washington at South Lake Union, Seattle, WA 98109, USA.,Department of Radiation Oncology, University of Washington, Seattle, WA 98109, USA
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57
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Björn Andtback H, Björnhagen-Säfwenberg V, Shi H, Lui WO, Masucci GV, Villabona L. Sex Differences in Overall Survival and the Effect of Radiotherapy in Merkel Cell Carcinoma-A Retrospective Analysis of a Swedish Cohort. Cancers (Basel) 2021; 13:cancers13020265. [PMID: 33445741 PMCID: PMC7828197 DOI: 10.3390/cancers13020265] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Merkel cell carcinoma (MCC) is a rare and aggressive skin cancer which is believed to be partially caused by a virus or ultraviolet exposure. Most previous studies have shown that MCC is more common in men compared to women, virus associated MCC has a better prognosis and surgery followed by radiotherapy gives a better outcome. In this article, we explore these traits in a Swedish cohort of 113 patients and find that MCC is more common in women and female patients have a longer survival compared to male patients. In addition, we found that virus negative MCC has a worse outcome in male patients and radiotherapy after surgery gives a better outcome for patients who are treated with a curative dosage, irrespective of sex. Abstract Merkel cell carcinoma (MCC) is a rare and aggressive skin cancer where Merkel cell Polyomavirus (MCPyV) contributes to the pathogenesis. In an adjuvant setting, radiotherapy (RT) is believed to give a survival benefit. The prognostic impact of sex related to MCPyV-status and adjuvant RT were analyzed in patients referred to Karolinska University Hospital. Data were collected from 113 patients’ hospital records and MCPyV analyses were made in 54 patients (48%). We found a significantly better overall survival (OS) for women compared to men and a significant difference in OS in patients receiving adjuvant RT. Furthermore, we found that men with virus negative MCC have an increased risk for earlier death (HR 3.6). This indicates that MCPyV positive and negative MCC act as two different diseases, and it might be due to different mechanism in the immune response between male and female patients. This could have significance in tailoring treatment and follow-up in MCC patients in the future.
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Affiliation(s)
- Hannah Björn Andtback
- Department Oncology-Pathology, Karolinska Institute and BioClinicum, Karolinska University Hospital, 17176 Stockholm, Sweden; (H.B.A.); (H.S.); (W.-O.L.); (G.V.M.)
| | | | - Hao Shi
- Department Oncology-Pathology, Karolinska Institute and BioClinicum, Karolinska University Hospital, 17176 Stockholm, Sweden; (H.B.A.); (H.S.); (W.-O.L.); (G.V.M.)
| | - Weng-Onn Lui
- Department Oncology-Pathology, Karolinska Institute and BioClinicum, Karolinska University Hospital, 17176 Stockholm, Sweden; (H.B.A.); (H.S.); (W.-O.L.); (G.V.M.)
| | - Giuseppe V. Masucci
- Department Oncology-Pathology, Karolinska Institute and BioClinicum, Karolinska University Hospital, 17176 Stockholm, Sweden; (H.B.A.); (H.S.); (W.-O.L.); (G.V.M.)
| | - Lisa Villabona
- Department Oncology-Pathology, Karolinska Institute and BioClinicum, Karolinska University Hospital, 17176 Stockholm, Sweden; (H.B.A.); (H.S.); (W.-O.L.); (G.V.M.)
- Correspondence: ; Tel.: +46-736-63-98-98
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Abstract
Merkel cell polyomavirus (MCPyV) is the most recently discovered human oncogenic virus. MCPyV asymptomatically infects most of the human population. In the elderly and immunocompromised, however, it can cause a highly lethal form of human skin cancer called Merkel cell carcinoma (MCC). Distinct from the productive MCPyV infection that replicates the viral genome as episomes, MCC tumors contain replication-incompetent, integrated viral genomes. Mutant MCPyV tumor antigen genes expressed from the integrated viral genomes are essential for driving the oncogenic development of MCPyV-associated MCC. In this chapter, we summarize recent discoveries on MCPyV virology, mechanisms of MCPyV-mediated oncogenesis, and the current therapeutic strategies for MCPyV-associated MCCs.
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Affiliation(s)
- Wei Liu
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Jianxin You
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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Yildiz F, Demirci U, Küçükarda A, Büyüksimsek M, Sakalar T, Topcu T, Aslan F, Tufan G, Aydin O, Turna H, Babacan N, Basoglu T, Kurt B, Yildiz B, Eren T, Demiray A, Gumusay O, Arslan C, Özdemir N, Urun Y, Baykara M, Turan N, Uysal M, Bilici A, Kavgaci H, Çiçin İ, Kilickap S, Paydas S. Merkel cell carcinoma in Turkey: A multicentric study. J Cancer Res Ther 2021; 17:1525-1529. [DOI: 10.4103/jcrt.jcrt_950_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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60
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Alotaibi FH, Lugo R, Patel SY, Abdulsattar J, Ghali G. Primary Merkel Cell Carcinoma of the parotid gland; unusual location and clinical presentation. ORAL AND MAXILLOFACIAL SURGERY CASES 2020. [DOI: 10.1016/j.omsc.2020.100197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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61
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DeCaprio JA. Molecular Pathogenesis of Merkel Cell Carcinoma. ANNUAL REVIEW OF PATHOLOGY-MECHANISMS OF DISEASE 2020; 16:69-91. [PMID: 33228463 DOI: 10.1146/annurev-pathmechdis-012419-032817] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Merkel cell carcinoma (MCC) is an aggressive neuroendocrine carcinoma of the skin with two distinct etiologies. Clonal integration of Merkel cell polyomavirus DNA into the tumor genome with persistent expression of viral T antigens causes at least 60% of all MCC. UV damage leading to highly mutated genomes causes a nonviral form of MCC. Despite these distinct etiologies, both forms of MCC are similar in presentation, prognosis, and response to therapy. At least three oncogenic transcriptional programs feature prominently in both forms of MCC driven by the virus or by mutation. Both forms of MCC have a high proliferative growth rate with increased levels of cell cycle-dependent genes due to inactivation of the tumor suppressors RB and p53, a strong MYC signature due to MYCL activation by the virus or gene amplification, and an attenuated neuroendocrine differentiation program driven by the ATOH1 transcription factor.
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Affiliation(s)
- James A DeCaprio
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts 02215, USA; .,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts 02115, USA
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62
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Marchand A, Kervarrec T, Bhatia S, Samimi M. Pembrolizumab and other immune checkpoint inhibitors in locally advanced or metastatic Merkel Cell Carcinoma: safety and efficacy. Expert Rev Anticancer Ther 2020; 20:1093-1106. [PMID: 33044876 DOI: 10.1080/14737140.2021.1835477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Merkel Cell Carcinoma (MCC) is a rare aggressive skin cancer, mostly affecting elderly patients. Until recently, patients with advanced disease were treated with cytotoxic chemotherapies despite rapid chemoresistance and high toxicity. As with other cancers, immune checkpoint inhibitors (CPI), including pembrolizumab, allow durable responses with a manageable safety profile in these patients. AREAS COVERED This review describes the rationale for using PD-1/PD-L1 inhibitors in MCC, as well as efficacy and safety results from the three open-label trials investigating pembrolizumab or other PD-1/PD-L1 inhibitors in patients with advanced MCC. Real-life experience and predictive pre-treatment biomarkers are discussed to assess which patients are likely to be candidates for such strategies. Ongoing fields of research include the use of CPI in the adjuvant or neoadjuvant setting and combined strategies in refractory patients. Expert Opinion: CPI have become the standard of care for frontline treatment in patients with advanced MCC. Earlier introduction of CPI in the disease course, including neo-adjuvant and adjuvant settings, is likely to improve the outcomes further. Given the rarity of this cancer, we still need to harmonize efforts in order to conduct large-scale trials and efficiently identify best optimal care.
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Affiliation(s)
- Antoine Marchand
- Dermatology Department, University Hospital of Tours , Tours, France
| | - Thibault Kervarrec
- Pathology Department, University Hospital of Tours , Tours, France.,BIP (Biology of Polyomaviruses), ISP1282 INRA-University of Tours , Tours, France
| | - Shailender Bhatia
- Department of Medicine/Medical Oncology, University of Washington Medical Center , Seattle, Washington, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center , Seattle, Washington, USA
| | - Mahtab Samimi
- Dermatology Department, University Hospital of Tours , Tours, France.,BIP (Biology of Polyomaviruses), ISP1282 INRA-University of Tours , Tours, France
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63
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Farah M, Reuben A, Spassova I, Yang RK, Kubat L, Nagarajan P, Ning J, Li W, Aung PP, Curry JL, Torres-Cabala CA, Hudgens CW, Ugurel S, Schadendorf D, Gumbs C, Little LD, Futreal A, Wistuba II, Prieto VG, Wang L, Wong MK, Wargo JA, Becker JC, Tetzlaff MT. T-Cell Repertoire in Combination with T-Cell Density Predicts Clinical Outcomes in Patients with Merkel Cell Carcinoma. J Invest Dermatol 2020; 140:2146-2156.e4. [PMID: 32304704 DOI: 10.1016/j.jid.2020.02.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 02/09/2020] [Accepted: 02/12/2020] [Indexed: 02/03/2023]
Abstract
The integrity of the immune system represents a pivotal risk factor and prognostic biomarker for Merkel cell carcinoma. A higher density of tumor-associated T cells correlates with improved Merkel cell carcinoma-specific survival, but the prognostic importance of the T-cell infiltrate reactivity is unknown. We evaluated the T-cell receptor repertoire associated with 72 primary Merkel cell carcinomas and correlated metrics of the T-cell receptor repertoire with clinicopathologic characteristics and patient outcomes. We showed that a high Simpson's Dominance index (SDom) was significantly associated with fewer metastases (P = 0.01), lower stage at presentation (P = 0.02), lower final stage at last follow-up (P = 0.05), and longer time to first lymph node metastasis (P = 0.04). These correlations were mostly preserved in the Merkel cell polyomavirus-negative subgroup. Combining SDom with CD3+ or CD8+ T-cell density revealed three distinct prognostic groups with respect to disease-specific survival. Patients with both high SDom and high CD3+ or CD8+ T-cell density had markedly improved disease-specific survival compared with patients with low SDom and low CD3+ or CD8+ T-cell density (P = 0.002 and P = 0.03, respectively). Patients with either high SDom or high CD3+ or CD8+ had intermediate disease-specific survival. Our findings demonstrate that the quality of the tumor-associated T-cell infiltrate informs patient prognosis in primary Merkel cell carcinoma beyond the T-cell density.
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Affiliation(s)
- Maya Farah
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alexandre Reuben
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ivelina Spassova
- Translational Skin Cancer Research, University Clinic Essen, Essen, Germany
| | - Richard K Yang
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Linda Kubat
- Translational Skin Cancer Research, University Clinic Essen, Essen, Germany
| | - Priyadharsini Nagarajan
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jing Ning
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Wen Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Phyu P Aung
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jonathan L Curry
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Carlos A Torres-Cabala
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Courtney W Hudgens
- Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Selma Ugurel
- Department of Dermatology, University Clinic Essen, Essen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Clinic Essen, Essen, Germany
| | - Curtis Gumbs
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Latasha D Little
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Andrew Futreal
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ignacio I Wistuba
- Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Victor G Prieto
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Linghua Wang
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael K Wong
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jennifer A Wargo
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jürgen C Becker
- Translational Skin Cancer Research, University Clinic Essen, Essen, Germany; Department of Dermatology, University Clinic Essen, Essen, Germany; German Cancer Consortium, German Cancer Center, Heidelberg, Germany
| | - Michael T Tetzlaff
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
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Structural Analysis of Merkel Cell Polyomavirus (MCPyV) Viral Capsid Protein 1 (VP1) in HIV-1 Infected Individuals. Int J Mol Sci 2020; 21:ijms21217998. [PMID: 33121182 PMCID: PMC7663277 DOI: 10.3390/ijms21217998] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/20/2020] [Accepted: 10/24/2020] [Indexed: 12/12/2022] Open
Abstract
Merkel cell polyomavirus (MCPyV) viral protein 1 (VP1) is the capsid protein that mediates virus attachment to host cell receptors and is the major immune target. Given the limited data on MCPyV VP1 mutations, the VP1 genetic variability was examined in 100 plasma and 100 urine samples from 100 HIV+ individuals. Sequencing of VP1 DNA in 17 urine and 17 plasma specimens, simultaneously MCPyV DNA positive, revealed that 27 samples displayed sequences identical to VP1 of MCC350 strain. VP1 from two urine specimens had either Thr47Ser or Ile115Phe substitution, whereas VP1 of one plasma contained Asp69Val and Ser251Phe substitutions plus deletion (∆) of Tyr79. VP1 DNA in the remaining samples had mutations encoding truncated protein. Three-dimensional prediction models revealed that Asp69Val, Ser251Phe, and Ile115Phe caused neutral effects while Thr47Ser and Tyr79∆ produced a deleterious effect reducing VP1 stability. A549 cells infected with urine or plasma samples containing full-length VP1 variants with substitutions, sustained viral DNA replication and VP1 expression. Moreover, medium harvested from these cells was able to infect new A549 cells. In cells infected by samples with truncated VP1, MCPyV replication was hampered. In conclusion, MCPyV strains with unique mutations in the VP1 gene are circulating in HIV+ patients. These strains display altered replication efficiency compared to the MCC350 prototype strain in A549 cells.
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Hall ET, Fernandez-Lopez E, Silk AW, Dummer R, Bhatia S. Immunologic Characteristics of Nonmelanoma Skin Cancers: Implications for Immunotherapy. Am Soc Clin Oncol Educ Book 2020; 40:1-10. [PMID: 32207669 DOI: 10.1200/edbk_278953] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In this review, we summarize the immunology of nonmelanoma skin cancers (NMSCs) and the clinical data with immunotherapy in this heterogeneous group of cancers that include basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (CSCC), and Merkel cell carcinoma (MCC). NMSCs are exceedingly common, and their treatment consumes substantial health care resources. Annual global mortality from NMSCs is comparable to that from malignant melanoma. Although the majority of NMSCs are localized at diagnosis and are treated effectively with surgery, metastases (nodal and distant) can sometimes arise and require systemic therapy. Given the success of immunotherapy in treating cutaneous melanoma, there has been an increasing interest in studying the immunology of NMSCs. Immunocompromised patients have a substantially higher risk of developing NMSCs (particularly CSCC and MCC), suggesting a role of the immune system in the pathogenesis of these cancers. Similar to cutaneous melanoma, the pathogenesis of BCC, CSCC, and virus-negative MCC is related to DNA damage from ultraviolet radiation exposure, and these cancers have a very high tumor mutational burden, which likely results in higher levels of tumor neoantigens that may be targets for the immune system. Viral antigens in virus-positive MCC are also strongly immunogenic. Emerging data from clinical trials of immune checkpoint inhibitors in NMSCs look very promising and are rapidly changing the treatment landscape of these cancers. Specifically, pembrolizumab and avelumab are U.S. Food and Drug Administration-approved for treatment of metastatic MCC and cemiplimab for metastatic CSCC. Several ongoing trials are investigating novel immunotherapies (monotherapies as well as combination) for treatment of NMSCs.
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Affiliation(s)
- Evan T Hall
- Division of Medical Oncology, University of Washington, Seattle, WA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Ann W Silk
- Dana-Farber Cancer Institute, Boston, MA
| | - Reinhard Dummer
- Department of Dermatology, University Hospital of Zürich, Zürich, Switzerland
| | - Shailender Bhatia
- Division of Medical Oncology, University of Washington, Seattle, WA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
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66
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Zhou X, Nakashima K, Ito M, Zhang X, Sakai S, Feng C, Sun H, Chen H, Li TC, Suzuki T. Prevalence and viral loads of polyomaviruses BKPyV, JCPyV, MCPyV, TSPyV and NJPyV and hepatitis viruses HBV, HCV and HEV in HIV-infected patients in China. Sci Rep 2020; 10:17066. [PMID: 33051567 PMCID: PMC7555828 DOI: 10.1038/s41598-020-74244-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/25/2020] [Indexed: 12/19/2022] Open
Abstract
Human polyomaviruses (PyVs) and hepatitis viruses are often more prevalent or persistent in human immunodeficiency virus (HIV)-infected persons and the associated diseases are more abundant than in immunocompetent individuals. Here, we evaluated seroreactivities and viral loads of human PyVs and hepatitis viruses in HIV/AIDS patients and the general population in China in the combination antiretroviral therapy (cART) era. A total of 810 HIV-1-infected patients and age- and sex-matched HIV-negative individuals were enrolled to assess seroprevalence of PyVs BKPyV, JCPyV, MCPyV, TSPyV, and NJPyV and hepatitis viruses HBV, HCV, and HEV. 583 (72%) patients received cART, and among them, 31.2% had undetectable HIV RNA. While no significant difference was observed in prevalence of anti-PyV antibodies between HIV-positive and -negative groups, serum DNA positivity and DNA copy level of MCPyV were higher in the HIV-positive group. Among HIV-infected patients, BKPyV DNA positivity was significantly higher in patients with CD4 + cell counts < 200 cells/mm3 compared to those with CD4 + cell counts > 500 cells/mm3, suggesting possible reactivation caused by HIV-induced immune suppression. Higher HBV and HCV seropositivities but not HEV seropositivity were also observed in the HIV-positive group. Further correlation analyses demonstrated that HBV and HEV are potential risk factors for increased prevalence of PyV infection.
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Affiliation(s)
- Xianfeng Zhou
- The Collaboration Unit for Field Epidemiology of State Key Laboratory for Infectious Disease Prevention and Control, Jiangxi Provincial Key Laboratory of Animal-Origin and Vector-Borne Diseases, Nanchang Center for Disease Control and Prevention, Nanchang, 330038, China.,Department of Virology and Parasitology, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan
| | - Kenji Nakashima
- Department of Virology and Parasitology, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan
| | - Masahiko Ito
- Department of Virology and Parasitology, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan
| | - Xiaoling Zhang
- The Collaboration Unit for Field Epidemiology of State Key Laboratory for Infectious Disease Prevention and Control, Jiangxi Provincial Key Laboratory of Animal-Origin and Vector-Borne Diseases, Nanchang Center for Disease Control and Prevention, Nanchang, 330038, China
| | - Satoshi Sakai
- Department of Virology and Parasitology, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan.,Department of Molecular Biology, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan
| | - Changhua Feng
- The Collaboration Unit for Field Epidemiology of State Key Laboratory for Infectious Disease Prevention and Control, Jiangxi Provincial Key Laboratory of Animal-Origin and Vector-Borne Diseases, Nanchang Center for Disease Control and Prevention, Nanchang, 330038, China
| | - Huabao Sun
- Department of Clinical Laboratory, Affiliated Infectious Diseases Hospital of Nanchang University, Nanchang, 330002, China
| | - Haiying Chen
- The Collaboration Unit for Field Epidemiology of State Key Laboratory for Infectious Disease Prevention and Control, Jiangxi Provincial Key Laboratory of Animal-Origin and Vector-Borne Diseases, Nanchang Center for Disease Control and Prevention, Nanchang, 330038, China
| | - Tian-Cheng Li
- Department of Virology II, National Institute of Infectious Diseases, Musashi-Murayama, Tokyo, 208-0011, Japan
| | - Tetsuro Suzuki
- Department of Virology and Parasitology, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan.
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Sargen MR, Starrett GJ, Engels EA, Cahoon EK, Tucker MA, Goldstein AM. Sebaceous Carcinoma Epidemiology and Genetics: Emerging Concepts and Clinical Implications for Screening, Prevention, and Treatment. Clin Cancer Res 2020; 27:389-393. [PMID: 32907843 DOI: 10.1158/1078-0432.ccr-20-2473] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/31/2020] [Accepted: 09/03/2020] [Indexed: 11/16/2022]
Abstract
Sebaceous carcinoma is an aggressive skin cancer with a 5-year overall survival rate of 78% for localized/regional disease and 50% for metastatic disease. The incidence of this cancer has been increasing in the United States for several decades, but the underlying reasons for this increase are unclear. In this article, we review the epidemiology and genetics of sebaceous carcinoma, including recent population data and tumor genomic analyses that provide new insights into underlying tumor biology. We further discuss emerging evidence of a possible viral etiology for this cancer. Finally, we review the clinical implications of recent advances in sebaceous carcinoma research for screening, prevention, and treatment.
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Affiliation(s)
- Michael R Sargen
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, NCI, Rockville, Maryland.
| | - Gabriel J Starrett
- Laboratory of Cellular Oncology, Center for Cancer Research, NCI, Bethesda, Maryland
| | - Eric A Engels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, NCI, Rockville, Maryland
| | - Elizabeth K Cahoon
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, NCI, Rockville, Maryland
| | - Margaret A Tucker
- Human Genetics Program, Division of Cancer Epidemiology and Genetics, NCI, Rockville, Maryland
| | - Alisa M Goldstein
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, NCI, Rockville, Maryland
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68
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Nikolouzakis TK, Falzone L, Lasithiotakis K, Krüger-Krasagakis S, Kalogeraki A, Sifaki M, Spandidos DA, Chrysos E, Tsatsakis A, Tsiaoussis J. Current and Future Trends in Molecular Biomarkers for Diagnostic, Prognostic, and Predictive Purposes in Non-Melanoma Skin Cancer. J Clin Med 2020; 9:E2868. [PMID: 32899768 PMCID: PMC7564050 DOI: 10.3390/jcm9092868] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/26/2020] [Accepted: 09/01/2020] [Indexed: 12/11/2022] Open
Abstract
Skin cancer represents the most common type of cancer among Caucasians and presents in two main forms: melanoma and non-melanoma skin cancer (NMSC). NMSC is an umbrella term, under which basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and Merkel cell carcinoma (MCC) are found along with the pre-neoplastic lesions, Bowen disease (BD) and actinic keratosis (AK). Due to the mild nature of the majority of NMSC cases, research regarding their biology has attracted much less attention. Nonetheless, NMSC can bear unfavorable characteristics for the patient, such as invasiveness, local recurrence and distant metastases. In addition, late diagnosis is relatively common for a number of cases of NMSC due to the inability to recognize such cases. Recognizing the need for clinically and economically efficient modes of diagnosis, staging, and prognosis, the present review discusses the main etiological and pathological features of NMSC as well as the new and promising molecular biomarkers available including telomere length (TL), telomerase activity (TA), CpG island methylation (CIM), histone methylation and acetylation, microRNAs (miRNAs), and micronuclei frequency (MNf). The evaluation of all these aspects is important for the correct management of NMSC; therefore, the current review aims to assist future studies interested in exploring the diagnostic and prognostic potential of molecular biomarkers for these entities.
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Affiliation(s)
- Taxiarchis Konstantinos Nikolouzakis
- Laboratory of Anatomy-Histology-Embryology, Medical School, University of Crete, 71110 Heraklion, Crete, Greece;
- Department of General Surgery, University General Hospital of Heraklion, 71110 Heraklion, Crete, Greece; (K.L.); (E.C.)
| | - Luca Falzone
- Epidemiology Unit, IRCCS Istituto Nazionale Tumori ‘Fondazione G. Pascale’, I-80131 Naples, Italy;
| | - Konstantinos Lasithiotakis
- Department of General Surgery, University General Hospital of Heraklion, 71110 Heraklion, Crete, Greece; (K.L.); (E.C.)
| | | | - Alexandra Kalogeraki
- Department of Pathology-Cytopathology, Medical School, University of Crete, 70013 Heraklion, Crete, Greece;
| | - Maria Sifaki
- Centre of Toxicology Science and Research, Faculty of Medicine, University of Crete, 71003 Heraklion, Crete, Greece;
| | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Crete, Greece;
| | - Emmanuel Chrysos
- Department of General Surgery, University General Hospital of Heraklion, 71110 Heraklion, Crete, Greece; (K.L.); (E.C.)
| | - Aristidis Tsatsakis
- Centre of Toxicology Science and Research, Faculty of Medicine, University of Crete, 71003 Heraklion, Crete, Greece;
| | - John Tsiaoussis
- Laboratory of Anatomy-Histology-Embryology, Medical School, University of Crete, 71110 Heraklion, Crete, Greece;
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69
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Bryant MK, Ward C, Gaber CE, Strassle PD, Ollila DW, Laks S. Decreased survival and increased recurrence in Merkel cell carcinoma significantly linked with immunosuppression. J Surg Oncol 2020; 122:653-659. [PMID: 32562583 DOI: 10.1002/jso.26048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/12/2020] [Accepted: 05/18/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare and aggressive form of skin cancer. It is an immunogenic tumor as evident by its association with Polyomavirus, immunotherapy response, and increased prevalence in the immunosuppressed population. OBJECTIVE We sought to evaluate the impact of known clinicopathological determinants and immunosuppression on the risk of recurrence and mortality of MCC patients. METHODS A retrospective, observational cohort study of patients diagnosed and/or treated with MCC at two tertiary academic institutions. We compared clinicopathological determinants, treatment modalities, and immunosuppression status on clinical outcomes of recurrence, disease-specific survival, and overall survival. RESULTS We evaluated 90 patients within our study and 34% had a cancer recurrence during follow-up. Patients with recurrence were significantly more likely to be immunosuppressed (32% vs 5%; P = .001). Estimated 5-year recurrence was 43%, and immunosuppressed patients were significantly more likely to recur (Hazard ratio [HR] 3.67 [1.80-7.51]; P < .0001). Immunosuppressed patients had significantly elevated cancer-specific mortality (HR 6.11[1.61-23.26]; P = .008). LIMITATIONS Retrospective review with a prolonged observation period and changing treatment modalities. CONCLUSION Immunocompromised patients had a threefold increased incidence of 5-year mortality and over twofold increased incidence of any recurrence as non-immunocompromised patients. Patients' immunosuppressive status should be considered when making decisions regarding treatment, surveillance, and prognostication.
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Affiliation(s)
- Mary K Bryant
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Christine Ward
- Department of Surgery, Stony Brook University Hospital, Stony Brook, New York
| | - Charles E Gaber
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Paula D Strassle
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - David W Ollila
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Shachar Laks
- Department of Surgical Oncology, Sheba Medical Center, Ramat Gan, Israel
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70
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Bleicher J, Asare EA, Flores S, Bowles TL, Bowen GM, Hyngstrom JR. Oncologic outcomes of patients with Merkel Cell Carcinoma (MCC): A multi-institutional cohort study. Am J Surg 2020; 221:844-849. [PMID: 32878692 DOI: 10.1016/j.amjsurg.2020.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/05/2020] [Accepted: 08/14/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare cutaneous neuroendocrine tumor that primarily affects elderly patients. Despite aggressive treatment, overall survival (OS) remains low. METHODS This study is a multi-institutional, retrospective review of 102 patients with MCC. We evaluated OS, disease-specific survival (DSS), and risk factors for recurrence. RESULTS Median age of patients was 71.46% of patients recurred. Patients with stage I disease had median 5-year OS of 59.3%, compared to 68.1% DSS. For stage III, median 5-year OS was 46.0% vs 58.2% DSS. Disease stage and advanced age were risk factors for recurrence and decreased OS. Immunocompromised status and disease stage were the strongest predictors of DSS. CONCLUSIONS DSS is significantly better than OS for patients with MCC. Many elderly patients with newly diagnosed MCC have low remaining life expectancy, regardless of their MCC diagnosis. Patient age and overall health status should be considered to personalize care plans for patients with MCC.
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Affiliation(s)
- Josh Bleicher
- Department of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA.
| | - Elliot A Asare
- Department of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA; Department of Surgery, Intermountain Medical Center, Salt Lake City, UT, USA
| | - Shadai Flores
- Department of Dermatology, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
| | - Tawnya L Bowles
- Department of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA; Department of Surgery, Intermountain Medical Center, Salt Lake City, UT, USA
| | - Glen M Bowen
- Department of Dermatology, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
| | - John R Hyngstrom
- Department of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA; Department of Surgery, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
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71
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Akaike G, Akaike T, Fadl SA, Lachance K, Nghiem P, Behnia F. Imaging of Merkel Cell Carcinoma: What Imaging Experts Should Know. Radiographics 2020; 39:2069-2084. [PMID: 31697628 DOI: 10.1148/rg.2019190102] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Merkel cell carcinoma (MCC) is a rare and aggressive cutaneous neuroendocrine tumor with a higher mortality rate than melanoma. Approximately 40% of MCC patients have nodal or distant metastasis at initial presentation, and one-third of patients will develop distant metastatic disease over their clinical course. Although MCC is rare, its incidence has been steadily increasing. Furthermore, the immunogenicity of MCC and its diagnostic and therapeutic application have made MCC one of the most rapidly developing topics in dermatology and oncology. Owing to the aggressive and complex nature of MCC, a multidisciplinary approach is necessary for management of this tumor, including dermatologists, surgeons, radiation oncologists, medical oncologists, pathologists, radiologists, and nuclear medicine physicians. Imaging plays a crucial role in diagnosis, planning for surgery or radiation therapy, and assessment of treatment response and surveillance. However, MCC is still not well recognized among radiologists and nuclear medicine physicians, likely owing to its rarity. The purpose of this review is to raise awareness of MCC among imaging experts by describing the epidemiology, pathophysiology, and clinical features of MCC and current clinical management with a focus on the role of imaging. The authors highlight imaging findings characteristic of MCC, as well as the clinical significance of CT, MRI, sentinel lymph node mapping, fluorine 18 fluorodeoxyglucose PET/CT, and other nuclear medicine studies such as bone scintigraphy and somatostatin receptor scintigraphy. ©RSNA, 2019.
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Affiliation(s)
- Gensuke Akaike
- From the Division of Nuclear Medicine, Department of Radiology (G.A., F.B.), and Division of Dermatology, Department of Medicine (T.A., K.L., P.N.), University of Washington, 1959 NE Pacific St, Box 356113, Seattle, WA 98195-6113; and Department of Radiology, Virginia Commonwealth University Health System, Richmond, Va (S.A.F.)
| | - Tomoko Akaike
- From the Division of Nuclear Medicine, Department of Radiology (G.A., F.B.), and Division of Dermatology, Department of Medicine (T.A., K.L., P.N.), University of Washington, 1959 NE Pacific St, Box 356113, Seattle, WA 98195-6113; and Department of Radiology, Virginia Commonwealth University Health System, Richmond, Va (S.A.F.)
| | - Shaimaa A Fadl
- From the Division of Nuclear Medicine, Department of Radiology (G.A., F.B.), and Division of Dermatology, Department of Medicine (T.A., K.L., P.N.), University of Washington, 1959 NE Pacific St, Box 356113, Seattle, WA 98195-6113; and Department of Radiology, Virginia Commonwealth University Health System, Richmond, Va (S.A.F.)
| | - Kristina Lachance
- From the Division of Nuclear Medicine, Department of Radiology (G.A., F.B.), and Division of Dermatology, Department of Medicine (T.A., K.L., P.N.), University of Washington, 1959 NE Pacific St, Box 356113, Seattle, WA 98195-6113; and Department of Radiology, Virginia Commonwealth University Health System, Richmond, Va (S.A.F.)
| | - Paul Nghiem
- From the Division of Nuclear Medicine, Department of Radiology (G.A., F.B.), and Division of Dermatology, Department of Medicine (T.A., K.L., P.N.), University of Washington, 1959 NE Pacific St, Box 356113, Seattle, WA 98195-6113; and Department of Radiology, Virginia Commonwealth University Health System, Richmond, Va (S.A.F.)
| | - Fatemeh Behnia
- From the Division of Nuclear Medicine, Department of Radiology (G.A., F.B.), and Division of Dermatology, Department of Medicine (T.A., K.L., P.N.), University of Washington, 1959 NE Pacific St, Box 356113, Seattle, WA 98195-6113; and Department of Radiology, Virginia Commonwealth University Health System, Richmond, Va (S.A.F.)
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Brown HE, Dennis LK, Lauro P, Jain P, Pelley E, Oren E. Emerging Evidence for Infectious Causes of Cancer in the United States. Epidemiol Rev 2020; 41:82-96. [PMID: 32294189 DOI: 10.1093/epirev/mxz003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2019] [Indexed: 12/13/2022] Open
Abstract
Worldwide, infectious agents currently contribute to an estimated 15% of new cancer cases. Most of these (92%, or 2 million new cancer cases) are attributable to 4 infectious agents: Helicobacter pylori, human papillomavirus, and hepatitis B and C viruses. A better understanding of how infectious agents relate to the US cancer burden may assist new diagnostic and treatment efforts. We review US-specific crude mortality rates from infection-associated cancers and describe temporal and spatial trends since 1999. We review the US-specific evidence for infection-cancer associations by reporting available estimates for attributable fractions for the infection-cancer associations. Death due to cancers with established infectious associations varies geographically, but estimates for the US attributable fraction are limited to a few observational studies. To describe the burden of infection-associated cancer in the United States, additional observational studies are necessary to estimate the prevalence of infection nationally and within subpopulations. As infectious associations emerge to explain cancer etiologies, new opportunities and challenges to reducing the burden arise. Improved estimates for the United States would help target interventions to higher-risk subpopulations.
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Affiliation(s)
- Heidi E Brown
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Leslie K Dennis
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Priscilla Lauro
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Purva Jain
- Department of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California
| | - Erin Pelley
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Eyal Oren
- Department of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California
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Pietropaolo V, Prezioso C, Moens U. Merkel Cell Polyomavirus and Merkel Cell Carcinoma. Cancers (Basel) 2020; 12:E1774. [PMID: 32635198 PMCID: PMC7407210 DOI: 10.3390/cancers12071774] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/26/2020] [Accepted: 06/28/2020] [Indexed: 12/12/2022] Open
Abstract
Viruses are the cause of approximately 15% of all human cancers. Both RNA and DNA human tumor viruses have been identified, with Merkel cell polyomavirus being the most recent one to be linked to cancer. This virus is associated with about 80% of Merkel cell carcinomas, a rare, but aggressive cutaneous malignancy. Despite its name, the cells of origin of this tumor may not be Merkel cells. This review provides an update on the structure and life cycle, cell tropism and epidemiology of the virus and its oncogenic properties. Putative strategies to prevent viral infection or treat virus-positive Merkel cell carcinoma patients are discussed.
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Affiliation(s)
- Valeria Pietropaolo
- Department of Public Health and Infectious Diseases, “Sapienza” University, 00185 Rome, Italy; (V.P.); (C.P.)
| | - Carla Prezioso
- Department of Public Health and Infectious Diseases, “Sapienza” University, 00185 Rome, Italy; (V.P.); (C.P.)
- IRCSS San Raffaele Pisana, Microbiology of Chronic Neuro-Degenerative Pathologies, 00166 Rome, Italy
| | - Ugo Moens
- Molecular Inflammation Research Group, Department of Medical Biology, Faculty of Health Sciences, University of Tromsø—The Arctic University of Norway, 9037 Tromsø, Norway
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Abstract
Viral infection underlies a significant share of the global cancer burden. Merkel cell polyomavirus (MCPyV) is the newest member of the human oncogenic virus family. Its discovery over a decade ago marked the beginning of an exciting era in human tumor virology. Since then, significant evidence has emerged to support the etiologic role of MCPyV in Merkel cell carcinoma (MCC), an extremely lethal form of skin cancer. MCPyV infection is widespread in the general population. MCC diagnoses have tripled over the past 20 years, but effective treatments are currently lacking. In this review, we highlight recent discoveries that have shaped our understanding of MCPyV oncogenic mechanism and host cellular tropism, as well as the molecular events occurring in the viral infectious life cycle. These insights will guide future efforts in developing novel virus-targeted therapeutic strategies for treating the devastating human cancers associated with this new tumorigenic virus.
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Affiliation(s)
- Wei Liu
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104-6076, USA;
| | - Jianxin You
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104-6076, USA;
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Ramachandran P, Erdinc B, Gotlieb V. An Unusual Presentation of Merkel Cell Carcinoma in a HIV Patient: A Case Report and Literature Review. J Investig Med High Impact Case Rep 2020; 7:2324709619836695. [PMID: 30938171 PMCID: PMC6446430 DOI: 10.1177/2324709619836695] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare, rapidly growing, aggressive neuroendocrine skin cancer that generally arises on sun-exposed areas of body such as head, neck, upper limbs, and shoulders of people with light complexity. Typically, MCC presents as shiny, flesh-colored or bluish-red, intracutaneous nodule, possibly with ulceration or crusting. In most of the cases, there is an association with Merkel cell polyomavirus. Even though these are very aggressive tumors, early detection and treatment has always given favorable outcome. There seems to be no consensus in definite prognostic markers, and advanced stages have the worst outcome even with treatment. There has been a recent trend in using PD-I/PD-L1 target therapy rather than chemotherapy in these cancers and have shown to improve survival by many months. In this article, we report a very unusual presentation of MCC first found on left frontoparietal skull as an 8-cm diameter fixed, subcutaneous mass without any typical features of MCC and was found to have metastatic spread to lung and liver. The patient was treated with palliative radiotherapy to brain and chemotherapy with cisplatin/etoposide with addition of immunotherapy later.
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Affiliation(s)
| | - Burak Erdinc
- 1 Brookdale University Hospitals and Medical Center, New York, NY, USA
| | - Vladimir Gotlieb
- 1 Brookdale University Hospitals and Medical Center, New York, NY, USA
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Selective reactivation of STING signaling to target Merkel cell carcinoma. Proc Natl Acad Sci U S A 2020; 117:13730-13739. [PMID: 32482869 DOI: 10.1073/pnas.1919690117] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a lethal skin cancer that metastasizes rapidly. Few effective treatments are available for patients with metastatic MCC. Poor intratumoral T cell infiltration and activation are major barriers that prevent MCC eradication by the immune system. However, the mechanisms that drive the immunologically restrictive tumor microenvironment remain poorly understood. In this study, we discovered that the innate immune regulator stimulator of IFN genes (STING) is completely silenced in MCCs. To reactivate STING in MCC, we developed an application of a human STING mutant, STINGS162A/G230I/Q266I, which we found to be readily stimulated by a mouse STING agonist, DMXAA. This STING molecule was efficiently delivered to MCC cells via an AAV vector. Introducing STINGS162A/G230I/Q266I expression and stimulating its activity by DMXAA in MCC cells reactivates their antitumor inflammatory cytokine/chemokine production. In response to MCC cells with restored STING, cocultured T cells expressing MCPyV-specific T cell receptors (TCRs) show increased cytokine production, migration toward tumor cells, and tumor cell killing. Our study therefore suggests that STING deficiency contributes to the immune suppressive nature of MCCs. More importantly, DMXAA stimulation of STINGS162A/G230I/Q266I causes robust cell death in MCCs as well as several other STING-silenced cancers. Because tumor antigens and DNA released by dying cancer cells have the potential to amplify innate immune response and activate antitumor adaptive responses, our finding indicates that targeted delivery and activation of STINGS162A/G230I/Q266I in tumor cells holds great therapeutic promise for the treatment of MCC and many other STING-deficient cancers.
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Abstract
Merkel cell carcinoma is a rare and aggressive cutaneous malignancy of neuroendocrine origin-an often-missed diagnosis due to the wide histopathologic differential diagnosis of malignant small blue cell tumors. The advent of electron microscopy and immunohistochemistry staining for cytokeratin 20, a shared neuroendocrine marker, greatly improved diagnostic accuracy. Over the past decade, staging, treatment, and surveillance of the cancer have progressed at a remarkably rapid pace. Herein, the authors provide an update on the current guidelines around diagnosis and management and review the exciting advancements on the horizon.
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Affiliation(s)
- Yun Xue
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02215, USA
| | - Manisha Thakuria
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02215, USA; Department of Dermatology, Center for Cutaneous Oncology, Dana-Farber/Brigham and Women's Cancer Center, 450 Brookline Avenue, Boston, MA 02115, USA.
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Treatment of primary Merkel cell carcinoma: Radiotherapy can be an effective, less morbid alternative to surgery. Eur J Surg Oncol 2020; 47:483-485. [PMID: 32736916 DOI: 10.1016/j.ejso.2020.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/13/2020] [Indexed: 01/24/2023] Open
Abstract
The standard treatment approach for localised Merkel cell carcinoma (MCC) is wide surgical excision followed by adjuvant radiotherapy. However extensive surgery for locally advanced MCC may cause morbidity and disfigurement, compromise function and delay adjuvant therapy. Since MCC is a highly radiosensitive tumour, an alternative treatment option for advanced MCCs, especially those in anatomically challenging locations, is radiotherapy. Complete and durable control is achieved in up to 90% of cases if the definitive treatment of primary MCC is with radiotherapy. It is generally less morbid than surgery and can produce excellent cosmetic and functional outcomes.
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79
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Yusuf MB, Gaskins J, Wall W, Tennant P, Bumpous J, Dunlap N. Immune status and the efficacy of radiotherapy on overall survival for patients with localized Merkel cell carcinoma: An analysis of the National Cancer Database. J Med Imaging Radiat Oncol 2020; 64:435-443. [PMID: 32372566 DOI: 10.1111/1754-9485.13039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/01/2020] [Accepted: 03/30/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Immunosuppressed (IS) patients with Merkel cell carcinoma (MCC) have worse outcomes compared to immunocompetent (IC) patients, and it is unclear if adjuvant radiotherapy (RT) is beneficial for these patients. We sought to determine the effect of immune status on adjuvant RT efficacy regarding overall survival (OS) for patients with localized MCC. METHODS This was an observational study of National Cancer Database (NCDB) identifying patients with stage I/II or III MCC with known immune status diagnosed from 2010 to 2014. The median follow-up time was 29 months. OS was described using Kaplan-Meier methods and compared for subgroups by immune status and adjuvant RT using log-rank tests, multivariable Cox regression and interaction effect testing. RESULTS A total of 2049 IC and 255 IS patients were included. Adjuvant RT was associated with decreased hazard of death for stage I/II MCC (HR 0.65, CI 0.54-0.78) adjusting for factors including immune status. Interaction effect testing did not demonstrate a significant difference in the effect of adjuvant RT on OS between IC and IS status in either stage I/II or III MCC (both P values > 0.05). CONCLUSIONS In this observational study, adjuvant RT was associated with decreased hazard of death for patients with stage I/II MCC regardless of immune status. Adjuvant RT should be considered for both IS and IC patients with localized MCC.
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Affiliation(s)
- Mehran B Yusuf
- Department of Radiation Oncology, University of Louisville Hospital, Louisville, Kentucky, USA
| | - Jeremy Gaskins
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, Kentucky, USA
| | - Weston Wall
- Department of Dermatology, Medical College of Georgia, Augusta, Georgia, USA
| | - Paul Tennant
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville Hospital, Louisville, Kentucky, USA
| | - Jeffrey Bumpous
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville Hospital, Louisville, Kentucky, USA
| | - Neal Dunlap
- Department of Radiation Oncology, University of Louisville Hospital, Louisville, Kentucky, USA
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Prezioso C, Obregon F, Ambroselli D, Petrolo S, Checconi P, Rodio DM, Coppola L, Nardi A, de Vito C, Sarmati L, Andreoni M, Palamara AT, Ciotti M, Pietropaolo V. Merkel Cell Polyomavirus (MCPyV) in the Context of Immunosuppression: Genetic Analysis of Noncoding Control Region (NCCR) Variability among a HIV-1-Positive Population. Viruses 2020; 12:v12050507. [PMID: 32375383 PMCID: PMC7291121 DOI: 10.3390/v12050507] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 12/17/2022] Open
Abstract
Background: Since limited data are available about the prevalence of Merkel cell polyomavirus (MCPyV) and the genetic variability of its noncoding control region (NCCR) in the context of immunosuppression, this study aimed to investigate the distribution of MCPyV in anatomical sites other than the skin and the behavior of NCCR among an HIV-1-positive population. Methods: Urine, plasma, and rectal swabs specimens from a cohort of 66 HIV-1-positive patients were collected and subjected to quantitative real-time polymerase chain reaction (qPCR) for MCPyV DNA detection. MCPyV-positive samples were amplified by nested PCR targeting the NCCR, and NCCRs alignment was carried out to evaluate the occurrence of mutations and to identify putative binding sites for cellular factors. Results: MCPyV DNA was detected in 10/66 urine, in 7/66 plasma, and in 23/66 rectal samples, with a median value of 5 × 102 copies/mL, 1.5 × 102 copies/mL, and 2.3 × 103 copies/mL, respectively. NCCR sequence analysis revealed a high degree of homology with the MCC350 reference strain in urine, whereas transitions, transversions, and single or double deletions were observed in plasma and rectal swabs. In these latter samples, representative GTT and GTTGA insertions were also observed. Search for putative binding sites of cellular transcription factors showed that in several strains, deletions, insertions, or single base substitutions altered the NCCR canonical configuration. Conclusions: Sequencing analysis revealed the presence of numerous mutations in the NCCR, including insertions and deletions. Whether these mutations may have an impact on the pathogenic features of the virus remains to be determined. qPCR measured on average a low viral load in the specimens analyzed, with the exception of those with the GTTGA insertion.
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Affiliation(s)
- Carla Prezioso
- IRCSS San Raffaele Pisana, Microbiology of Chronic Neuro-Degenerative Pathologies, 00166 Rome, Italy; (C.P.); (A.T.P.)
- Department of Public Health and Infectious Diseases, “Sapienza” University, 00185 Rome, Italy; (F.O.); (D.A.); (S.P.); (D.M.R.); (A.N.); (C.d.V.)
| | - Francisco Obregon
- Department of Public Health and Infectious Diseases, “Sapienza” University, 00185 Rome, Italy; (F.O.); (D.A.); (S.P.); (D.M.R.); (A.N.); (C.d.V.)
| | - Donatella Ambroselli
- Department of Public Health and Infectious Diseases, “Sapienza” University, 00185 Rome, Italy; (F.O.); (D.A.); (S.P.); (D.M.R.); (A.N.); (C.d.V.)
| | - Sara Petrolo
- Department of Public Health and Infectious Diseases, “Sapienza” University, 00185 Rome, Italy; (F.O.); (D.A.); (S.P.); (D.M.R.); (A.N.); (C.d.V.)
| | - Paola Checconi
- IRCCS San Raffaele Pisana, Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, 00166 Rome, Italy;
| | - Donatella Maria Rodio
- Department of Public Health and Infectious Diseases, “Sapienza” University, 00185 Rome, Italy; (F.O.); (D.A.); (S.P.); (D.M.R.); (A.N.); (C.d.V.)
| | - Luigi Coppola
- Infectious Diseases Clinic, Policlinic Tor Vergata, 00133 Rome, Italy; (L.C.); (L.S.); (M.A.)
| | - Angelo Nardi
- Department of Public Health and Infectious Diseases, “Sapienza” University, 00185 Rome, Italy; (F.O.); (D.A.); (S.P.); (D.M.R.); (A.N.); (C.d.V.)
| | - Corrado de Vito
- Department of Public Health and Infectious Diseases, “Sapienza” University, 00185 Rome, Italy; (F.O.); (D.A.); (S.P.); (D.M.R.); (A.N.); (C.d.V.)
| | - Loredana Sarmati
- Infectious Diseases Clinic, Policlinic Tor Vergata, 00133 Rome, Italy; (L.C.); (L.S.); (M.A.)
- Department of System Medicine, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Massimo Andreoni
- Infectious Diseases Clinic, Policlinic Tor Vergata, 00133 Rome, Italy; (L.C.); (L.S.); (M.A.)
- Department of System Medicine, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Anna Teresa Palamara
- IRCSS San Raffaele Pisana, Microbiology of Chronic Neuro-Degenerative Pathologies, 00166 Rome, Italy; (C.P.); (A.T.P.)
- Department of Public Health and Infectious Diseases, Institute Pasteur, Cenci-Bolognetti Foundation, Sapienza University of Rome, 00185 Rome, Italy
| | - Marco Ciotti
- Laboratory of Clinical Microbiology and Virology, Polyclinic Tor Vergata Foundation, 00133 Rome, Italy;
| | - Valeria Pietropaolo
- Department of Public Health and Infectious Diseases, “Sapienza” University, 00185 Rome, Italy; (F.O.); (D.A.); (S.P.); (D.M.R.); (A.N.); (C.d.V.)
- Correspondence: ; Tel.: +39-06-4991-4439
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Young S, Oh J, Bukhari H, Ng T, Chau N, Tran E. Primary Parotid Merkel Type Small Cell Neuroendocrine Carcinoma with Oligometastasis to the Brain and Adrenal Gland: Case Report and Review of Literature. Head Neck Pathol 2020; 15:311-318. [PMID: 32350808 PMCID: PMC8010043 DOI: 10.1007/s12105-020-01164-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 04/22/2020] [Indexed: 01/09/2023]
Abstract
Oligometastatic disease is a hypothesized intermediate stage of disease between localized and widespread metastatic cancer. Localized treatment of oligometastatic lesions may offer survival advantages in addition to systemic treatment. In this case report, we describe a patient who presented with small cell neuroendocrine carcinoma "Merkel type" (SNECM) of the parotid gland which had metastasized to the brain and adrenal gland. He was treated with chemotherapy followed by stereotactic radiotherapy and volumetric modulated arc therapy for oligometastasis. He maintains good functional status with low burden of disease at 20-months after diagnosis. SNECM is a rare and aggressive parotid cancer with immunohistochemical and morphologic similarities to Merkel cell carcinoma (MCC). There are only 44 cases of parotid SNECM in the English literature. This is the first case to describe management of oligometastatic SNECM and we review literature on management of both SNECM and metastatic MCC.
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Affiliation(s)
- Sympascho Young
- University of British Columbia Faculty of Medicine, Vancouver, BC Canada
| | - Justin Oh
- Department of Radiation Oncology, BC Cancer, Vancouver, BC Canada
| | - Hussam Bukhari
- Department of Pathology, BC Cancer, Vancouver, BC Canada
| | - Tony Ng
- Department of Pathology, BC Cancer, Vancouver, BC Canada
| | - Nichole Chau
- Department of Medical Oncology, BC Cancer, Vancouver, BC Canada
| | - Eric Tran
- Department of Radiation Oncology, BC Cancer, Vancouver, BC Canada
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82
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McIlroy D, Halary F, Bressollette-Bodin C. Intra-patient viral evolution in polyomavirus-related diseases. Philos Trans R Soc Lond B Biol Sci 2020; 374:20180301. [PMID: 30955497 DOI: 10.1098/rstb.2018.0301] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Human polyomaviruses show relatively little genetic polymorphism between isolates, indicating that these viruses are genetically stable between hosts. However, it has become increasingly clear that intra-host molecular evolution is a feature of some polyomavirus (PyV) infections in humans. Mutations inducing premature stop codons in the early region of the integrated Merkel cell PyV genome lead to the expression of a truncated form of the large tumour (LT) antigen that is critical for the transformation of Merkel cell carcinoma (MCC) cells. Non-coding control region (NCCR) rearrangements and point mutations in virion protein (VP) 1 have been described in both JCPyV and BKPyV infections. In the context of JCPyV infection, molecular evolution at both these loci allows the virus to replicate effectively in the central nervous system, thereby leading to the development of progressive multifocal leukoencephalopathy (PML). In BKPyV infection, NCCR rearrangements have been linked to higher rates of virus replication in the kidney, and are proposed to play a direct causal role in the development of PyV-associated nephropathy. In all three of these infections, therefore, intra-host viral evolution appears to be an essential component of the disease process. This article is part of the theme issue 'Silent cancer agents: multi-disciplinary modelling of human DNA oncoviruses'.
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Affiliation(s)
- Dorian McIlroy
- 1 Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes , 44093 Nantes cedex 01 , France.,2 Faculté des Sciences et des Techniques, Université de Nantes , 44093 Nantes cedex 01 , France.,4 Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes , 44093 Nantes cedex 01 , France
| | - Franck Halary
- 1 Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes , 44093 Nantes cedex 01 , France.,4 Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes , 44093 Nantes cedex 01 , France
| | - Céline Bressollette-Bodin
- 1 Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes , 44093 Nantes cedex 01 , France.,3 Faculté de Médecine, Université de Nantes , 44093 Nantes cedex 01 , France.,4 Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes , 44093 Nantes cedex 01 , France.,5 Service de Virologie, CHU Nantes , 44093 Nantes cedex 01 , France
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83
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Sahin IH, Kane SR, Brutcher E, Guadagno J, Smith KE, Wu C, Lesinski GB, Gunthel CJ, El-Rayes BF. Safety and Efficacy of Immune Checkpoint Inhibitors in Patients With Cancer Living With HIV: A Perspective on Recent Progress and Future Needs. JCO Oncol Pract 2020; 16:319-325. [PMID: 32160138 DOI: 10.1200/jop.19.00754] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Recent studies have identified durable responses with the use of immune checkpoint inhibitors in patients with mismatch repair-deficient (MMR-D)/microsatellite instability-high (MSI-H) metastatic colorectal cancer (CRC). The dramatic improvement in clinical outcomes led to the US Food and Drug Administration approval of pembrolizumab, nivolumab, and nivolumab in combination with ipilimumab in metastatic patients with MSI-H/MMR-D CRC who previously experienced progression on cytotoxic therapies. In the clinical trials investigating these agents, HIV-seropositive patients were not included and therefore the clinical efficacy of these agents in patients with metastatic MSI-H/MMR-D CRC living with HIV is unclear. On the basis of growing evidence, immune checkpoint blockade therapies seem to be a safe approach in patients with well-controlled HIV infection. Research on immunotherapeutic approaches in patients living with HIV and cancer is an area of unmet medical need that can be addressed by clinical trial designs that are inclusive of patients with well-controlled seropositive HIV and trials that specifically evaluate immune therapies in patients living with HIV.
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Affiliation(s)
| | - Sujata R Kane
- Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA
| | - Edith Brutcher
- Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA
| | - Jessica Guadagno
- Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA
| | - Katherine E Smith
- Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA
| | - Christina Wu
- Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA
| | - Gregory B Lesinski
- Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA
| | - Clifford J Gunthel
- Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA
| | - Bassel F El-Rayes
- Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA
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84
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Arora R, Gupta K, Vijaykumar A, Krishna S. DETECTing Merkel Cell Polyomavirus in Merkel Tumors. Front Mol Biosci 2020; 7:10. [PMID: 32118036 PMCID: PMC7011098 DOI: 10.3389/fmolb.2020.00010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/14/2020] [Indexed: 12/26/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer caused either by Merkel cell polyomavirus (MCV) T antigen expression, post-integration (~80% cases), or by UV-mediated DNA damage. Interestingly, overall survival of MCV-positive Merkel cell carcinoma patients is better, making this differential information of significant diagnostic and prognostic value. Also, MCV provides a direct target for therapy in MCC patients. Currently, the methods used for diagnosis of MCV in tumors are often discordant and unreliable. Here we used a guided molecular scissors based-DNA Endonuclease Targeted CRISPR Trans Reporter (DETECTR) technique to develop an in vitro molecular diagnostic tool for MCV-positive MCC. DETECTR couples recombinase polymerase based amplification of target MCV DNA with Cas12a mediated detection. CRISPR diagnostics couple specific detection followed by cutting of the pathogenic DNA by the Cas enzyme-gRNA complex, with non-specific cutting of ssDNA that provides a measurable visual cue. To detect MCV DNA in MCC, we designed Cas12a gRNAs targeting the MCV DNA and tested their targeting efficiency, and sensitivity using a fluorophore quencher labeled reporter assay. We show that MCV DETECTR system can detect MCV integrated in Merkel tumor rapidly, specifically and with femto-molar sensitivity. Our study is a preliminary, proof-of-principle analysis showing the use of CRISPR for MCV diagnosis. Further validation in human tumor samples is needed for its clinical use in the near future. This new system is promising and we hope it can be coupled with immunohistochemical studies to diagnose the viral status of MCC in clinics soon.
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Affiliation(s)
- Reety Arora
- National Centre for Biological Sciences, Tata Institute of Fundamental Research (TIFR), Bangalore, India
| | - Komal Gupta
- National Centre for Biological Sciences, Tata Institute of Fundamental Research (TIFR), Bangalore, India
- Department of Biology, Indian Institute of Science Education and Research, Pune, India
| | - Anjali Vijaykumar
- National Centre for Biological Sciences, Tata Institute of Fundamental Research (TIFR), Bangalore, India
| | - Sudhir Krishna
- National Centre for Biological Sciences, Tata Institute of Fundamental Research (TIFR), Bangalore, India
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85
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PD-L1 Detection-Pearls and Pitfalls Associated With Current Methodologies Focusing on Entities Relevant to Dermatopathology. Am J Dermatopathol 2020; 41:539-565. [PMID: 31335407 DOI: 10.1097/dad.0000000000001287] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PD-L1 is a transmembrane glycoprotein with an extracellular as well as an intracellular cytoplasmic domain. Physiologically, it plays a pivotal role in regulating T-cell activation and tolerance. Many tumor cells have exploited this regulatory mechanism by overexpressing PD-L1 in an effort to escape immunologic surveillance. In this review, we parse the literature regarding the prognostic value of tumoral PD-L1 expression before discussing the various methodologies as well as the pearls and pitfalls associated with each for predicting response to anti-PD-1/PD-L1 therapies. Special attention is given to cutaneous entities in which PD-L1 expression has been documented with an emphasis on cutaneous malignancies that have seen the broadest applications of anti-PD-L1/PD-1 therapies. Currently, immunohistochemistry is the method that is most commonly used for detection of PD-L1. However, with the wide array of immunohistochemistry protocols and staining platforms available in the market, there seems to be different cutoffs not just for different entities but also for the same entity. This review is an attempt to address the need for standardization and validation of existing protocols for PD-L1 detection.
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86
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Danger is only skin deep: aggressive epidermal carcinomas. An overview of the diagnosis, demographics, molecular-genetics, staging, prognostic biomarkers, and therapeutic advances in Merkel cell carcinoma. Mod Pathol 2020; 33:42-55. [PMID: 31676786 DOI: 10.1038/s41379-019-0394-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/27/2019] [Accepted: 10/14/2019] [Indexed: 12/19/2022]
Abstract
Merkel cell carcinoma (MCC) is a high grade primary cutaneous neuroendocrine carcinoma and is among the most aggressive cutaneous malignancies. The rising incidence of MCC, together with its often rapidly aggressive course, underscore a critical need to recognize the histopathologic and the immunohistochemical features that inform its accurate diagnosis. In the current review, we summarize the current state of knowledge regarding the accurate diagnosis of MCC and the exclusion of other entities in the differential diagnosis. We provide a comprehensive review of genomic studies that identified the molecular-genetic drivers of MCC as well as a summary of studies identifying prognostic biomarkers that can facilitate risk stratification. Importantly, Merkel cell polyomavirus (MCPyV) appears to be causative in most cases of MCC and represents both a diagnostic and prognostic marker. Finally, as staging of MCC has undergone critical refinements with the introduction of the 8th Edition of the American Joint Committee on Cancer staging system, we provide an update on MCC staging. In particular, the prognostic significance of the sentinel lymph node (SLN) in MCC necessitates a systematic approach to its evaluation and diagnosis to ensure accurate and consistent risk stratification for patients, and we therefore provide a comprehensive overview of SLN evaluation in MCC. Finally, the intimate relationship between MCC and the integrity of the host immune system has led to paradigm-shifting therapeutic advances with the successful application of immune checkpoint blockade to treat patients with advanced disease, and we therefore summarize those studies and the correlative studies in which predictive biomarkers have been identified.
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87
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Kansara S, Bell D, Weber R. Surgical management of non melanoma skin cancer of the head and neck. Oral Oncol 2019; 100:104485. [PMID: 31821988 DOI: 10.1016/j.oraloncology.2019.104485] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/17/2019] [Accepted: 11/20/2019] [Indexed: 12/12/2022]
Abstract
Non-melanoma skin cancer (NMSC) is the most common malignancy in the world and is reaching epidemic proportions. The most common types of NMSC include basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The head and neck is the most common site for NMSC, and surgery remains the mainstay of treatment. We review the etiology, risk factors, pathogenesis as well as the preoperative, operative, and postoperative considerations in the management of NMSC. Multidisciplinary evaluation and attention to each of these phases is imperative for favorable oncologic and functional patient outcomes.
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Affiliation(s)
- Sagar Kansara
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Diana Bell
- Department of Pathology, MD Anderson Cancer Center, Houston, TX, United States
| | - Randal Weber
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, TX, United States.
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88
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Starrett GJ, Buck CB. The case for BK polyomavirus as a cause of bladder cancer. Curr Opin Virol 2019; 39:8-15. [PMID: 31336246 PMCID: PMC6901737 DOI: 10.1016/j.coviro.2019.06.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 06/20/2019] [Accepted: 06/21/2019] [Indexed: 12/17/2022]
Abstract
In 2014, the International Agency for Research on Cancer judged Merkel cell polyomavirus (MCPyV) to be a probable human carcinogen. BK polyomavirus (BKPyV, a distant cousin of MCPyV) was ruled a possible carcinogen. In this review, we argue that it has recently become reasonable to view both of these viruses as known human carcinogens. In particular, several complementary lines of evidence support a causal role for BKPyV in the development of bladder carcinomas affecting organ transplant patients. The expansion of inexpensive deep sequencing has opened new approaches to investigating the important question of whether BKPyV causes urinary tract cancers in the general population.
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Affiliation(s)
- Gabriel J Starrett
- National Cancer Institute, Building 37 Room 4118, 9000 Rockville Pike, Bethesda, MD 20892-4263, United States.
| | - Christopher B Buck
- National Cancer Institute, Building 37 Room 4118, 9000 Rockville Pike, Bethesda, MD 20892-4263, United States
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89
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Bowe CM, Gurney B, Whitaker S, Newlands C. Management of regional metastatic disease in cutaneous malignancy of the head and neck. 3. Merkel cell carcinoma. Br J Oral Maxillofac Surg 2019; 57:847-856. [PMID: 31615708 DOI: 10.1016/j.bjoms.2019.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 08/22/2019] [Indexed: 01/27/2023]
Abstract
This is the third of three articles that give an overview of the current evidence for management of the neck and parotid in patients with cutaneous cancers of the head and neck. In this paper we discuss Merkel cell carcinoma (MCC) and review the latest evidence for management of the regional nodes.
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Affiliation(s)
- C M Bowe
- Department of Oral and Maxillofacial Surgery, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, GU2 7XX, UK.
| | - B Gurney
- Department of Oral and Maxillofacial Surgery, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, GU2 7XX, UK
| | - S Whitaker
- Department of Clinical Oncology, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, GU2 7XX, UK
| | - C Newlands
- Department of Oral and Maxillofacial Surgery, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, GU2 7XX, UK
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91
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Bobrowicz M, Zagozdzon R, Domagala J, Vasconcelos-Berg R, Guenova E, Winiarska M. Monoclonal Antibodies in Dermatooncology-State of the Art and Future Perspectives. Cancers (Basel) 2019; 11:E1420. [PMID: 31554169 PMCID: PMC6826541 DOI: 10.3390/cancers11101420] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/08/2019] [Accepted: 09/17/2019] [Indexed: 12/21/2022] Open
Abstract
Monoclonal antibodies (mAbs) targeting specific proteins are currently the most popular form of immunotherapy used in the treatment of cancer and other non-malignant diseases. Since the first approval of anti-CD20 mAb rituximab in 1997 for the treatment of B-cell malignancies, the market is continuously booming and the clinically used mAbs have undergone a remarkable evolution. Novel molecular targets are constantly emerging and the development of genetic engineering have facilitated the introduction of modified mAbs with improved safety and increased capabilities to activate the effector mechanisms of the immune system. Next to their remarkable success in hematooncology, mAbs have also an already established role in the treatment of solid malignancies. The recent development of mAbs targeting the immune checkpoints has opened new avenues for the use of this form of immunotherapy, also in the immune-rich milieu of the skin. In this review we aim at presenting a comprehensive view of mAbs' application in the modern treatment of skin cancer. We present the characteristics and efficacy of mAbs currently used in dermatooncology and summarize the recent clinical trials in the field. We discuss the side effects and strategies for their managing.
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Affiliation(s)
| | - Radoslaw Zagozdzon
- Department of Clinical Immunology, Medical University of Warsaw, 02-006 Warsaw, Poland.
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, 02-006 Warsaw, Poland.
| | - Joanna Domagala
- Department of Immunology, Medical University of Warsaw, 02-097 Warsaw, Poland.
- Postgraduate School of Molecular Medicine, 02-091 Warsaw, Poland.
| | - Roberta Vasconcelos-Berg
- Department of Dermatology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland.
| | - Emmanuella Guenova
- Department of Dermatology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland.
- Department of Dermatology, University of Lausanne, 1011 Lausanne, Switzerland.
| | - Magdalena Winiarska
- Department of Immunology, Medical University of Warsaw, 02-097 Warsaw, Poland.
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92
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Principe DR, Clark JI, Emami B, Borowicz S. Combined radio-immunotherapy leads to complete clinical regression of stage IV Merkel cell carcinoma. BMJ Case Rep 2019; 12:12/8/e230518. [PMID: 31439556 DOI: 10.1136/bcr-2019-230518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine tumour of the skin. While localised disease carries an overall favourable prognosis, metastatic disease is associated with poor clincal outcomes. Most cases of metastatic MCC are managed with systemic chemotherapy or immunotherapy, though 5-year survival for these patients remains a dismal 17%. Here, we present the case of a 79-year-old man with MCC of the right ear with metastases to regional lymph nodes, ipsilateral parotid gland and thoracic spine. He was treated with a combination of first-line radiotherapy and concurrent immune checkpoint inhibition (avelumab), which led to complete clinical regression of disease with minimal adverse effects. This observation suggests that combined radio-immunotherapy warrants larger-scale investigation for use in patients with unresectable MCC.
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Affiliation(s)
- Daniel R Principe
- Medical Scientist Training Program, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Joseph I Clark
- Division of Hematology-Oncology, Department of Medicine, Cardinal Bernardin Cancer Center, Loyola University Medical Center, Hines, Illinois, USA.,Medical Service, Edward Hines, Jr. Hines VA Hospital, Hines, Illinois, USA
| | - Bahman Emami
- Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Loyola University Medical Center, Hines, Illinois, USA
| | - Stanley Borowicz
- Division of Hematology-Oncology, Department of Medicine, Cardinal Bernardin Cancer Center, Loyola University Medical Center, Hines, Illinois, USA.,Medical Service, Edward Hines, Jr. Hines VA Hospital, Hines, Illinois, USA
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93
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Paulson KG, Lahman MC, Chapuis AG, Brownell I. Immunotherapy for skin cancer. Int Immunol 2019; 31:465-475. [PMID: 30753483 PMCID: PMC6626298 DOI: 10.1093/intimm/dxz012] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 02/04/2019] [Indexed: 12/12/2022] Open
Abstract
Among all tumor types, skin cancers are profoundly sensitive to immunotherapy. Indeed, the recently reported response rates for anti-PD-1 (anti-programmed-death 1) therapy for cutaneous malignant melanomas (MM), Merkel cell carcinomas, basal cell carcinomas, cutaneous squamous cell carcinomas and Kaposi sarcomas are all above 40%. This unique immunogenicity renders skin cancers as a paradigm for tumor-immune interactions and is driven by high mutational burdens, over-expressed tumor antigens and/or viral antigens. However, despite the clear demonstration of immunologic cure of skin cancer in some patients, most tumors develop either early (primary) or late (adaptive) resistance to immunotherapy. Resistance mechanisms are complex, and include contributions of tumor cell-intrinsic, T cell and microenvironment factors that have been recently further elucidated with the advent of single-cell technologies. This review will focus on the exciting progress with immunotherapy for skin cancers to date, and also our current understanding of the mechanisms of resistance to immunotherapy.
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Affiliation(s)
- Kelly G Paulson
- Clinical Research Division, Program in Immunology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Divisions of Medical Oncology and Molecular Medicine, Departments of Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Miranda C Lahman
- Clinical Research Division, Program in Immunology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Divisions of Medical Oncology and Molecular Medicine, Departments of Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Aude G Chapuis
- Clinical Research Division, Program in Immunology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Divisions of Medical Oncology and Molecular Medicine, Departments of Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Isaac Brownell
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
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Abstract
HIV has long been associated with a number of inflammatory, infectious, and neoplastic skin conditions. In the era of anti-retroviral therapy, we have discovered even more about the relationship between skin disease and chronic immunosuppression. In particular, clinicians still face the propensity of persons living with HIV to develop difficult-to-control viral infections, chronic skin inflammation, and pruritus and—particularly as patients age—various types of skin cancers. Here, we summarize recent updates in the field of HIV dermatology and make recommendations to providers caring for these patients.
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Affiliation(s)
- Sarah J Coates
- Department of Dermatology, University of California San Francisco, 1701 Divisadero Street, San Francisco, CA, 94115, USA
| | - Kieron S Leslie
- Department of Dermatology, University of California San Francisco, 1701 Divisadero Street, San Francisco, CA, 94115, USA
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95
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Abstract
Merkel cell carcinoma (MCC) is a highly aggressive, primary neuroendocrine cancer of the skin. The majority of MCC cases are associated with the recently discovered Merkel cell polyomavirus (MCPyV), while the remaining are caused by ultraviolet (UV) light-induced mutations from excessive sunlight exposure. The risk of developing MCC is much higher in the white population relative to all other races. Approximately 10% of all patients with MCC have some form of immunosuppression including HIV-1/AIDS, chronic inflammatory conditions, solid organ transplantation, or hematological malignancies. The age of onset of MCC is lower and the mortality is higher in immunosuppressed individuals than in immune-competent patients. It is plausible that HIV-1/AIDS predisposes to virus-positive MCC, but it should be noted that HIV-1/AIDS increases the risk for developing of UV-induced skin cancers such as cutaneous squamous cell carcinoma and basal cell carcinoma and therefore may also increase the risk for virus-negative MCC. Surgical management is considered standard of care for localized Merkel cell carcinoma with current recommendations advising a wide local excision of the lesion. Most international guidelines support the use of local adjuvant radiotherapy coupled with tumor staging to improve the frequency of cure. For advanced, metastatic, and recurrent MCC, checkpoint blockade inhibitors targeting PD-1 and PD-L1 have shown remarkable activity including durable long-term. MCC in patients living with HIV-1/AIDS are treated with similar modalities as HIV-1 uninfected individuals with MCC.
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Affiliation(s)
- Robert H Goldstein
- Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - James A DeCaprio
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA. .,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA.
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Immune Checkpoint Inhibitors and Beyond: An Overview of Immune-Based Therapies in Merkel Cell Carcinoma. Am J Clin Dermatol 2019; 20:391-407. [PMID: 30784027 DOI: 10.1007/s40257-019-00427-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Merkel cell carcinoma (MCC) is an aggressive skin cancer. Until 2017, patients with advanced disease were typically treated with conventional chemotherapies, with a median response duration of 3 months. Increased evidence of the role of the immune system in controlling this cancer has paved the way for immune-based therapies, with programmed cell death protein 1 (PD-1)/programmed cell death protein ligand 1 (PD-L1) inhibitors at the frontline. Avelumab, an anti-PD-L1 antibody, was the first-ever drug approved in advanced MCC after showing meaningful efficacy in a second-line setting. Objective responses were observed in one-third of patients and, most importantly, were durable with half of patients and one-third of patients still alive at 1 and 2 years, respectively. When used in a first-line setting, PD-1/PD-L1 inhibitors (avelumab, pembrolizumab, nivolumab) are even more promising as objective responses are observed in approximately 50-70% of patients within the first 4-8 weeks of treatment. Safety profiles are acceptable with 10-20% of patients experiencing adverse events grade ≥ 3. PD-1/PD-L1 inhibitors are considered the standard of care in advanced MCC and are currently being investigated in the adjuvant and neoadjuvant settings. However, innovative treatments are still needed in the metastatic setting, as approximately 50% of these patients will not persistently respond to currently available immunotherapies, and no predictors of response are available yet. Therefore, other immunotherapeutic strategies are now being investigated-ideally in combinations-to enhance the various aspects of the immune response against tumoral cells.
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97
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Rossi MK, Kanagasabapathy DAR, Hoffman HT. Seed and soil? - Pharyngeal Merkel cell carcinoma after radiotherapy for laryngeal squamous cell carcinoma. Am J Otolaryngol 2019; 40:448-452. [PMID: 30885449 DOI: 10.1016/j.amjoto.2019.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 03/04/2019] [Indexed: 11/29/2022]
Abstract
Merkel cell carcinoma (MCC) is a neuroendocrine cutaneous malignancy that may present as metastatic disease without a known primary site but, most commonly originates in the sun-exposed skin of the head, neck, and extremities. We present a 66-year-old male treated with chemo-radiation for T3N2cM0 laryngeal squamous cell carcinoma (SCCa) six years before he was diagnosed with MCC isolated to the radiated laryngopharynx. Mucosal MCC is rare and radiation-induced MCC has been hypothesized to occur in previously radiated tissue but, never before to the laryngopharynx. Implications regarding cancer biology and management is focused with discussion on relevant advances in pathologic assessment and immunotherapy.
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MESH Headings
- Aged
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Agents, Immunological/therapeutic use
- B7-H1 Antigen/therapeutic use
- Carcinoma, Merkel Cell/etiology
- Carcinoma, Merkel Cell/pathology
- Carcinoma, Merkel Cell/therapy
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/therapy
- Chemoradiotherapy/adverse effects
- Humans
- Immunotherapy
- Laryngeal Neoplasms/etiology
- Laryngeal Neoplasms/pathology
- Laryngeal Neoplasms/radiotherapy
- Laryngeal Neoplasms/therapy
- Male
- Neoplasm Staging
- Neoplasms, Second Primary
- Programmed Cell Death 1 Receptor
- Ultraviolet Rays/adverse effects
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Affiliation(s)
- Monica K Rossi
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa Hospitals and Clinics, 21151 Pomerantz Family Pavilion, 200 Hawkins Drive, 52240, Iowa City, IA, USA.
| | - D Anand Rajan Kanagasabapathy
- Department of Pathology, University of Iowa Hospitals and Clinics, 5329-A Roy Carver Pavilion, 200 Hawkins Drive, 52240 Iowa City, IA, USA
| | - Henry T Hoffman
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa Hospitals and Clinics, 21151 Pomerantz Family Pavilion, 200 Hawkins Drive, 52240, Iowa City, IA, USA
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98
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Merkel Cell Carcinoma of the Digit. Ann Plast Surg 2019; 83:169-171. [PMID: 31008795 DOI: 10.1097/sap.0000000000001897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Merkel cell carcinoma (MCC) is a biologically aggressive neuroendocrine tumor of the skin. There are roughly 1500 new cases of MCC diagnosed every year in the United States, with an increased incidence over the past 15 years reaching up to 8%. Epidemiological studies show that the highest MCC incidence is seen in men older than 65 years, with a ratio of 0.23 per 10,000 among whites. Merkel cell carcinoma of the skin most commonly presents as a single, rapidly growing, flesh-colored, painless mass. Because MCC is uncommon, histopathological examination is usually delayed. Because of the high mortality rate associated with this aggressive tumor, a multidisciplinary panel is recommended to ensure high-quality coordinated care. The choice of treatment option depends on disease characteristics, staging at presentation, regional lymph node involvement, comorbidities, and performance status of the patient. We report a case of MCC to alert medical professionals of this potentially fatal tumor, as early diagnosis and treatment may improve morbidity and mortality rates.
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99
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Laikova KV, Oberemok VV, Krasnodubets AM, Gal'chinsky NV, Useinov RZ, Novikov IA, Temirova ZZ, Gorlov MV, Shved NA, Kumeiko VV, Makalish TP, Bessalova EY, Fomochkina II, Esin AS, Volkov ME, Kubyshkin AV. Advances in the Understanding of Skin Cancer: Ultraviolet Radiation, Mutations, and Antisense Oligonucleotides as Anticancer Drugs. Molecules 2019; 24:E1516. [PMID: 30999681 PMCID: PMC6514765 DOI: 10.3390/molecules24081516] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/13/2019] [Accepted: 04/15/2019] [Indexed: 12/15/2022] Open
Abstract
Skin cancer has always been and remains the leader among all tumors in terms of occurrence. One of the main factors responsible for skin cancer, natural and artificial UV radiation, causes the mutations that transform healthy cells into cancer cells. These mutations inactivate apoptosis, an event required to avoid the malignant transformation of healthy cells. Among these deadliest of cancers, melanoma and its 'younger sister', Merkel cell carcinoma, are the most lethal. The heavy toll of skin cancers stems from their rapid progression and the fact that they metastasize easily. Added to this is the difficulty in determining reliable margins when excising tumors and the lack of effective chemotherapy. Possibly the biggest problem posed by skin cancer is reliably detecting the extent to which cancer cells have spread throughout the body. The initial tumor is visible and can be removed, whereas metastases are invisible to the naked eye and much harder to eliminate. In our opinion, antisense oligonucleotides, which can be used in the form of targeted ointments, provide real hope as a treatment that will eliminate cancer cells near the tumor focus both before and after surgery.
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Affiliation(s)
- Kateryna V Laikova
- Medical Academy named after S.I. Georgievsky, V.I. Vernadsky Crimean Federal University, Lenin Boulevard 5/7, 295051 Simferopol, Crimea.
- Research Institute of Agriculture of Crimea, Kiyevskaya St. 150, 295493, Simferopol, Crimea.
| | - Volodymyr V Oberemok
- Taurida Academy, V.I. Vernadsky Crimean Federal University, Vernadsky Av. 4, 295007 Simferopol, Crimea.
- Nikita Botanical Gardens ⁻ National Scientific Centre RAS, Nikitsky spusk 52, vil. Nikita, 298648 Yalta, Crimea.
| | - Alisa M Krasnodubets
- Taurida Academy, V.I. Vernadsky Crimean Federal University, Vernadsky Av. 4, 295007 Simferopol, Crimea.
| | - Nikita V Gal'chinsky
- Taurida Academy, V.I. Vernadsky Crimean Federal University, Vernadsky Av. 4, 295007 Simferopol, Crimea.
| | - Refat Z Useinov
- Taurida Academy, V.I. Vernadsky Crimean Federal University, Vernadsky Av. 4, 295007 Simferopol, Crimea.
| | - Ilya A Novikov
- Taurida Academy, V.I. Vernadsky Crimean Federal University, Vernadsky Av. 4, 295007 Simferopol, Crimea.
| | - Zenure Z Temirova
- Medical Academy named after S.I. Georgievsky, V.I. Vernadsky Crimean Federal University, Lenin Boulevard 5/7, 295051 Simferopol, Crimea.
| | - Mikhail V Gorlov
- D. Mendeleev University of Chemical Technology of Russia, Miusskaya sq. 9, 125047 Moscow, Russia.
| | - Nikita A Shved
- Centre for Genomic and Regenerative Medicine, School of Biomedicine, Far Eastern Federal University, Sukhanova St. 8, 690090 Vladivostok, Russia.
- National Scientific Center of Marine Biology, Far Eastern Branch of Russian Academy of Sciences, Palchevsky St. 17, 690041 Vladivostok, Russia.
| | - Vadim V Kumeiko
- Centre for Genomic and Regenerative Medicine, School of Biomedicine, Far Eastern Federal University, Sukhanova St. 8, 690090 Vladivostok, Russia.
- National Scientific Center of Marine Biology, Far Eastern Branch of Russian Academy of Sciences, Palchevsky St. 17, 690041 Vladivostok, Russia.
| | - Tatiana P Makalish
- Medical Academy named after S.I. Georgievsky, V.I. Vernadsky Crimean Federal University, Lenin Boulevard 5/7, 295051 Simferopol, Crimea.
| | - Evgeniya Y Bessalova
- Medical Academy named after S.I. Georgievsky, V.I. Vernadsky Crimean Federal University, Lenin Boulevard 5/7, 295051 Simferopol, Crimea.
| | - Iryna I Fomochkina
- Medical Academy named after S.I. Georgievsky, V.I. Vernadsky Crimean Federal University, Lenin Boulevard 5/7, 295051 Simferopol, Crimea.
| | - Andrey S Esin
- D. Mendeleev University of Chemical Technology of Russia, Miusskaya sq. 9, 125047 Moscow, Russia.
| | - Mikhail E Volkov
- Ltd "NPF Syntol", Тimiryazevskaya St. 42, 127434 Moscow, Russia.
| | - Anatoly V Kubyshkin
- Medical Academy named after S.I. Georgievsky, V.I. Vernadsky Crimean Federal University, Lenin Boulevard 5/7, 295051 Simferopol, Crimea.
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100
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Jin HT, Park SJ, Choi EK, Kim YS. The frequency of Merkel cell polyomavirus in whole blood from immunocompetent and immunosuppressed patients with kidney disease and healthy donors. Microb Pathog 2019; 131:75-80. [PMID: 30910721 DOI: 10.1016/j.micpath.2019.03.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/09/2019] [Accepted: 03/15/2019] [Indexed: 10/27/2022]
Abstract
Merkel cell polyomavirus (MCPyV) is a rare, aggressive and related to human diseases in immunocompromised patients. MCPyV has been detected in skin neoplasms, various cancers, immunosuppressed patients and immunocompetent individuals. Several studies have confirmed the presence of MCPyV in patients with kidney dysfunction, such as kidney transplant (KTx) and long-term dialysis patients. The aims of this study were to quantify and compare the frequency of MCPyV in whole blood samples from immunocompetent and immunosuppressed patients and healthy blood donors and to compare MCPyV genotypes in a Korean population. DNA from Groups 1, 2, and 3 was screened for MCPyV using polymerase chain reaction (PCR) and quantitative real-time PCR (qPCR) with primer pairs targeting two regions of the large T-antigen. Thirteen of 122 whole-blood samples (12.7%) were positive for MCPyV. The virus was detected in the three groups of patients and healthy donors; specifically, in 5 of 30 (16.7%) KTx patients (Group 1), 6 of 52 (11.5%) dialysis patients (Group 2), and 4 of 40 (10%) healthy donors (Group 3). Low viral DNA loads 4.4-18 copies/μl were observed using qPCR DNA sequences from the two MCPyV-LT regions, which showed high homology with MCPyV sequences belonging to the TKS strain from Japan rather than the Chinese/European/North American strains. The MCPyV DNA was similarly amplified in whole blood from immunocompetent and immunosuppressed patients and healthy donors. This virus may be involved in establishing the persistence of infected peripheral leukocytes in the host, based on the incidence of detection of MCPyV DNA in blood samples from immunocompromised and immunocompetent subjects. This study is the first to identify a Korean MCPyV strain in whole-blood samples from Korean patients with kidney disease and healthy individuals.
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Affiliation(s)
- Hyoung-Tae Jin
- Ilsong Institute of Life Science, Hallym University, Anyang, Gyeonggi-do, 14066, South Korea
| | - Seok-Joo Park
- Ilsong Institute of Life Science, Hallym University, Anyang, Gyeonggi-do, 14066, South Korea
| | - Eun-Kyoung Choi
- Ilsong Institute of Life Science, Hallym University, Anyang, Gyeonggi-do, 14066, South Korea; Department of Biomedical Gerontology, Graduate School of Hallym University, Chuncheon, Gangwon-do, 24252, South Korea.
| | - Yong-Sun Kim
- Ilsong Institute of Life Science, Hallym University, Anyang, Gyeonggi-do, 14066, South Korea; Department of Microbiology, College of Medicine, Hallym University, Chuncheon, Gangwon-do, 24252, South Korea.
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