1
|
Karpinski P, Mendez-Pena JE, Wu CL, Akalin A, Cornejo KM, Hung YP, Hoang MP. POU4F3 is a Sensitive and Specific Marker of Merkel Cell Carcinoma. Mod Pathol 2024:100627. [PMID: 39341281 DOI: 10.1016/j.modpat.2024.100627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 09/04/2024] [Accepted: 09/20/2024] [Indexed: 09/30/2024]
Abstract
Although of therapeutic importance, a single sensitive and specific immunostain to distinguish Merkel cell carcinoma (MCC) from mimics is not currently available. In addition, single tumor cells are difficult to detect in sentinel lymph node biopsy. Leveraging publicly available data sets of 9264 solid tumors and over 600,000 single-cell transcriptomes, we identified POU4F3 to be a specific marker of MCC. Analyses of Pan-Cancer RNA bulk sequencing data of 24 tumor types from Tumor Cancer Genomic Atlas (TCGA) datasets as well as non-TCGA SCLC and MCC datasets confirmed POU4F3 specificity for MCC. Single-cell RNA sequencing analyses also confirmed lack of POU4F3 expression in lung small cell carcinoma as well as a variety of normal tissues. Nuclear POU4F3 immunohistochemical expression was noted in 98.7% of 153 MCCs and in only 1.7% of mimics (3 of 180 cases, including 95 small cell carcinomas of which 55 from lung and the remainder from other sites). Three POU4F3-positive non-MCC cases were from lung (2 cases) and vagina (1 case). All 153 tested MCC cases were negative for ASCL1, a key transcriptional regulator highly expressed in SCLC. NeuroD1 was seen in a subset of MCC cases (20.9%, 32/153). POU4F3 immunostain was performed on 29 sentinel lymph nodes and strong POU4F3 nuclear expression facilitated ease of metastasis detection, even single tumor cells. Our study built on prior works shows that POU4F3 to be a sensitive and specific clinical marker of MCC.
Collapse
Affiliation(s)
- Pawel Karpinski
- Department of Genetics, Wroclaw Medical University, Wroclaw, Poland.
| | - Javier E Mendez-Pena
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Cheng-Lin Wu
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ali Akalin
- Department of Pathology, UMass Medical Center, Worcester, MA, USA
| | - Kristine M Cornejo
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Yin P Hung
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Mai P Hoang
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
2
|
Sun L, Verhaegen ME, McGue J, Olivei AC, Dlugosz AA, Frankel TL, Harms PW. Development of a Multiplex Immunofluorescence Assay for Tumor Microenvironment Studies of Human and Murine Merkel Cell Carcinoma. J Transl Med 2024; 104:102128. [PMID: 39182611 DOI: 10.1016/j.labinv.2024.102128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 08/15/2024] [Accepted: 08/20/2024] [Indexed: 08/27/2024] Open
Abstract
Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine carcinoma. Checkpoint inhibitor immunotherapy plays an essential role in management of advanced MCC; however, predictors of immunotherapy response remain poorly defined. Syngeneic mouse models suitable for testing novel immunotherapy and combination therapy approaches are likely to soon become available and will require assays for evaluating the tumor microenvironment (TME). Multiplex immunofluorescence (mIF) is a powerful approach to characterize the TME for understanding immunotherapy responses and immune surveillance. In this method article, we provide detailed instructions on assay development for mIF, using as examples 2 new mIF panels for TME investigations of human and murine MCC tumors. Specifically, we demonstrate panels that allow simultaneous visualization of the Merkel cell master transcription factor SOX2 for tumor cell identification, alongside T-cell markers (CD3, CD8, and FOXP3), macrophage markers (F4/80 for mouse and CD163 for human tumors), together with the checkpoint marker PD-L1 for human tumors, and the myeloid-derived suppressor cell marker Arg1 for mouse tumors. We provide detailed protocols for investigators to incorporate these mIF panels into their investigations of human and murine MCC. We also provide fundamental guidance for mIF assay development that will be broadly useful for investigators who consider modifying the panels presented in this study or developing their own mIF panels.
Collapse
Affiliation(s)
- Lei Sun
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Monique E Verhaegen
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan; Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Jake McGue
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Alberto C Olivei
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Andrzej A Dlugosz
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan; Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan; Department of Cell & Developmental Biology, University of Michigan, Ann Arbor, Michigan
| | - Timothy L Frankel
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Paul W Harms
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan; Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan; Department of Pathology, University of Michigan, Ann Arbor, Michigan.
| |
Collapse
|
3
|
Pedersen EA, Verhaegen ME, Joseph MK, Harms KL, Harms PW. Merkel cell carcinoma: updates in tumor biology, emerging therapies, and preclinical models. Front Oncol 2024; 14:1413793. [PMID: 39136002 PMCID: PMC11317257 DOI: 10.3389/fonc.2024.1413793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 07/08/2024] [Indexed: 08/15/2024] Open
Abstract
Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine carcinoma thought to arise via either viral (Merkel cell polyomavirus) or ultraviolet-associated pathways. Surgery and radiotherapy have historically been mainstays of management, and immunotherapy has improved outcomes for advanced disease. However, there remains a lack of effective therapy for those patients who fail to respond to these established approaches, underscoring a critical need to better understand MCC biology for more effective prognosis and treatment. Here, we review the fundamental aspects of MCC biology and the recent advances which have had profound impact on management. The first genetically-engineered mouse models for MCC tumorigenesis provide opportunities to understand the potential MCC cell of origin and may prove useful for preclinical investigation of novel therapeutics. The MCC cell of origin debate has also been advanced by recent observations of MCC arising in association with a clonally related hair follicle tumor or squamous cell carcinoma in situ. These studies also suggested a role for epigenetics in the origin of MCC, highlighting a potential utility for this therapeutic avenue in MCC. These and other therapeutic targets form the basis for a wealth of ongoing clinical trials to improve MCC management. Here, we review these recent advances in the context of the existing literature and implications for future investigations.
Collapse
Affiliation(s)
| | | | - Mallory K. Joseph
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States
| | - Kelly L. Harms
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States
| | - Paul W. Harms
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States
- Department of Pathology, University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
4
|
Lugowska I, Becker JC, Ascierto PA, Veness M, Blom A, Lebbe C, Migliano E, Hamming-Vrieze O, Goebeler M, Kneitz H, Nathan P, Rutkowski P, Slowinska M, Schadendorf D, Piulats JM, Petrelli F, van Akkooi ACJ, Berruti A. Merkel-cell carcinoma: ESMO-EURACAN Clinical Practice Guideline for diagnosis, treatment and follow-up. ESMO Open 2024; 9:102977. [PMID: 38796285 PMCID: PMC11145756 DOI: 10.1016/j.esmoop.2024.102977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 02/16/2024] [Accepted: 02/29/2024] [Indexed: 05/28/2024] Open
Abstract
•This ESMO Clinical Practice Guideline provides key recommendations for managing Merkel-cell carcinoma (MCC). •Recommendations are based on available scientific data and the multidisciplinary group of experts’ collective opinion. •The guideline covers clinical and pathological diagnosis, staging and risk assessment, treatment and follow-up. •Algorithms for the management of locoregional and inoperable/metastatic disease are provided. •A multidisciplinary team with a high level of expertise in MCC should diagnose and make decisions about therapy.
Collapse
Affiliation(s)
- I Lugowska
- Department of Early Phase Clinical Trials, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - J C Becker
- Department of Translational Skin Cancer Research, German Cancer Consortium (DKTK), University Hospital of Essen, Essen; Department of Translational Skin Cancer Research, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
| | - P A Ascierto
- Department of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - M Veness
- Sydney Medical School, The University of Sydney, Sydney; Department of Radiation Oncology, Westmead Hospital, Sydney, Australia
| | - A Blom
- CARADERM Network, Department of General and Oncologic Dermatology, Université Paris-Saclay, UVSQ, EA4340-BECCOH, AP-HP, Ambroise-Paré Hospital, Boulogne-Billancourt
| | - C Lebbe
- Université de Paris Cite, Paris; Dermato-Oncology and CIC Department, AP-HP Hôpital Saint Louis, Paris; INSERM U976, Paris, France
| | - E Migliano
- Department of Plastic and Regenerative Surgery, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - O Hamming-Vrieze
- Department of Radiation Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - M Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - H Kneitz
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - P Nathan
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw
| | - M Slowinska
- Department of Dermatology, Military Institute of Medicine-National Research Institute, Warsaw, Poland
| | - D Schadendorf
- Department of Dermatology, Westdeutsches Tumorzentrum (WTZ), University Hospital Essen, Essen; German Cancer Consortium (DKTK), Partner Site Essen & NCT-West Campus Essen & University Alliance Ruhr, Research Center One Health, Essen, Germany
| | - J M Piulats
- Medical Oncology Department, Institut Català d'Oncologia (ICO), Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), CIBEROnc, Universitat de Barcelona, Barcelona, Spain
| | - F Petrelli
- Oncology Unit, Azienda Socio Sanitaria Territoriale (ASST) Bergamo Ovest, Treviglio, Italy
| | - A C J van Akkooi
- Department of Melanoma and Surgical Oncology, Melanoma Institute Australia, Sydney; Faculty of Medicine and Health, University of Sydney, Sydney; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | - A Berruti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology Unit, University of Brescia, ASST Spedali Civili, Brescia, Italy
| |
Collapse
|
5
|
Szumera-Cieckiewicz A, Massi D, Cassisa A, Krzyzinski M, Dudzisz-Sledz M, Biecek P, Rutkowski P, Marszalek A, Hoang MP, Donizy P. SATB2, CKAE1/AE3, and synaptophysin as a sensitive immunohistochemical panel for the detection of lymph node metastases of Merkel cell carcinoma. Virchows Arch 2024; 484:629-636. [PMID: 38066198 PMCID: PMC11062961 DOI: 10.1007/s00428-023-03691-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/11/2023] [Accepted: 10/29/2023] [Indexed: 05/02/2024]
Abstract
Histopathological evaluation of lymph nodes in Merkel cell carcinoma has become crucial in progression estimation and treatment modification. This study was undertaken to determine the most sensitive immunohistochemical panel for detecting MCC nodal metastases. We included 56 patients with 102 metastatic MCC lymph nodes, which were tested with seven antibodies: cytokeratin (CKAE1/AE3), CK20, chromogranin A, synaptophysin, INSM1, SATB2, and neurofilament (NF). Tissue microarrays (TMA) composed of 2-mm tissue cores from each nodal metastasis were constructed. A semiquantitative 5-tier scoring system (0%, < 25%, 25-74%, 75-99%, 100% positive MCC cells with moderate to strong reactivity) was implemented. In the statistical assessment, we included Merkel cell polyomavirus (MCPyV) status and expression heterogeneity between lymph nodes from one patient. A cumulative percentage of moderate to strong expression ≥ 75% of tumoral cells was observed for single cell markers as follows: 91/102 (89.2%) SATB2, 85/102 (83%) CKAE1/AE3, 80/102 (78.4%) synaptophysin, 75/102 (75.5%) INSM1, 68/102 (66.7%) chromogranin A, 60/102 cases (58.8%) CK20, and 0/102 (0%) NF. Three markers presented a complete lack of immunoreactivity: 8/102 (7.8%) CK20, 7/102 (6.9%) chromogranin A, and 6/102 (5.9%) NF. All markers showed expression heterogeneity in lymph nodes from one patient; however, the most homogenous was INSM1. The probability of detecting nodal MCC metastases was the highest while using SATB2 as a first-line marker (89.2%) with subsequential adding CKAE1/AE3 (99%); these results were independent of MCPyV status. Synaptophysin showed a superior significance in confirming the neuroendocrine origin of metastatic cells. This comprehensive analysis allows us to recommend simultaneous evaluation of SATB2, CKAE1/AE3, and synaptophysin in the routine pathologic MCC lymph node protocol.
Collapse
Affiliation(s)
- Anna Szumera-Cieckiewicz
- Department of Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, W.K. Roentgena 5, 02-781, Warsaw, Poland.
- Member of EORTC Melanoma Pathology Working Group, Brussels, Belgium.
| | - Daniela Massi
- Member of EORTC Melanoma Pathology Working Group, Brussels, Belgium
- Section of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy
| | - Angelo Cassisa
- Section of Pathology, Department of Oncology, San Giovanni Di Dio Hospital, USL Centro Toscana, Florence, Italy
| | - Mateusz Krzyzinski
- Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland
| | - Monika Dudzisz-Sledz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Przemyslaw Biecek
- Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Andrzej Marszalek
- Department of Pathology, Poznan University Medical Sciences and Greater Poland Cancer Center, Poznan, Poland
| | - Mai P Hoang
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Piotr Donizy
- Department of Clinical and Experimental Pathology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland.
- Department of Pathology and Clinical Cytology, Jan Mikulicz-Radecki University Hospital, Wroclaw, Poland.
| |
Collapse
|
6
|
Legrand M, Tallet A, Guyétant S, Samimi M, Ortonne N, Kervarrec T. CD5 expression in Merkel cell carcinoma and extracutaneous neuroendocrine carcinomas. Pathology 2023; 55:141-143. [PMID: 35835644 DOI: 10.1016/j.pathol.2022.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/13/2022] [Accepted: 04/26/2022] [Indexed: 01/24/2023]
Affiliation(s)
- Mélanie Legrand
- Department of Pathology, Université de Tours, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Anne Tallet
- Platform of Somatic Tumor Molecular Genetics, Université de Tours, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Serge Guyétant
- Department of Pathology, Université de Tours, Centre Hospitalier Universitaire de Tours, Tours, France; Platform of Somatic Tumor Molecular Genetics, Université de Tours, Centre Hospitalier Universitaire de Tours, Tours, France; Biologie des Infections à Polyomavirus Team, UMR INRA ISP 1282, Université de Tours, Tours, France
| | - Mahtab Samimi
- Biologie des Infections à Polyomavirus Team, UMR INRA ISP 1282, Université de Tours, Tours, France; Department of Dermatology, Université de Tours, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Nicolas Ortonne
- Department of Pathology, Hopital Henri-Mondor, APHP, Créteil, France; CARADERM Network, France
| | - Thibault Kervarrec
- Department of Pathology, Université de Tours, Centre Hospitalier Universitaire de Tours, Tours, France; Biologie des Infections à Polyomavirus Team, UMR INRA ISP 1282, Université de Tours, Tours, France; CARADERM Network, France.
| |
Collapse
|
7
|
Mazziotta C, Cervellera CF, Lanzillotti C, Touzé A, Gaboriaud P, Tognon M, Martini F, Rotondo JC. MicroRNA dysregulations in Merkel cell carcinoma: Molecular mechanisms and clinical applications. J Med Virol 2023; 95:e28375. [PMID: 36477874 DOI: 10.1002/jmv.28375] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022]
Abstract
Merkel cell carcinoma (MCC) is an aggressive skin malignancy with two distinct etiologies. The first, which accounts for the highest proportion, is caused by Merkel cell polyomavirus (MCPyV), a DNA tumor virus. A second, UV-induced, MCC form has also been identified. Few MCC diagnostic, prognostic, and therapeutic options are available. MicroRNAs (miRNAs) are small noncoding RNA molecules, which play a key role in regulating various physiologic cellular functions including cell cycling, proliferation, differentiation, and apoptosis. Numerous miRNAs are dysregulated in cancer, by acting as either tumor suppressors or oncomiRs. The aim of this review is to collect, summarize, and discuss recent findings on miRNAs whose dysregulation has been assumed to play a role in MCC. The potential clinical application of miRNAs as diagnostic and prognostic biomarkers in MCC is also described. In the future, miRNAs will potentially gain clinical significance for the improvement of MCC diagnostic, prognostic, and therapeutic options.
Collapse
Affiliation(s)
- Chiara Mazziotta
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy.,Department of Medical Sciences, Center for Studies on Gender Medicine, University of Ferrara, Ferrara, Italy
| | | | - Carmen Lanzillotti
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy.,Department of Medical Sciences, Center for Studies on Gender Medicine, University of Ferrara, Ferrara, Italy
| | - Antoine Touzé
- "Biologie des infections à polyomavirus" Team, UMR INRAE 1282, University of Tours, Tours, France
| | - Pauline Gaboriaud
- "Biologie des infections à polyomavirus" Team, UMR INRAE 1282, University of Tours, Tours, France
| | - Mauro Tognon
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Fernanda Martini
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy.,Department of Medical Sciences, Center for Studies on Gender Medicine, University of Ferrara, Ferrara, Italy.,Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, Ferrara, Italy
| | - John Charles Rotondo
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy.,Department of Medical Sciences, Center for Studies on Gender Medicine, University of Ferrara, Ferrara, Italy
| |
Collapse
|
8
|
Cappellesso R, Nicolè L, Del Fiore P, Barzon L, Sinigaglia A, Riccetti S, Franco R, Zito Marino F, Munari G, Zamuner C, Cavallin F, Sbaraglia M, Galuppini F, Bassetto F, Alaibac M, Chiarion-Sileni V, Piccin L, Benna C, Fassan M, Mocellin S, Dei Tos AP. TRK Protein Expression in Merkel Cell Carcinoma Is Not Caused by NTRK Fusions. Int J Mol Sci 2022; 23:ijms232315366. [PMID: 36499693 PMCID: PMC9737899 DOI: 10.3390/ijms232315366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare and aggressive cutaneous malignant tumor with neuroendocrine differentiation, with a rapidly growing incidence rate, high risk of recurrence, and aggressive behavior. The available therapeutic options for advanced disease are limited and there is a pressing need for new treatments. Tumors harboring fusions involving one of the neurotrophin receptor tyrosine kinase (NTRK) genes are now actionable with targeted inhibitors. NTRK-fused genes have been identified in neuroendocrine tumors of other sites; thus, a series of 76 MCCs were firstly analyzed with pan-TRK immunohistochemistry and the positive ones with real-time RT-PCR, RNA-based NGS, and FISH to detect the eventual underlying gene fusion. Despite 34 MCCs showing pan-TRK expression, NTRK fusions were not found in any cases. As in other tumors with neural differentiation, TRK expression seems to be physiological and not caused by gene fusions.
Collapse
Affiliation(s)
- Rocco Cappellesso
- Pathological Anatomy Unit, Padua University Hospital, 35121 Padua, Italy
- Correspondence: ; Tel.: +39-049-8217962
| | - Lorenzo Nicolè
- Department of Pathology, Angelo Hospital, 30174 Venice, Italy
- Department of Medicine (DIMED), University of Padua, 35121 Padua, Italy
| | - Paolo Del Fiore
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
| | - Luisa Barzon
- Department of Molecular Medicine (DMM), University of Padua, 35121 Padua, Italy
| | | | - Silvia Riccetti
- Department of Molecular Medicine (DMM), University of Padua, 35121 Padua, Italy
| | - Renato Franco
- Pathology Unit, University of Campania “L. Vanvitelli”, 80129 Naples, Italy
| | | | - Giada Munari
- Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
| | | | | | - Marta Sbaraglia
- Department of Medicine (DIMED), University of Padua, 35121 Padua, Italy
| | | | - Franco Bassetto
- Department of Neurosciences (DNS), University of Padua, 35128 Padua, Italy
| | - Mauro Alaibac
- Department of Medicine (DIMED), University of Padua, 35121 Padua, Italy
| | - Vanna Chiarion-Sileni
- Melanoma Unit, Oncology 2 Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
| | - Luisa Piccin
- Melanoma Unit, Oncology 2 Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
| | - Clara Benna
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, 35128 Padua, Italy
| | - Matteo Fassan
- Department of Medicine (DIMED), University of Padua, 35121 Padua, Italy
- Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
| | - Simone Mocellin
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, 35128 Padua, Italy
| | | |
Collapse
|
9
|
Vanderbeck K, Cho WC, Aung PP, Ivan D, Rothrock AT, Torres-Cabala CA, Prieto VG, Curry JL, Nagarajan P. Ductal differentiation: A rare phenomenon in Merkel cell carcinoma. J Cutan Pathol 2022; 50:511-519. [PMID: 36454019 DOI: 10.1111/cup.14372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/20/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022]
Abstract
Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine carcinoma that may occasionally present divergent histopathologic features. We present two cases of MCC demonstrating ductal differentiation, one on the lower lip of an 81-year-old man and another on the right forearm of a 67-year-old man. The histopathologic features included TTF1-negative, infiltrative, high-grade basaloid tumor with paranuclear punctate positivity for cytokeratin (CK) 20 and synaptophysin. Rare luminal structures lined by atypical epithelioid cells positive for CEA and CK19 were noted, confirming the presence of ductal differentiation. Although the ductal differentiation is unusual, other histopathologic features and the immunohistochemical profile supported the diagnosis of MCC. Like most divergent features, ductal differentiation is rare in MCC and typically constitutes a very small proportion of the tumor, and is therefore under-recognized. Although the clinical significance of this feature is unclear, recognition and documentation of ductal differentiation and distinguishing it from other mimics such as acantholysis within squamous nests and entrapped eccrine ducts is essential to determine its clinical significance. We also discuss the differential diagnoses of cutaneous basaloid neoplasms with ductal differentiation.
Collapse
Affiliation(s)
- Kaitlin Vanderbeck
- Department of Pathology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Woo Cheal Cho
- Department of Pathology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Phyu P Aung
- Department of Pathology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Doina Ivan
- Department of Pathology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Aimi T Rothrock
- Department of Pathology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Carlos A Torres-Cabala
- Department of Pathology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Victor G Prieto
- Department of Pathology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Jonathan L Curry
- Department of Pathology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Priyadharsini Nagarajan
- Department of Pathology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
10
|
Ireland AM, Leecy TN, Wood BA, Mirzai B, Giardina T, Mesbah Ardakani N. Merkel Cell Carcinosarcoma With a Bland Sarcomatous Component. Am J Dermatopathol 2022; 44:846-849. [PMID: 36075572 DOI: 10.1097/dad.0000000000002294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Merkel cell carcinoma with a sarcomatous component is very rare, with only 12 cases reported in the literature, often with overtly malignant myoid differentiation. We report a case of metastatic Merkel cell carcinosarcoma presenting in a lymph node 6 months after a diagnosis of cutaneous Merkel cell carcinoma with conventional histologic features. The metastatic lesion showed a unique biphasic appearance with admixed populations of neuroendocrine epithelial cells and fascicles of mitotically active spindle cells with mild cytological atypia. In addition to the immunomorphological features, a common molecular profile between the epithelial and mesenchymal components further supported the notion of carcinosarcoma in this case. To the best of our knowledge, a bland sarcomatous component has not been previously described in Merkel cell carcinosarcoma, which can be easily overlooked as a reactive stromal reaction microscopically.
Collapse
Affiliation(s)
- Amanda M Ireland
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, Australia; and
| | - Tamazin N Leecy
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, Australia; and
| | - Benjamin A Wood
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, Australia; and
| | - Bob Mirzai
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, Australia; and
| | - Tindaro Giardina
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, Australia; and
| | - Nima Mesbah Ardakani
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, Australia; and
| |
Collapse
|
11
|
Dataset for the Reporting of Merkel Cell Carcinoma: Recommendations From the International Collaboration on Cancer Reporting (ICCR). Am J Surg Pathol 2022; 46:1583-1591. [PMID: 36001458 DOI: 10.1097/pas.0000000000001959] [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
Accurate and complete pathology reports are critical for the optimal management of cancer patients. Protocols for the pathologic reporting of Merkel cell carcinoma (MCC) have been developed independently by the Royal College of Pathologists (UK) and the College of American Pathologists. In this study, data elements for pathologic reporting of MCC were analyzed by an international panel of pathologists and clinicians with the aim of developing a common, internationally agreed upon dataset useful for clinical practice. The International Collaboration on Cancer Reporting expert review panel developed a protocol containing "core" (required) and "noncore" (recommended) elements. Core elements were defined as those that had evidentiary support and were unanimously agreed upon by the review panel as essential for the clinical management, staging, and/or assessment of prognosis in patients with MCC. Noncore elements were those considered to be clinical of interest, but with lesser degrees of supportive evidence or nonactionable implications. Ten core data elements for pathology reports on primary MCC were defined. Development and agreement on this evidence-based protocol at an international level was accomplished in a timely and efficient manner. The template developed for melanoma reporting was used as a structural base for this initiative. It is applicable to, and may facilitate the development of, protocols for other tumor types. Widespread utilization of an internationally agreed upon structured pathology dataset for MCC can be expected to lead to improved patient management. It should also facilitate collaborative clinical research.
Collapse
|
12
|
Silk AW, Barker CA, Bhatia S, Bollin KB, Chandra S, Eroglu Z, Gastman BR, Kendra KL, Kluger H, Lipson EJ, Madden K, Miller DM, Nghiem P, Pavlick AC, Puzanov I, Rabinowits G, Ruiz ES, Sondak VK, Tavss EA, Tetzlaff MT, Brownell I. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of nonmelanoma skin cancer. J Immunother Cancer 2022; 10:e004434. [PMID: 35902131 PMCID: PMC9341183 DOI: 10.1136/jitc-2021-004434] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 12/21/2022] Open
Abstract
Nonmelanoma skin cancers (NMSCs) are some of the most commonly diagnosed malignancies. In general, early-stage NMSCs have favorable outcomes; however, a small subset of patients develop resistant, advanced, or metastatic disease, or aggressive subtypes that are more challenging to treat successfully. Recently, immune checkpoint inhibitors (ICIs) have been approved by the US Food and Drug Administration (FDA) for the treatment of Merkel cell carcinoma (MCC), cutaneous squamous cell carcinoma (CSCC), and basal cell carcinoma (BCC). Although ICIs have demonstrated activity against NMSCs, the routine clinical use of these agents may be more challenging due to a number of factors including the lack of predictive biomarkers, the need to consider special patient populations, the management of toxicity, and the assessment of atypical responses. With the goal of improving patient care by providing expert guidance to the oncology community, the Society for Immunotherapy of Cancer (SITC) convened a multidisciplinary panel of experts to develop a clinical practice guideline (CPG). The expert panel drew on the published literature as well as their own clinical experience to develop recommendations for healthcare professionals on important aspects of immunotherapeutic treatment for NMSCs, including staging, biomarker testing, patient selection, therapy selection, post-treatment response evaluation and surveillance, and patient quality of life (QOL) considerations, among others. The evidence- and consensus-based recommendations in this CPG are intended to provide guidance to cancer care professionals treating patients with NMSCs.
Collapse
Affiliation(s)
- Ann W Silk
- Merkel Cell Carcinoma Center of Excellence, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Christopher A Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Shailender Bhatia
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Kathryn B Bollin
- Hematology and Medical Oncology, Scripps MD Anderson Cancer Center, San Diego, California, USA
| | - Sunandana Chandra
- Hematology Oncology Division, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Zeynep Eroglu
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Brian R Gastman
- Melanoma and High-Risk Skin Cancer Program, Cleveland Clinic Cancer Center, Cleveland, Ohio, USA
| | - Kari L Kendra
- Division Of Medical Oncology, The Ohio State University, Columbus, Ohio, USA
| | - Harriet Kluger
- Yale Cancer Center, Yale University, New Haven, Connecticut, USA
| | - Evan J Lipson
- Bloomberg Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kathleen Madden
- Melanoma/Cutaneous Oncology Program, New York University Langone Perlmutter Cancer Center, New York, New York, USA
| | - David M Miller
- Department of Medicine and Department of Dermatology, Massachusetts General Cancer Center, Boston, Massachusetts, USA
| | - Paul Nghiem
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Anna C Pavlick
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Igor Puzanov
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Guilherme Rabinowits
- Department of Hematology/Oncology, Miami Cancer Institute/Baptist Health South Florida, Miami, Florida, USA
| | - Emily S Ruiz
- Mohs and Dermatologic Surgery Center, Dana-Farber/Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Vernon K Sondak
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | | | - Michael T Tetzlaff
- Dermopathology Division, University of California San Francisco, San Francisco, California, USA
| | - Isaac Brownell
- Dermatology Branch, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
13
|
Santoro F, Maletta F, Parente R, Fissore J, Tampieri C, Santoro L, Birocco N, Picciotto F, Quaglino P, Volante M, Asioli S, Senetta R, Papotti M. Clinical-Pathological Evaluation and Prognostic Analysis of 228 Merkel Cell Carcinomas Focusing on Tumor-Infiltrating Lymphocytes, MCPYV Infection and ALK Expression. Endocr Pathol 2022; 33:289-303. [PMID: 35551625 PMCID: PMC9135831 DOI: 10.1007/s12022-022-09716-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 11/24/2022]
Abstract
Merkel cell carcinoma is a rare and aggressive primary neuroendocrine carcinoma of the skin, whose pathogenesis can be traced back to UV radiation damage or Merkel cell polyomavirus (MCPyV) infection. Despite some improvements on the characterization of the disease partly due to its increased incidence, crucial pathogenetic and prognostic factors still need to be refined. A consecutive series of 228 MCC from three hospitals in Turin was collected with the aim of both analyzing the apparent increase in MCC incidence in our area and investigating the distribution and prognostic role of clinical-pathological parameters, with a focus on MCPyV status, ALK tumor expression and tumor infiltrating lymphocytes (TILs). Review of morphology and conventional immunohistochemical staining was possible in 191 cases. In 50 cases, the expression of the novel neuroendocrine marker INSM1 was additionally assessed. Fourteen cases of MCC of unknown primary skin lesion were identified and separately analyzed. While confirming an exponential trend in MCC incidence in the last decades and providing a description of histological and cytological features of a large series of MCC, the present study concludes that 1) INSM1 is a highly sensitive marker in both skin and lymph node primary MCC; 2) positive MCPyV status, brisk TILs and lower tumor size and thickness are independent positive prognostic parameters, and the combination of the former two may provide a novel tool for prognostic stratification; 3) ALK is expressed 87% of MCC and associated with positive viral status, and could represent a prognostic biomarker, if validated in larger series.
Collapse
Affiliation(s)
- Federica Santoro
- Pathology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Francesca Maletta
- Pathology Unit, Department of Laboratory Medicine, Città Della Salute e Della Scienza of Turin, Turin, Italy
| | - Renato Parente
- Pathology Unit, Humanitas-Gradenigo Hospital, Turin, Italy
| | - Jessica Fissore
- Pathology Unit, Department of Oncology, Città Della Salute e Della Scienza of Turin, University of Turin, Via Santena 7, 10126, Turin, Italy
| | - Cristian Tampieri
- Pathology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Nadia Birocco
- Oncology Unit, Città della Salute e della Scienza, Turin, Italy
| | - Franco Picciotto
- Dermatologic Surgery Section, Department of Surgery, Città Della Salute e Della Scienza of Turin, Turin, Italy
| | - Pietro Quaglino
- Dermatology Clinic, Department of Medical Sciences, Città Della Salute e Della Scienza of Turin, University of Turin, Turin, Italy
| | - Marco Volante
- Pathology Unit, Department of Oncology, San Luigi Hospital of Orbassano, University of Turin, Turin, Italy
| | - Sofia Asioli
- Pathology Unit, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Rebecca Senetta
- Pathology Unit, Department of Oncology, Città Della Salute e Della Scienza of Turin, University of Turin, Via Santena 7, 10126, Turin, Italy.
| | - Mauro Papotti
- Pathology Unit, Department of Oncology, Città Della Salute e Della Scienza of Turin, University of Turin, Via Santena 7, 10126, Turin, Italy
| |
Collapse
|
14
|
Investigation of the RB1-SOX2 axis constitutes a tool for viral status determination and diagnosis in Merkel cell carcinoma. Virchows Arch 2022; 480:1239-1254. [PMID: 35412101 DOI: 10.1007/s00428-022-03315-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 12/30/2022]
Abstract
MCC (Merkel cell carcinoma) is an aggressive neuroendocrine cutaneous neoplasm. Integration of the Merkel cell polyomavirus (MCPyV) is observed in about 80% of the cases, while the remaining 20% are related to UV exposure. Both MCPyV-positive and -negative MCCs-albeit by different mechanisms-are associated with RB1 inactivation leading to overexpression of SOX2, a major contributor to MCC biology. Moreover, although controversial, loss of RB1 expression seems to be restricted to MCPyV-negative cases.The aim of the present study was to assess the performances of RB1 loss and SOX2 expression detected by immunohistochemistry to determine MCPyV status and to diagnose MCC, respectively.Overall, 196 MCC tumors, 233 non-neuroendocrine skin neoplasms and 70 extra-cutaneous neuroendocrine carcinomas (NEC) were included. SOX2 and RB1 expressions were assessed by immunohistochemistry in a tissue micro-array. Diagnostic performances were determined using the likelihood ratio (LHR).RB1 expression loss was evidenced in 27% of the MCC cases, 12% of non-neuroendocrine skin tumors and 63% of extra-cutaneous NEC. Importantly, among MCC cases, RB1 loss was detected in all MCPyV(-) MCCs, while MCPyV( +) cases were consistently RB1-positive (p < 0.001). SOX2 diffuse expression was observed in 92% of the MCC cases and almost never observed in non-neuroendocrine skin epithelial neoplasms (2%, p < 0.0001, LHR + = 59). Furthermore, SOX2 diffuse staining was more frequently observed in MCCs than in extra-cutaneous NECs (30%, p < 0.001, LHR + = 3.1).These results confirm RB1 as a robust predictor of MCC viral status and further suggest SOX2 to be a relevant diagnostic marker of MCC.
Collapse
|
15
|
Thibault K. Evidence of an epithelial origin of Merkel cell carcinoma. Mod Pathol 2022; 35:446-448. [PMID: 34732840 DOI: 10.1038/s41379-021-00964-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Kervarrec Thibault
- Department of Pathology, University Hospital Center of Tours, Tours, France. .,"Biologie des infections à Polyomavirus" team, UMR INRA ISP1282, University of Tours, Tours, France.
| |
Collapse
|
16
|
Genomic evidence suggests that cutaneous neuroendocrine carcinomas can arise from squamous dysplastic precursors. Mod Pathol 2022; 35:506-514. [PMID: 34593967 PMCID: PMC8964828 DOI: 10.1038/s41379-021-00928-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/24/2021] [Accepted: 09/07/2021] [Indexed: 02/06/2023]
Abstract
Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine carcinoma without a known dysplastic precursor. In some cases, MCC is associated with SCCIS in the overlying epidermis; however, the MCC and SCCIS populations display strikingly different morphologies, and thus far a relationship between these components has not been demonstrated. To better understand the relationship between these distinct tumor cell populations, we evaluated 7 pairs of MCC-SCCIS for overlapping genomic alterations by cancer profiling panel. A subset was further characterized by transcriptional profiling and immunohistochemistry. In 6 of 7 MCC-SCCIS pairs there was highly significant mutational overlap including shared TP53 and/or RB1 mutations. In some cases, oncogenic events previously implicated in MCC (MYCL gain, MDM4 gain, HRAS mutation) were detected in both components. Although FBXW7 mutations were enriched in MCC, no gene mutation was unique to the MCC component across all cases. Transcriptome analysis identified 2736 differentially expressed genes between MCC and SCCIS. Genes upregulated in the MCC component included Polycomb repressive complex targets; downregulated transcripts included epidermal markers, and immune genes such as HLA-A. Immunohistochemical studies revealed increased expression of SOX2 in the MCC component, with diminished H3K27Me3, Rb, and HLA-A expression. In summary, MCC-SCCIS pairs demonstrate clonal relatedness. The shift to neuroendocrine phenotype is associated with loss of Rb protein expression, decrease in global H3K27Me3, and increased expression of Merkel cell genes such as SOX2. Our findings suggest an epidermal origin of MCC in this setting, and to our knowledge provide the first molecular evidence that intraepithelial squamous dysplasia may represent a direct precursor for small cell carcinoma.
Collapse
|
17
|
Grisic AM, Xiong W, Tanneau L, Jönsson S, Friberg LE, Karlsson MO, Dai H, Zheng J, Girard P, Khandelwal A. Model-Based Characterization of the Bidirectional Interaction Between Pharmacokinetics and Tumor Growth Dynamics in Patients with Metastatic Merkel Cell Carcinoma Treated with Avelumab. Clin Cancer Res 2022; 28:1363-1371. [PMID: 34921021 PMCID: PMC9365383 DOI: 10.1158/1078-0432.ccr-21-2662] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/05/2021] [Accepted: 12/13/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Empirical time-varying clearance models have been reported for several immune checkpoint inhibitors, including avelumab (anti-programmed death ligand 1). To investigate the exposure-response relationship for avelumab, we explored semimechanistic pharmacokinetic (PK)-tumor growth dynamics (TGD) models. PATIENTS AND METHODS Plasma PK data were pooled from three phase I and II trials (JAVELIN Merkel 200, JAVELIN Solid Tumor, and JAVELIN Solid Tumor JPN); tumor size (TS) data were collected from patients with metastatic Merkel cell carcinoma (mMCC) enrolled in JAVELIN Merkel 200. A PK model was developed first, followed by TGD modeling to investigate interactions between avelumab exposure and TGD. A PK-TGD feedback loop was evaluated with simultaneous fitting of the PK and TGD models. RESULTS In total, 1,835 PK observations and 338 TS observations were collected from 147 patients. In the final PK-TGD model, which included the bidirectional relationship between PK and TGD, avelumab PK was described by a two-compartment model with a positive association between clearance and longitudinal TS, with no additional empirical time-varying clearance identified. TGD was described by first-order tumor growth/shrinkage rates, with the tumor shrinkage rate decreasing exponentially over time; the exponential time-decay constant decreased with increasing drug concentration, representing the treatment effect through tumor shrinkage inhibition. CONCLUSIONS We developed a TGD model that mechanistically captures the prevention of loss of antitumor immunity (i.e., T-cell suppression in the tumor microenvironment) by avelumab, and a bidirectional interaction between PK and TGD in patients with mMCC treated with avelumab, thus mechanistically describing previously reported time variance of avelumab elimination.
Collapse
Affiliation(s)
| | - Wenyuan Xiong
- Merck Institute of Pharmacometrics, Lausanne, Switzerland, an affiliate of Merck KGaA, Darmstadt, Germany
| | - Lénaïg Tanneau
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
| | - Siv Jönsson
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
| | | | | | | | | | - Pascal Girard
- Merck Institute of Pharmacometrics, Lausanne, Switzerland, an affiliate of Merck KGaA, Darmstadt, Germany
| | - Akash Khandelwal
- the healthcare business of Merck KGaA, Darmstadt, Germany.,Corresponding Author: Akash Khandelwal, the healthcare business of Merck KGaA, Frankfurter Str. 250, Darmstadt 64293, Germany. Phone: 4961-5172-43323; Fax: 4961-5172-56684; E-mail:
| |
Collapse
|
18
|
Harms PW, Verhaegen ME, Vo JN, Tien JC, Pratt D, Su F, Dhanasekaran SM, Cao X, Mangelberger D, VanGoor J, Choi JE, Ma VT, Dlugosz AA, Chinnaiyan AM. Viral Status Predicts the Patterns of Genome Methylation and Decitabine Response in Merkel Cell Carcinoma. J Invest Dermatol 2022; 142:641-652. [PMID: 34474081 PMCID: PMC8860850 DOI: 10.1016/j.jid.2021.07.173] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/22/2021] [Accepted: 07/12/2021] [Indexed: 12/13/2022]
Abstract
Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine carcinoma that is classified as Merkel cell polyomavirus-positive (virus positive [VP]) or Merkel cell polyomavirus-negative (virus negative [VN]). Epigenetic changes, such as DNA methylation, can alter gene expression and influence cancer progression. However, patterns of DNA methylation and the therapeutic efficacy of hypomethylating agents have not been fully explored in MCC. We characterized genome-wide DNA methylation in 16 MCC cell lines from both molecular subclasses in comparison with other cancer types and found that the overall profile of MCC is similar to that of small-cell lung carcinoma. Comparison of VP MCC with VN MCC revealed 2,260 differentially methylated positions. The hypomethylating agent decitabine upregulated the expression of antigen-presenting machinery in MCC cell lines and stimulated membrane expression of HLA-A in VP and VN MCC xenograft tumors. Decitabine also induced prominent caspase- and large T antigen‒independent cell death in VP MCC, whereas VN MCC cell lines displayed decreased proliferation without increased cell death. In mouse xenografts, decitabine significantly decreased the size of VP tumors but not that of VN tumors. Our findings indicate that viral status predicts genomic methylation patterns in MCC and that decitabine may be therapeutically effective against MCC through antiproliferative effects, cell death, and increased immune recognition.
Collapse
Affiliation(s)
- Paul W. Harms
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA,Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, 48109, USA,Rogel Cancer Center, University of Michigan, Ann Arbor, MI, 48109, USA,Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA
| | | | - Josh N. Vo
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA,Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Jean C. Tien
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA,Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Drew Pratt
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Fengyun Su
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA,Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Saravana M. Dhanasekaran
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA,Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Xuhong Cao
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA,Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, 48109, USA,Howard Hughes Medical Institute, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Doris Mangelberger
- Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Julia VanGoor
- College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Jae Eun Choi
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA,Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Vincent T. Ma
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Andrzej A. Dlugosz
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, 48109, USA,Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA,Department of Cell and Developmental Biology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Arul M. Chinnaiyan
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA,Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, 48109, USA,Rogel Cancer Center, University of Michigan, Ann Arbor, MI, 48109, USA,Howard Hughes Medical Institute, University of Michigan, Ann Arbor, MI, 48109, USA,Department of Urology, University of Michigan, Ann Arbor, MI, 48109, USA,Corresponding Author: Arul M. Chinnaiyan, M.D., Ph.D., Investigator, Howard Hughes Medical Institute, American Cancer Society Professor, S. P. Hicks Endowed Professor of Pathology, Rogel Cancer Center, University of Michigan Medical School, 1400 E. Medical Center Dr. 5316 CCGC, Ann Arbor, MI 48109-0602,
| |
Collapse
|
19
|
Laurito TL, França FT, Vieira-Damiani G, Pelegati VB, Baratti MO, de Carvalho HF, Cesar CL, de Moraes AM, Cintra ML, Teixeira F. The texture of collagen in the microenvironments of Merkel cell carcinoma. Medicine (Baltimore) 2021; 100:e27925. [PMID: 34964766 PMCID: PMC8615296 DOI: 10.1097/md.0000000000027925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 10/18/2021] [Accepted: 11/08/2021] [Indexed: 02/07/2023] Open
Abstract
ABSTRACT Solid tumors typically contain high levels of fibrillar collagen. The increased stromal collagen deposition usually promotes cancer progression since biochemical and biophysical cues from tumor-associated collagen fibers stimulate neoplastic cells. Few studies have investigated the relationship between Merkel cell carcinoma (MCC) and the extracellular matrix (ECM), but there are no works evaluating collagen.This is an observational, analytical, retrospective study including 11 patients with MCC. Primary tumor-stained sections were evaluated by second harmonic generation microscopy and texture analysis.Peritumoral texture features (area fraction, mean gray value, entropy, and contrast) showed much lower values than normal skin (P < .0001) revealing extensively altered structure of peritumoral collagen fibers. These differences were not significant between tumors with unfavorable and favorable known prognostic factors.Profound changes in collagen fibers present in the stroma accompanying primary MCC may contribute to the aggressive behavior of this tumor. Our results indicate that whatever MCC histological subtype, size or anatomical location, MCC promotes the same type of ECM for its development. As an outlook, therapies using ECM macromolecules or fibroblasts (the architects of ECM remodeling) as target could be useful in the treatment of MCC.
Collapse
Affiliation(s)
- Tiago Luders Laurito
- Department of Pathology, Faculty of Medical Sciences, State University of Campinas, Rua Tessália Vieira de Camargo, 126. Cidade Universitária Zeferino Vaz, Campinas, SP, Brazil
| | - Flávia Thomé França
- Department of Pathology, Faculty of Medical Sciences, State University of Campinas, Rua Tessália Vieira de Camargo, 126. Cidade Universitária Zeferino Vaz, Campinas, SP, Brazil
| | - Gislaine Vieira-Damiani
- Federal Institute of Education, Science and Technology of São Paulo, Avenida Ênio Pires de Camargo, 2971, Capivari, SP, Brazil
| | - Vitor Bianchin Pelegati
- National Institute of Photonics Applied to Cell Biology, Department of Quantum Electronics, Institute of Physics, State University of Campinas, Rua Sergio Buarque de Holanda, 777, SP, Brazil
| | - Mariana Ozello Baratti
- National Institute of Photonics Applied to Cell Biology, Department of Quantum Electronics, Institute of Physics, State University of Campinas, Rua Sergio Buarque de Holanda, 777, SP, Brazil
| | - Hernandez Faustino de Carvalho
- National Institute of Photonics Applied to Cell Biology, Department of Quantum Electronics, Institute of Physics, State University of Campinas, Rua Sergio Buarque de Holanda, 777, SP, Brazil
| | - Carlos Lenz Cesar
- National Institute of Photonics Applied to Cell Biology, Department of Quantum Electronics, Institute of Physics, State University of Campinas, Rua Sergio Buarque de Holanda, 777, SP, Brazil
| | - Aparecida Machado de Moraes
- Department of Dermatology, Faculty of Medical Sciences, State University of Campinas, Rua Tessália Vieira de Camargo, 126. Cidade Universitária Zeferino Vaz, Campinas, SP, Brazil
| | - Maria Letícia Cintra
- Department of Pathology, Faculty of Medical Sciences, State University of Campinas, Rua Tessália Vieira de Camargo, 126. Cidade Universitária Zeferino Vaz, Campinas, SP, Brazil
| | - Fernanda Teixeira
- Department of Pathology, Faculty of Medical Sciences, State University of Campinas, Rua Tessália Vieira de Camargo, 126. Cidade Universitária Zeferino Vaz, Campinas, SP, Brazil
| |
Collapse
|
20
|
Esnault C, Leblond V, Martin C, Desgranges A, Baltus CB, Aubrey N, Lakhrif Z, Lajoie L, Lantier L, Clémenceau B, Sarma B, Schrama J, Houben R, Schrama D, Hesbacher S, Gouilleux-Gruart V, Feng Y, Dimitrov D, Guyétant S, Berthon P, Viaud-Massuard MC, Samimi M, Touzé A, Kervarrec T. Adcitmer ® , a new CD56-targeting monomethyl auristatin E-conjugated antibody, is a potential therapeutic approach in Merkel cell carcinoma. Br J Dermatol 2021; 186:295-306. [PMID: 34582565 DOI: 10.1111/bjd.20770] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is an aggressive skin cancer, whose tumour cells often express CD56. While immune checkpoint inhibitors constitute a major advance for treating patients with MCC with advanced disease, new therapeutic options are still urgently required. OBJECTIVES To produce and evaluate the therapeutic performance of a new antibody-drug conjugate (Adcitmer® ) targeting CD56 in preclinical models of MCC. METHODS CD56 expression was evaluated in a MCC cohort (immunohistochemistry on a tissue microarray of 90 tumour samples) and MCC cell lines. Interaction of an unconjugated CD56-targeting antibody with CD56+ MCC cell lines was investigated by immunohistochemistry and imaging flow cytometry. Adcitmer® product was generated by the bioconjugation of CD56-targeting antibody to a cytotoxic drug (monomethyl auristatin E) using the McSAF Inside® bioconjugation process. The chemical properties and homogeneity of Adcitmer® were characterized by hydrophobic interaction chromatography. Adcitmer® cytotoxicity was evaluated in vitro and in an MCC xenograft mice model. RESULTS Similar to previous reports, CD56 was expressed by 66% of MCC tumours in our cohort, confirming its relevance as a therapeutic target. Specific binding and internalization of the unconjugated CD56-targeting antibody was validated in MCC cell lines. The high homogeneity of the newly generated Adcitmer® was confirmed by hydrophobic interaction chromatography. The CD56-mediated cytotoxicity of Adcitmer® was demonstrated in vitro in MCC cell lines. Moreover, Adcitmer® significantly reduced tumour growth in a MCC mouse model. CONCLUSIONS Our study suggests that Adcitmer® should be further assessed as a therapeutic option in patients with MCC, as an alternative therapy or combined with immune checkpoint inhibitors.
Collapse
Affiliation(s)
- C Esnault
- Team 'Biologie des Infections à Polyomavirus', ISP UMR 1282, INRAE, Université de Tours, Tours, 37200, France.,Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, 97080, Germany
| | - V Leblond
- Team 'Biologie des Infections à Polyomavirus', ISP UMR 1282, INRAE, Université de Tours, Tours, 37200, France
| | | | | | | | - N Aubrey
- Team BIOMAP, ISP UMR 1282, INRAE, Université de Tours, Tours, 37200, France
| | - Z Lakhrif
- Team BIOMAP, ISP UMR 1282, INRAE, Université de Tours, Tours, 37200, France
| | - L Lajoie
- Team FRAME, GICC EA7501, Université de Tours, Tours, 37200, France.,Plateforme Scientifique et Technique, Analyse des Systèmes Biologiques Département des Cytométries, Université de Tours, Tours, 37200, France
| | - L Lantier
- Team BIOMAP, ISP UMR 1282, INRAE, Université de Tours, Tours, 37200, France
| | - B Clémenceau
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France.,LabEx IGO 'Immunotherapy, Graft, Oncology', Nantes, France.,CHU de Nantes, Hôtel Dieu, Nantes, F-44000, France
| | - B Sarma
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, 97080, Germany
| | - J Schrama
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, 97080, Germany
| | - R Houben
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, 97080, Germany
| | - D Schrama
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, 97080, Germany
| | - S Hesbacher
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, 97080, Germany
| | | | - Y Feng
- Tumor Angiogenesis Unit, Mouse Cancer Genetics Program, NCI at Frederick, Frederick, MD, 21702, USA
| | - D Dimitrov
- Protein Interactions Section, Cancer and Inflammation Program, Center for Cancer Research, National Cancer Institute, Frederick, MD, USA
| | - S Guyétant
- Team 'Biologie des Infections à Polyomavirus', ISP UMR 1282, INRAE, Université de Tours, Tours, 37200, France.,Department of Pathology, Université de Tours, CHU de Tours, Chambray-les-Tours, 37170, France
| | - P Berthon
- Team 'Biologie des Infections à Polyomavirus', ISP UMR 1282, INRAE, Université de Tours, Tours, 37200, France
| | - M C Viaud-Massuard
- McSAF, Tours, 37200, France.,Team IMT, GICC EA7501, Université de Tours, Tours, 37200, France
| | - M Samimi
- Team 'Biologie des Infections à Polyomavirus', ISP UMR 1282, INRAE, Université de Tours, Tours, 37200, France.,Department of Dermatology, Université de Tours, CHU de Tours, Chambray-les-Tours, 37170, France
| | - A Touzé
- Team 'Biologie des Infections à Polyomavirus', ISP UMR 1282, INRAE, Université de Tours, Tours, 37200, France
| | - T Kervarrec
- Team 'Biologie des Infections à Polyomavirus', ISP UMR 1282, INRAE, Université de Tours, Tours, 37200, France.,Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, 97080, Germany.,Department of Pathology, Université de Tours, CHU de Tours, Chambray-les-Tours, 37170, France
| |
Collapse
|
21
|
Torchio M, Cattaneo L, Milione M, Prinzi N, Corti F, Ungari M, Anichini A, Mortarini R, Occhini A, Bertino G, Maurichi A, Coppa J, Di Bartolomeo M, de Braud FG, Pusceddu S. Case Report: Exceptional Response to Avelumab After Failure of Electrochemotherapy in a Patient With Rapidly Progressive, PD-L1-Negative Merkel Cell Carcinoma. Front Oncol 2021; 11:628324. [PMID: 34221958 PMCID: PMC8248546 DOI: 10.3389/fonc.2021.628324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/29/2021] [Indexed: 01/22/2023] Open
Abstract
This case report shows, for the first time, a patient experiencing a complete response after one dose of avelumab following extensive disease progression with prior electrochemotherapy (ECT) treatment. We suggest that ECT may help to establish a tumor microenvironment favorable to immunotherapy. Merkel cell carcinoma (MCC) is a highly aggressive skin cancer with seldom durable chemotherapy responses. ECT has recently emerged as a potential treatment option for several malignancies, including MCC. Avelumab, an anti-programmed cell death-ligand 1 (PD-L1) monoclonal antibody, became the first approved treatment for patients with metastatic MCC. ECT has been shown to activate the immune response, but it is still unknown how ECT may affect patient’s response to subsequent immunotherapy. We report a case of a patient with MCC who presented with a rapidly growing skin nodule of the right cheek and experienced extensive disease progression following surgical debulking and ECT treatment. The patient received a flat dose of 800 mg avelumab intravenously every 2 weeks showing complete tumor regression after only one dose. Immunohistochemical analysis of surgical and post-ECT biopsies collected from the primary lesion revealed tumor expression of programmed cell death protein-1 (PD-1), but not PD-L1. Analysis of the tumor samples also revealed no expression of Merkel cell polyomavirus (MCPyV). Comparison of the biopsies showed a decrease in myeloid and T-cell markers after ECT but an increase in major histocompatibility complex (MHC) class I expression on tumor cells. Additionally, the patient experienced an increase in neutrophil-to-lymphocyte ratio and lactate dehydrogenase values post-ECT, which subsequently decreased with avelumab treatment. As of 30 October 2019, the patient was still receiving avelumab treatment and had an ongoing complete response. In this case report, a patient with PD-L1-negative and MCPyV-negative MCC who had disease progression following ECT experienced complete tumor regression with avelumab treatment, suggesting, for the first time to our knowledge, that ECT may help to establish a tumor microenvironment favorable to immunotherapy via a potential abscopal effect. Tumor-intrinsic PD-1 expression and modulation of MHC class I antigens after ECT may contribute to the clinical efficacy of avelumab in this context.
Collapse
Affiliation(s)
- Martina Torchio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, ENETS Center of Excellence, Milan, Italy
| | - Laura Cattaneo
- First Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, ENETS Center of Excellence, Milan, Italy
| | - Massimo Milione
- First Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, ENETS Center of Excellence, Milan, Italy
| | - Natalie Prinzi
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, ENETS Center of Excellence, Milan, Italy
| | - Francesca Corti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, ENETS Center of Excellence, Milan, Italy
| | - Marco Ungari
- Department of Pathology, Azienda Socio-Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Andrea Anichini
- Human Tumor Immunobiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, ENETS Center of Excellence, Milan, Italy
| | - Roberta Mortarini
- Human Tumor Immunobiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, ENETS Center of Excellence, Milan, Italy
| | - Antonio Occhini
- Department of Otolaryngology Head and Neck Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giulia Bertino
- Department of Otolaryngology Head and Neck Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Maurichi
- Melanoma and Sarcoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, ENETS Center of Excellence, Milan, Italy
| | - Jorgelina Coppa
- GI and Liver Transplantation Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, ENETS Center of Excellence, Milan, Italy
| | - Maria Di Bartolomeo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, ENETS Center of Excellence, Milan, Italy
| | - Filippo Guglielmo de Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, ENETS Center of Excellence, Milan, Italy.,Oncology and Hematology-Oncology Department, University of Milan, Milan, Italy
| | - Sara Pusceddu
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, ENETS Center of Excellence, Milan, Italy
| |
Collapse
|
22
|
Harms KL, Zhao L, Johnson B, Wang X, Carskadon S, Palanisamy N, Rhodes DR, Mannan R, Vo JN, Choi JE, Chan MP, Fullen DR, Patel RM, Siddiqui J, Ma VT, Hrycaj S, McLean SA, Hughes TM, Bichakjian CK, Tomlins SA, Harms PW. Virus-positive Merkel Cell Carcinoma Is an Independent Prognostic Group with Distinct Predictive Biomarkers. Clin Cancer Res 2021; 27:2494-2504. [PMID: 33547200 DOI: 10.1158/1078-0432.ccr-20-0864] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 12/31/2020] [Accepted: 02/02/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine carcinoma that can be divided into two classes: virus-positive (VP) MCC, associated with oncogenic Merkel cell polyomavirus (MCPyV); and virus-negative (VN) MCC, associated with photodamage. EXPERIMENTAL DESIGN We classified 346 MCC tumors from 300 patients for MCPyV using a combination of IHC, ISH, and qPCR assays. In a subset of tumors, we profiled mutation status and expression of cancer-relevant genes. MCPyV and molecular profiling results were correlated with disease-specific outcomes. Potential prognostic biomarkers were further validated by IHC. RESULTS A total of 177 tumors were classified as VP-MCC, 151 tumors were VN-MCC, and 17 tumors were indeterminate. MCPyV positivity in primary tumors was associated with longer disease-specific and recurrence-free survival in univariate analysis, and in multivariate analysis incorporating age, sex, immune status, and stage at presentation. Prioritized oncogene or tumor suppressor mutations were frequent in VN-MCC but rare in VP-MCC. TP53 mutation developed with recurrence in one VP-MCC case. Importantly, for the first time we find that VP-MCC and VN-MCC display distinct sets of prognostic molecular biomarkers. For VP-MCC, shorter survival was associated with decreased expression of immune markers including granzyme and IDO1. For VN-MCC, shorter survival correlated with high expression of several genes including UBE2C. CONCLUSIONS MCPyV status is an independent prognostic factor for MCC. Features of the tumor genome, transcriptome, and microenvironment may modify prognosis in a manner specific to viral status. MCPyV status has clinicopathologic significance and allows for identification of additional prognostic subgroups.
Collapse
Affiliation(s)
- Kelly L Harms
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan.,Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Lili Zhao
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | | | - Xiaoming Wang
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan.,Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Shannon Carskadon
- Department of Urology, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Nallasivam Palanisamy
- Department of Urology, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | | | - Rahul Mannan
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan.,Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Josh N Vo
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan.,Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Jae Eun Choi
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - May P Chan
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan.,Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Douglas R Fullen
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan.,Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Rajiv M Patel
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan.,Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Javed Siddiqui
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan.,Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Vincent T Ma
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan.,Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan
| | - Steven Hrycaj
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Scott A McLean
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Tasha M Hughes
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Christopher K Bichakjian
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan.,Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Scott A Tomlins
- Strata Oncology, Ann Arbor, Michigan.,Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan.,Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Paul W Harms
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan. .,Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan.,Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan.,Department of Pathology, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
23
|
Mokánszki A, Méhes G, Csoma SL, Kollár S, Chang Chien YC. Molecular Profiling of Merkel Cell Polyomavirus-Associated Merkel Cell Carcinoma and Cutaneous Melanoma. Diagnostics (Basel) 2021; 11:diagnostics11020212. [PMID: 33535453 PMCID: PMC7912722 DOI: 10.3390/diagnostics11020212] [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: 12/22/2020] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 02/07/2023] Open
Abstract
Merkel cell carcinoma (MCC) is a rare, high-grade, aggressive cutaneous neuroendocrine malignancy most commonly associated with sun-exposed areas of older individuals. A relatively newly identified human virus, the Merkel cell polyomavirus (MCPyV) has been implicated in the pathogenesis of MCC. Our study aimed to examine nine MCC cases and randomly selected 60 melanoma cases to identify MCPyV status and to elucidate genetic differences between virus-positive and -negative cases. Altogether, seven MCPyV-positive MCC samples and four melanoma samples were analyzed. In MCPyV-positive MCC RB1, TP53, FBXW7, CTNNB1, and HNF1A pathogenic variants were identified, while in virus-negative cases only benign variants were found. In MCPyV-positive melanoma cases, besides BRAF mutations the following genes were also affected: PIK3CA, STK11, CDKN2A, SMAD4, and APC. In contrast to studies found in the literature, a higher tumor burden was detected in virus-associated MCC compared to MCPyV-negative cases. No association was identified between virus infection and tumor burden in melanoma samples. We concluded that analyzing the key morphologic and immunohistological features of MCC is critical to avoid confusion with other cutaneous malignancies. Molecular genetic investigations such as next-generation sequencing (NGS) enable molecular stratification, which may have future clinical impact.
Collapse
Affiliation(s)
- Attila Mokánszki
- Department of Pathology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (G.M.); (S.L.C.); (Y.-C.C.C.)
- Correspondence: ; Tel.: +36-52-411-600
| | - Gábor Méhes
- Department of Pathology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (G.M.); (S.L.C.); (Y.-C.C.C.)
| | - Szilvia Lilla Csoma
- Department of Pathology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (G.M.); (S.L.C.); (Y.-C.C.C.)
| | - Sándor Kollár
- Department of Pathology, Kenézy Gyula Teaching Hospital, University of Debrecen, H-4032 Debrecen, Hungary;
| | - Yi-Che Chang Chien
- Department of Pathology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (G.M.); (S.L.C.); (Y.-C.C.C.)
| |
Collapse
|
24
|
Benisty D, Kay S, Rund D, Katz BZ. Differential diagnosis of malignant mononuclear cells in the cerebrospinal fluid: Merkel carcinoma cells. Diagn Cytopathol 2020; 49:443-445. [PMID: 33264487 DOI: 10.1002/dc.24664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/08/2020] [Accepted: 11/03/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Dan Benisty
- Department of Hematology, Tel-Aviv University, Tel Aviv, Israel
| | - Sigi Kay
- Department of Hematology, Tel-Aviv University, Tel Aviv, Israel
| | - Deborah Rund
- Department of Hematology, Tel-Aviv University, Tel Aviv, Israel
| | - Ben-Zion Katz
- Department of Hematology, Tel-Aviv University, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| |
Collapse
|
25
|
Talsma CE, Wang M, Andea AA, Fullen DR, Harms PW, Chan MP. Expression of p16 in Merkel cell carcinoma. J Cutan Pathol 2020; 48:455-457. [PMID: 32592172 DOI: 10.1111/cup.13790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/01/2020] [Accepted: 06/23/2020] [Indexed: 12/24/2022]
Affiliation(s)
| | - Min Wang
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Aleodor A Andea
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Douglas R Fullen
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Paul W Harms
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - May P Chan
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
26
|
Babadzhanov M, Doudican N, Wilken R, Stevenson M, Pavlick A, Carucci J. Current concepts and approaches to merkel cell carcinoma. Arch Dermatol Res 2020; 313:129-138. [PMID: 32666149 DOI: 10.1007/s00403-020-02107-9] [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: 04/19/2020] [Revised: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 02/07/2023]
Abstract
Merkel cell carcinoma (MCC) is an aggressive and rare cutaneous cancer of the mechanoreceptor unit of the skin with a neuroendocrine origin. MCC incidence has been on the rise over the past two decades. Risk factors include old age, chronic UV exposure, and immunosuppression. Although MCC is a cutaneous malignancy that is often misdiagnosed as a benign nodule at the time of diagnosis, it has an aggressive disease course due to its high recurrence and metastatic potential. The PD-1/PD-L1 checkpoint blockade has recently shown promising results in the management of advanced MCC. Avelumab and pembrolizumab are considered the new standard of care for metastatic MCC. Despite advances in the field, studies are needed to elucidate the role of immunotherapy for patients who are resistant to treatment. Most ongoing clinical trials aim to assess the efficacy of checkpoint inhibitor combination therapies. This article reviews the most current literature on the surgical and medical management of MCC.
Collapse
Affiliation(s)
| | | | - Reason Wilken
- Dermatology, NYU Langone Med Center, New York, NY, USA
| | | | - Anna Pavlick
- Dermatology, NYU Langone Med Center, New York, NY, USA
| | - John Carucci
- Dermatology, NYU Langone Med Center, New York, NY, USA.
| |
Collapse
|
27
|
DEREBAŞINLIOĞLU H, NEMMEZİ KARACA S. A 20-YEAR RETROSPECTIVE ANALYSIS OF SKIN CANCERS: COMPARISON OF THE FIRST AND SECOND DECADES. KONURALP TIP DERGISI 2020. [DOI: 10.18521/ktd.708364] [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]
|
28
|
The Evolution of Care of Cancers of the Head and Neck Region: State of the Science in 2020. Cancers (Basel) 2020; 12:cancers12061543. [PMID: 32545409 PMCID: PMC7352543 DOI: 10.3390/cancers12061543] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 12/15/2022] Open
Abstract
Cancers that arise in the head and neck region are comprised of a heterogeneous group of malignancies that include carcinogen- and human papillomavirus (HPV)-driven mucosal squamous cell carcinoma as well as skin cancers such as cutaneous squamous cell carcinoma, basal cell carcinoma, melanoma, and Merkel cell carcinoma. These malignancies develop in critical areas for eating, talking, and breathing and are associated with substantial morbidity and mortality despite advances in treatment. Understanding of advances in the management of these various cancers is important for all multidisciplinary providers who care for patients across the cancer care continuum. Additionally, the recent Coronavirus Disease 2019 (COVID-19) pandemic has necessitated adaptations to head and neck cancer care to accommodate the mitigation of COVID-19 risk and ensure timely treatment. This review explores advances in diagnostic criteria, prognostic factors, and management for subsites including head and neck squamous cell carcinoma and the various forms of skin cancer (basal cell carcinoma, cutaneous squamous cell carcinoma, Merkel cell carcinoma, and melanoma). Then, this review summarizes emerging developments in immunotherapy, radiation therapy, cancer survivorship, and the delivery of care during the COVID-19 era.
Collapse
|
29
|
Management Recommendations for Merkel Cell Carcinoma-A Danish Perspective. Cancers (Basel) 2020; 12:cancers12030554. [PMID: 32121063 PMCID: PMC7139291 DOI: 10.3390/cancers12030554] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 02/23/2020] [Accepted: 02/25/2020] [Indexed: 02/06/2023] Open
Abstract
Merkel cell carcinoma (MCC) is a rare malignant neuroendocrine carcinoma of the skin with a poor prognosis and an apparent increase in incidence. Due to its rarity, evidence-based guidelines are limited, and there is a lack of awareness among clinicians. This review constitutes the consensus management recommendations developed by the Danish MCC expert group and is based on a systematic literature search. Patients with localized disease are recommended surgical excision and adjuvant radiotherapy to the primary site; however, this may be omitted in patients with MCC with low risk features. Patients with regional lymph node involvement are recommended complete lymph node removal and adjuvant radiotherapy in case of extracapsular disease. Metastatic disease was traditionally treated with chemotherapy, however, recent clinical trials with immune therapy have been promising. Immune checkpoint inhibitors targeting the programmed cell death protein 1(PD-1)/programmed death-ligand 1(PD-L1) axis should therefore be strongly considered as first-line treatment for fit patients. A 5-year follow-up period is recommended involving clinical exam every 3 months for 2 years and every 6 months for the following 3 years and PET-CT one to two times a year or if clinically indicated. These national recommendations are intended to offer uniform patient treatment and hopefully improve prognosis.
Collapse
|