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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.
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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
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2
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Terrell M, Dongarwar D, Rashid R, Hamisu S, Orengo I. Inpatient prevalence and factors associated with Merkel Cell Carcinoma inpatient hospitalization in the United States. Arch Dermatol Res 2024; 316:489. [PMID: 39066821 DOI: 10.1007/s00403-024-03222-7] [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: 05/07/2024] [Revised: 06/16/2024] [Accepted: 07/06/2024] [Indexed: 07/30/2024]
Abstract
Merkel Cell Carcinoma is a rare and aggressive cutaneous carcinoma with a propensity for metastasis and death. Our study describes the prevalence, sociodemographics and inpatient mortality of Merkel Cell Carcinoma related hospitalizations in the United States from 2011 to 2020. We conducted an observational study using the Nationwide Inpatient Sample database, which captures a 20% sample of all hospitalizations in the United States. We utilized the International Classification of Disease Clinical Modification codes from the ninth and tenth revision to identify Merkel Cell Carcinoma and demographic factors. There was a total of 28,809 cases of Merkel Cell Carcinoma in the United States from 2011 to 2020. Merkel Cell Carcinoma was associated with white race (11.4 per 100,000) and disposition of death (26.8 per 100,000). It was most prevalent in the highest quartile income (12.5 per 100,000) and Medicare as primary payer (13.0 per 100,000). Hospitalization was lowest in nonwhite races, particularly NH-Blacks and NH-Others. Inpatient mortality was significantly associated with NH-Others (odds ratio 2.18, 95% confidence interval = 1.38-3.45) and self-pay patients (odds ratio = 2.93, 95% confidence interval 1.84-4.67).This study contributes to reported socio-demographic factors related to Merkel Cell Carcinomas and brings awareness to factors associated with increased hospitalization and inpatient mortality.
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Affiliation(s)
- Maci Terrell
- School of Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, USA.
| | - Deepa Dongarwar
- Department of Neurology, University of Texas Houston Health Science Center, Houston, TX, USA
| | | | - Salihu Hamisu
- School of Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, USA
| | - Ida Orengo
- School of Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, USA
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3
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Sayeed S, Kapustin D, Rubin SJ, Fan J, Wiedmer C, Chung D, Khorsandi A, Brandwein-Weber M, Friedlander P, Bakst R, Ramirez RJ, Urken ML. Metastatic merkel cell carcinoma to the thyroid gland: Case report and review of the literature. Am J Otolaryngol 2024; 45:104278. [PMID: 38604100 DOI: 10.1016/j.amjoto.2024.104278] [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: 01/24/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is an aggressive and rare neuroendocrine tumor, accounting for less than 1% of skin cancers. Metastasis primarily manifests in the cervical lymph nodes but rarely affect the thyroid. METHODS We report a case of primary head and neck cutaneous MCC with metastasis to the thyroid gland. A review of the literature of MCC with thyroid metastasis was conducted. RESULTS We identified five cases of MCC with thyroid metastasis. Primary sites included the distal upper and lower extremities, axilla, buttock, and groin. Treatment courses varied including thyroidectomy, immunotherapy, and expectant palliative measures. Time from initial diagnosis to thyroid metastasis ranged from four months to four years. Tissue diagnosis was achieved in 5 of 6 cases. CONCLUSIONS MCC with thyroid metastasis is rare and likely represents aggressive disease. Despite advances in treatment and surveillance, outcomes for MCC remain poor. Ongoing research may establish predictors for treatment response.
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Affiliation(s)
- Salmaan Sayeed
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, NY, USA; Dept. of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Danielle Kapustin
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, NY, USA; Dept. of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samuel J Rubin
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, NY, USA; Dept. of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jun Fan
- Dept. of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christina Wiedmer
- Dept. of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel Chung
- Dept. of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Azita Khorsandi
- Dept. of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Philip Friedlander
- Hematology and Medical Oncology, Waldman Dept. of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Richard Bakst
- Dept. of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ricardo J Ramirez
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, NY, USA; Dept. of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mark L Urken
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, NY, USA; Dept. of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Nudelman NT, Ekhator N, Rothschild M, Wladis EJ. A SEER program study of survival trends in Merkel cell carcinoma of the eyelid: 2000-2019. Orbit 2024; 43:290-295. [PMID: 38032687 DOI: 10.1080/01676830.2023.2286380] [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: 08/18/2023] [Accepted: 11/16/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE Merkel cell carcinoma of the eyelid (MCCE) is a rare yet aggressive neuroendocrine tumour associated with significant morbidity and mortality. This study aimed to investigate survival trends and demographic factors related to MCCE, 2000-2019, using the Surveillance, Epidemiology, and End Results (SEER) Program. METHODS Cases were analysed by demographic parameters, disease properties, and survival. Statistical analyses were performed via a dedicated computerized software package. RESULTS A total 349 cases of MCCE were identified, accounting for 2% of all MCC cases in the United States during that time. Of note, the incidence of MCCE remained stable over the study period (p = .35). Female patients accounted for 56% of the cases, and males for 44%. White patients accounted for 90.8% of the the cases, and Black patients for 2.9%. MCCE incidence increased with age, with the majority of patients age 85+ (p < .05). Incidence was greatest in metropolitan areas and among those with median incomes >$75,000/year. Income correlated with likelihood of MCCE diagnosis (p < .05). Analysis of 5-year survival data showed 20% of the patients died due to MCCE within 5 years of diagnosis. Of these, the majority died within one year of diagnosis. CONCLUSIONS Consistent with previous reports, most patients were white, female, and age 85+.Incidence correlated with metropolitan environments and median income. While most patients did not die from MCCE, majority of recorded deaths occurred within one year of diagnosis.
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Affiliation(s)
- Nicole T Nudelman
- Department of Ophthalmology, Albany Medical College, Albany, New York, USA
| | - Nehikhare Ekhator
- Department of Ophthalmology, Albany Medical College, Albany, New York, USA
| | - Michael Rothschild
- Department of Ophthalmology, Albany Medical College, Albany, New York, USA
| | - Edward J Wladis
- Department of Ophthalmology, Albany Medical College, Albany, New York, USA
- Department of Otolaryngology, Albany Medical College, Albany, New York, USA
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5
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Ashby HE, Jones GN, Leedhanachoke O, Jen P, Helphenstine N, Al Akhrass F. Merkel Cell Carcinoma Masquerading Clinically as a Cyst in a Young Patient. Int Med Case Rep J 2024; 17:289-293. [PMID: 38596400 PMCID: PMC11001544 DOI: 10.2147/imcrj.s449543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/21/2024] [Indexed: 04/11/2024] Open
Abstract
Merkel cell carcinoma (MCC) is an extremely rare and aggressive tumor. Here we report an unusual MCC that manifested as an abruptly enlarging, painful skin lesion over the right antecubital fossa and masqueraded as an epidermal cyst in a 42-year-old male. The lesion was surgically excised and subjected to histopathologic and immunohistochemical examinations. The subsequent analysis allowed for the diagnosis of MCC. Clinicians should always be cognizant of MCC, which can be easily misdiagnosed. Early diagnosis and appropriate treatment are keys to improving the survival rates of MCC patients.
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Affiliation(s)
| | - Grayson N Jones
- Department of Pathology, Pikeville Medical Center, Pikeville, KY, USA
| | - Oon Leedhanachoke
- Department of General Surgery, Pikeville Medical Center, Pikeville, KY, USA
| | - Phillip Jen
- Department of BioMedical Science, University of Pikeville, Pikeville, KY, USA
| | - Noah Helphenstine
- Department of BioMedical Science, University of Pikeville, Pikeville, KY, USA
| | - Fadi Al Akhrass
- Department of Infectious Diseases, Pikeville Medical Center, Pikeville, KY, USA
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6
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Uhara H, Kiyohara Y, Isei T, Nagase K, Kambe A, Sato M, Tanaka Y, Yamazaki N. Safety and effectiveness of avelumab in patients with Merkel cell carcinoma in general clinical practice in Japan: Post-marketing surveillance. J Dermatol 2024; 51:475-483. [PMID: 38433375 DOI: 10.1111/1346-8138.17096] [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: 07/19/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 03/05/2024]
Abstract
Avelumab, a programmed cell death ligand 1 blocking antibody, was approved for its first indication in Japan in September 2017 to treat unresectable Merkel cell carcinoma (MCC). Given that the pivotal JAVELIN Merkel 200 study only included a few Japanese patients, this post-marketing surveillance (PMS) evaluated the safety and effectiveness outcomes of patients with MCC who received avelumab in general clinical practice in Japan. This prospective, non-comparative, multicenter PMS included data from all patients with unresectable MCC who received avelumab between November 22, 2017 (avelumab launch date) and October 31, 2019. The primary objective was to evaluate avelumab safety (i.e., adverse events [AEs], adverse drug reactions [ADRs], and ADRs of safety specifications). The secondary objective was to evaluate avelumab effectiveness (i.e., objective response rate and overall survival [OS] rate). Seventy-five evaluable patients were included, of whom 81.3% experienced AEs of any grade (57.3% experienced AEs of grade ≥ 3; 41.3% experienced AEs of grade 5) and 61.3% experienced ADRs (14.7% experienced ADRs of grade ≥ 3; no grade 5 ADRs were observed). The most common ADRs were pyrexia (18.7%), infusion related reaction (10.7%), and chills (6.7%). The most common ADRs of safety specifications were infusion reactions (any grade: n = 21 [28.0%]; grade 3 or 4: n = 3 [4.0%]), thyroid dysfunction (n = 7 [9.3%]), and hepatic function disorders (n = 4 [5.3%]). The median observation period was 51 weeks. An objective response was achieved by 34/75 patients (45.3%; complete response, 24.0%; partial response, 21.3%) and 6- and 12-month OS rates were 77.7% and 59.6%, respectively. This PMS confirmed the clinical tolerability and effectiveness of avelumab in patients with MCC, with no new safety concerns. The risk-benefit profile of avelumab was comparable with that observed in clinical trials and remains favorable for use in general clinical practice in Japan.
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Affiliation(s)
- Hisashi Uhara
- Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Yoshio Kiyohara
- Shizuoka Cancer Center Hospital and Research Institute, Shizuoka, Japan
| | - Taiki Isei
- Osaka International Cancer Institution, Osaka, Japan
| | - Kotaro Nagase
- Department of Dermatology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Anzu Kambe
- Merck Biopharma Co., Ltd., Tokyo, Japan, an affiliate of Merck KGaA
| | - Masashi Sato
- Merck Biopharma Co., Ltd., Tokyo, Japan, an affiliate of Merck KGaA
| | - Yutaro Tanaka
- Merck Biopharma Co., Ltd., Tokyo, Japan, an affiliate of Merck KGaA
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Zhan S, Nguyen M, Hollsten J. Immune checkpoint inhibition therapy as first-line treatment for localized eyelid Merkel cell carcinoma in a nonsurgical candidate. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:e183-e184. [PMID: 38006902 DOI: 10.1016/j.jcjo.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/03/2023] [Accepted: 10/28/2023] [Indexed: 11/27/2023]
Affiliation(s)
- Senmiao Zhan
- University of Texas Health Science Center at San Antonio, San Antonio, TX.
| | - Michelle Nguyen
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Jordan Hollsten
- University of Texas Health Science Center at San Antonio, San Antonio, TX
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8
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Fojnica A, Ljuca K, Akhtar S, Gatalica Z, Vranic S. An Updated Review of the Biomarkers of Response to Immune Checkpoint Inhibitors in Merkel Cell Carcinoma: Merkel Cell Carcinoma and Immunotherapy. Cancers (Basel) 2023; 15:5084. [PMID: 37894451 PMCID: PMC10605355 DOI: 10.3390/cancers15205084] [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: 09/10/2023] [Revised: 10/08/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
Merkel cell carcinoma (MCC) is primarily a disease of the elderly Caucasian, with most cases occurring in individuals over 50. Immune checkpoint inhibitors (ICI) treatment has shown promising results in MCC patients. Although ~34% of MCC patients are expected to exhibit at least one of the predictive biomarkers (PD-L1, high tumor mutational burden/TMB-H/, and microsatellite instability), their clinical significance in MCC is not fully understood. PD-L1 expression has been variably described in MCC, but its predictive value has not been established yet. Our literature survey indicates conflicting results regarding the predictive value of TMB in ICI therapy for MCC. Avelumab therapy has shown promising results in Merkel cell polyomavirus (MCPyV)-negative MCC patients with TMB-H, while pembrolizumab therapy has shown better response in patients with low TMB. A study evaluating neoadjuvant nivolumab therapy found no significant difference in treatment response between the tumor etiologies and TMB levels. In addition to ICI therapy, other treatments that induce apoptosis, such as milademetan, have demonstrated positive responses in MCPyV-positive MCC, with few somatic mutations and wild-type TP53. This review summarizes current knowledge and discusses emerging and potentially predictive biomarkers for MCC therapy with ICI.
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Affiliation(s)
- Adnan Fojnica
- Institute of Virology, TUM School of Medicine, Technical University of Munich, 81675 Munich, Germany;
- Molecular Biology and Biochemistry, Gottfried Schatz Research Center, Medical University of Graz, 8036 Graz, Austria
| | - Kenana Ljuca
- Health Center of Sarajevo Canton, 71000 Sarajevo, Bosnia and Herzegovina;
| | - Saghir Akhtar
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha 2713, Qatar;
| | - Zoran Gatalica
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73019, USA;
- Reference Medicine, Phoenix, AZ 85040, USA
| | - Semir Vranic
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha 2713, Qatar;
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DeCoste RC, Carter MD, Ly TY, Gruchy JR, Nicolela AP, Pasternak S. Merkel cell carcinoma: an update. Hum Pathol 2023; 140:39-52. [PMID: 36898590 DOI: 10.1016/j.humpath.2023.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023]
Abstract
Merkel cell carcinoma (MCC) is an uncommon primary cutaneous neuroendocrine carcinoma associated with an adverse prognosis. In recent years, our understanding of MCC biology has markedly progressed. Since the discovery of the Merkel cell polyomavirus, it has become clear that MCC represents an ontogenetically dichotomous group of neoplasms with overlapping histopathology. Specifically, most MCCs arise secondary to viral oncogenesis, while a smaller subset is the direct result of UV-associated mutations. The distinction of these groups bears relevance in their immunohistochemical and molecular characterization, as well as in disease prognosis. Further recent developments relate to the landmark utilization of immunotherapeutics in MCC, providing optimistic options for the management of this aggressive disease. In this review, we discuss both fundamental and emerging concepts in MCC, with a particular focus on topics of practical relevance to the surgical or dermatopathologist.
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Affiliation(s)
- Ryan C DeCoste
- Department of Pathology and Laboratory Medicine, QEII Health Science Centre, Nova Scotia Health, Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada.
| | - Michael D Carter
- Department of Pathology and Laboratory Medicine, QEII Health Science Centre, Nova Scotia Health, Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada
| | - Thai Yen Ly
- Department of Pathology and Laboratory Medicine, QEII Health Science Centre, Nova Scotia Health, Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada
| | - Jennette R Gruchy
- Department of Pathology and Laboratory Medicine, QEII Health Science Centre, Nova Scotia Health, Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada
| | - Anna P Nicolela
- Department of Biomedical and Molecular Sciences, Queens University, Kingston, Ontario, K7L 3N6, Canada
| | - Sylvia Pasternak
- Department of Pathology and Laboratory Medicine, QEII Health Science Centre, Nova Scotia Health, Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada
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10
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Zhang L, Yu B, Liu Z, Wei J, Pan J, Jiang C, Li Z. Analysis of the Clinicopathological Characteristics, Prognosis, and Lymphocyte Infiltration of Esophageal Neuroendocrine Neoplasms: A Surgery-Based Cohort and Propensity-Score Matching Study. Cancers (Basel) 2023; 15:cancers15061732. [PMID: 36980618 PMCID: PMC10046526 DOI: 10.3390/cancers15061732] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/31/2023] [Accepted: 02/22/2023] [Indexed: 03/14/2023] Open
Abstract
Background: Esophageal neuroendocrine neoplasms (E-NENs) are a rare and poorly reported subtype of esophageal carcinoma. We analyzed the differences in clinicopathological features, prognosis, and tumor-infiltrating lymphocytes (TILs) between E-NENs and esophageal squamous cell carcinoma (ESCC). Methods: A total of 3620 patients who underwent esophagectomy were enrolled retrospectively. The study cohort was divided into two groups (E-NENs and ESCC) through propensity-score matching, and the prognosis and TILs were compared between the two groups. The TILs were assessed using tumor specimens (including six cases of ESCC, six cases of neuroendocrine carcinomas [NECs], and six cases of mixed neuroendocrine–non-neuroendocrine neoplasms [MiNENs]). Results: E-NENs accounted for 3.0% (107/3620) of cases, among which there were just 3 neuroendocrine tumor cases, 51 NEC cases, and 53 MiNENs cases. After matching, esophageal neuroendocrine carcinomas (E-NECs) showed both poorer 5-year overall survival (OS; 35.4% vs. 54.8%, p = 0.0019) and recurrence-free survival (RFS; 29.3% vs. 48.9%, p < 0.001) compared with ESCC. However, the differences were not prominent in the subgroup with stage I. No significant survival benefit was observed for E-NECs with multimodal therapy. Multivariate analysis demonstrated that E-NECs are an independent risk factor for OS and RFS. In the exploratory analysis, E-NECs were associated with less infiltration of immune cells compared with ESCC. Conclusion: E-NECs are significantly associated with a poorer prognosis than ESCC except for early-stage disease. The fewer TILs within the tumor microenvironment of E-NECs compared with ESCC results in weaker anti-tumor immunity and may lead to a poorer prognosis.
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Affiliation(s)
- Long Zhang
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Boyao Yu
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Zhichao Liu
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Jinzhi Wei
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Jie Pan
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Chao Jiang
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Zhigang Li
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
- Correspondence:
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11
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Okonkwo PC, Henning A, Plaza J, Agrawal A, Contreras CM. A rare tonsillar metastasis of Merkel cell carcinoma: A case report. Clin Case Rep 2023; 11:e7063. [PMID: 36950672 PMCID: PMC10025251 DOI: 10.1002/ccr3.7063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/02/2023] [Accepted: 02/20/2023] [Indexed: 03/22/2023] Open
Abstract
Merkel cell carcinoma (MCC) metastasis to the tonsil is extremely rare with five published cases. We report the case of a patient with palatine tonsillar MCC metastasis, who presented without oropharyngeal symptoms, which contrast prior reported cases.
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Affiliation(s)
| | - Ania Henning
- The Ohio State Wexner Medical CenterColumbusOhioUSA
| | - Jose Plaza
- The Ohio State Wexner Medical CenterColumbusOhioUSA
| | - Amit Agrawal
- The Ohio State Wexner Medical CenterColumbusOhioUSA
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12
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Rubatto M, Sciamarrelli N, Borriello S, Pala V, Mastorino L, Tonella L, Ribero S, Quaglino P. Classic and new strategies for the treatment of advanced melanoma and non-melanoma skin cancer. Front Med (Lausanne) 2023; 9:959289. [PMID: 36844955 PMCID: PMC9947410 DOI: 10.3389/fmed.2022.959289] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/23/2022] [Indexed: 02/11/2023] Open
Abstract
Advanced melanoma and non-melanoma skin cancers (NMSCs) are burdened with a dismal prognosis. To improve the survival of these patients, studies on immunotherapy and target therapies in melanoma and NMSCs are rapidly increasing. BRAF and MEK inhibitors improve clinical outcomes, and anti-PD1 therapy demonstrates better results than chemotherapy or anti-CTLA4 therapy in terms of the survival of patients with advanced melanoma. In recent years, the combination therapy of nivolumab plus ipilimumab has gained ground in studies for its survival and response rate benefits in patients with advanced melanoma. In addition, neoadjuvant treatment for stages III and IV melanoma, either as monotherapy or combination therapy, has recently been discussed. Another promising strategy evaluated in recent studies is the triple combination of anti-PD-1/PD-L1 immunotherapy and anti-BRAF plus anti-MEK targeted therapy. On the contrary, in advanced and metastatic BCC, successful therapeutic strategies, such as vismodegib and sonidegib, are based on the inhibition of aberrant activation of the Hedgehog signaling pathway. In these patients, anti-PD-1 therapy with cemiplimab should be reserved as the second-line therapy in case of disease progression or poor response. In patients with locally advanced or metastatic SCC, who are not candidates for surgery or radiotherapy, anti-PD1 agents such as cemiplimab, pembrolizumab, and cosibelimab (CK-301) have shown significant results in terms of response rate. PD-1/PD-L1 inhibitors, such as avelumab, have also been used in Merkel carcinoma, achieving responses in half of the patients with advanced disease. The latest prospect emerging for MCC is the locoregional approach involving the injection of drugs that can stimulate the immune system. Two of the most promising molecules used in combination with immunotherapy are cavrotolimod (a Toll-like receptor 9 agonist) and a Toll-like receptor 7/8 agonist. Another area of study is cellular immunotherapy with natural killer cells stimulated with an IL-15 analog or CD4/CD8 cells stimulated with tumor neoantigens. Neoadjuvant treatment with cemiplimab in CSCCs and nivolumab in MCCs has shown promising results. Despite the successes of these new drugs, the new challenges ahead will be to select patients who will benefit from these treatments based on biomarkers and parameters of the tumor microenvironment.
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Affiliation(s)
| | | | - Silvia Borriello
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Torino, Italy
| | - Valentina Pala
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Torino, Italy
| | - Luca Mastorino
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Torino, Italy
| | - Luca Tonella
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Torino, Italy
| | - Simone Ribero
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Torino, Italy
| | - Pietro Quaglino
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Torino, Italy
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Heredia-Torres TG, Rincón-Sánchez AR, Lozano-Sepúlveda SA, Galan-Huerta K, Arellanos-Soto D, García-Hernández M, Garza-Juarez ADJ, Rivas-Estilla AM. Unraveling the Molecular Mechanisms Involved in HCV-Induced Carcinogenesis. Viruses 2022; 14:v14122762. [PMID: 36560766 PMCID: PMC9786602 DOI: 10.3390/v14122762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Cancer induced by a viral infection is among the leading causes of cancer. Hepatitis C Virus (HCV) is a hepatotropic oncogenic positive-sense RNA virus that leads to chronic infection, exposing the liver to a continuous process of damage and regeneration and promoting hepatocarcinogenesis. The virus promotes the development of carcinogenesis through indirect and direct molecular mechanisms such as chronic inflammation, oxidative stress, steatosis, genetic alterations, epithelial-mesenchymal transition, proliferation, and apoptosis, among others. Recently, direct-acting antivirals (DAAs) showed sustained virologic response in 95% of cases. Nevertheless, patients treated with DAAs have reported an unexpected increase in the early incidence of Hepatocellular carcinoma (HCC). Studies suggest that HCV induces epigenetic regulation through non-coding RNAs, DNA methylation, and chromatin remodeling, which modify gene expressions and induce genomic instability related to HCC development that persists with the infection's clearance. The need for a better understanding of the molecular mechanisms associated with the development of carcinogenesis is evident. The aim of this review was to unravel the molecular pathways involved in the development of carcinogenesis before, during, and after the viral infection's resolution, and how these pathways were regulated by the virus, to find control points that can be used as potential therapeutic targets.
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Affiliation(s)
- Tania Guadalupe Heredia-Torres
- Department of Biochemistry and Molecular Medicine, CIIViM, School of Medicine, Universidad Autónoma de Nuevo León (UANL), Monterrey 64460, Mexico
| | - Ana Rosa Rincón-Sánchez
- IBMMTG, Departamento de Biología Molecular y Genómica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44100, Mexico
| | - Sonia Amelia Lozano-Sepúlveda
- Department of Biochemistry and Molecular Medicine, CIIViM, School of Medicine, Universidad Autónoma de Nuevo León (UANL), Monterrey 64460, Mexico
| | - Kame Galan-Huerta
- Department of Biochemistry and Molecular Medicine, CIIViM, School of Medicine, Universidad Autónoma de Nuevo León (UANL), Monterrey 64460, Mexico
| | - Daniel Arellanos-Soto
- Department of Biochemistry and Molecular Medicine, CIIViM, School of Medicine, Universidad Autónoma de Nuevo León (UANL), Monterrey 64460, Mexico
| | - Marisela García-Hernández
- Department of Biochemistry and Molecular Medicine, CIIViM, School of Medicine, Universidad Autónoma de Nuevo León (UANL), Monterrey 64460, Mexico
| | - Aurora de Jesús Garza-Juarez
- Department of Biochemistry and Molecular Medicine, CIIViM, School of Medicine, Universidad Autónoma de Nuevo León (UANL), Monterrey 64460, Mexico
| | - Ana María Rivas-Estilla
- Department of Biochemistry and Molecular Medicine, CIIViM, School of Medicine, Universidad Autónoma de Nuevo León (UANL), Monterrey 64460, Mexico
- Correspondence: ; Tel.: +52-81-8333-7747
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14
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Gruchy JR, Pasternak S, Ly TY, DeCoste RC, Fleming KE, Moss PM, Carter MD, Walsh NM. Morphological patterns of metastases from combined Merkel cell carcinomas: study of an eastern Canadian cohort of cases. Hum Pathol 2022; 129:47-55. [PMID: 35944612 DOI: 10.1016/j.humpath.2022.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/25/2022] [Indexed: 12/14/2022]
Abstract
Combined Merkel cell carcinomas are hybrid tumors composed of neuroendocrine and other phenotypic (usually squamous) elements. They form a minority of Merkel cell carcinomas (MCCs) as a whole, are usually Merkel cell polyomavirus-negative, and have rarely been segregated for specific study. Sporadic reports have indicated that metastases from these tumors can show a combined phenotype. We retrospectively studied 38 cases (24 men [63%], 14 women [37%], mean age 78 years [range, 46-99 years]) of combined MCC. Metastases occurred in 20 patients (53%) (at presentation and/or in follow-up [mean 38 months (range, 0.6-185 months)]). Those from 17 individuals (45%) were examined microscopically. These were mainly nodal in distribution. In 12 patients (71%), the secondary deposits were of pure neuroendocrine type, whereas in 5 (29%), combined deposits were identified. Squamous elements were the most common divergent component, in the primary and secondary tumors. The combined metastases varied from obvious squamous nests in a neuroendocrine background to scattered bizarre tumor giant cells expressing CK5/6 on immunohistochemistry. In one case, individual nodes within a single basin displayed purely squamous or purely neuroendocrine deposits. The mean overall survival in the cohort was 48 months (range, 30-67 months) and the mortality was 82%. Our work sheds light on the frequency and patterns of metastases in combined MCCs. In concert with the poor outcome data documented by others, it also raises a question as to the potential prognostic significance of a combined phenotype per se, independent of a virus-negative status and other variables. This issue deserves further study.
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Affiliation(s)
- Jennette R Gruchy
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada.
| | - Sylvia Pasternak
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada; Department of Medicine, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada
| | - Thai Yen Ly
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada
| | - Ryan C DeCoste
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada
| | - Kirsten E Fleming
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Nanaimo Regional General Hospital, 1200 Dufferin Crescent, Nanaimo, British Columbia, V9S 2B7, Canada
| | - Phillip M Moss
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada
| | - Michael D Carter
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada
| | - Noreen M Walsh
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada; Department of Medicine, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada
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15
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Bhatia S, Nghiem P, Veeranki SP, Vanegas A, Lachance K, Tachiki L, Chiu K, Boller E, Bharmal M. Real-world clinical outcomes with avelumab in patients with Merkel cell carcinoma treated in the USA: a multicenter chart review study. J Immunother Cancer 2022; 10:jitc-2022-004904. [PMID: 35981787 PMCID: PMC9394192 DOI: 10.1136/jitc-2022-004904] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/24/2022] Open
Abstract
Background Merkel cell carcinoma (MCC) is a rare, aggressive, cutaneous neuroendocrine neoplasm with annual incidence rates of 0.13–1.6 cases/100,000/year worldwide as of 2018. Chemotherapy for metastatic MCC (mMCC) has high objective response rates (ORRs), but responses are not durable and overall survival (OS) is poor. Avelumab (anti-programmed death-ligand 1) has demonstrated meaningful survival benefit and durable responses in clinical trials for mMCC. This study investigated real-world clinical outcomes in avelumab-treated patients with advanced (stage IIIB/IV) MCC in US academic medical centers. Methods We conducted a retrospective chart review of patients with advanced MCC who initiated avelumab between March 1, 2017, and July 31, 2019, at six US academic centers. Data were requested for eligible patients from index date through December 31, 2020. Descriptive analyses were conducted to assess demographic and clinical characteristics, real-world ORR (rwORR), real-world duration of response, real-world progression-free survival (rwPFS), and OS. Results Ninety patients with advanced MCC (82%, stage IV; 18%, stage IIIB) received avelumab. Median follow-up was 20.8 months (95% CI: 19.1 to 24.2). Median age was 68 years (range, 48–83), and the majority of patients were men (58%) and white (93%). The primary tumor was most commonly located on the lower limb (38%), with metastases mostly located in lymph nodes (68%), lung (52%), and viscera (52%). Approximately 42% and 26% of patients had an Eastern Cooperative Oncology Group performance status of 2 and 3, respectively. Seventy-three patients (81%) received avelumab as first-line treatment of advanced MCC, while 17 (19%) received avelumab as second-line or later treatment. The median duration of avelumab treatment was 13.5 months (95% CI: 6.4 to 30.6), with 42% of patients still receiving avelumab by the end of follow-up. Patients with avelumab treatment had an rwORR of 73% (95% CI: 64 to 83), median rwPFS of 24.4 months (95% CI: 8.31 to not estimable (NE)), and median OS of 30.7 months (95% CI: 11.2 to NE). Conclusions This real-world study of patients with advanced MCC demonstrated that avelumab treatment resulted in a high response rate with durable responses and prolonged survival. The study findings validate the results demonstrated in prospective clinical trials and other observational studies.
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Affiliation(s)
- Shailender Bhatia
- Division of Medical Oncology, University of Washington, Seattle, Washington, USA .,Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Paul Nghiem
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,UW Medical Center at Lake Union, Seattle, Washington, USA
| | | | | | - Kristina Lachance
- Division of Medical Oncology, University of Washington, Seattle, Washington, USA
| | - Lisa Tachiki
- Division of Medical Oncology, University of Washington, Seattle, Washington, USA.,Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Kevin Chiu
- PRECISIONheor, Los Angeles, California, USA
| | | | - Murtuza Bharmal
- EMD Serono Research & Development Institute, Inc, Billerica, Massachusetts, USA, an affiliate of Merck KGaA
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Spada F, Bossi P, Caracò C, Sileni VC, Dei Tos AP, Fazio N, Grignani G, Maio M, Quaglino P, Queirolo P, Ascierto PA. Nationwide multidisciplinary consensus on the clinical management of Merkel cell carcinoma: a Delphi panel. J Immunother Cancer 2022; 10:jitc-2022-004742. [PMID: 35701070 PMCID: PMC9198700 DOI: 10.1136/jitc-2022-004742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/04/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare and highly aggressive cutaneous neuroendocrine carcinoma. The MCC incidence rate has rapidly grown over the last years, with Italy showing the highest increase among European countries. This malignancy has been the focus of active scientific research over the last years, focusing mainly on pathogenesis, new therapeutic trials and diagnosis. A national expert board developed 28 consensus statements that delineated the evolution of disease management and highlighted the paradigm shift towards the use of immunological strategies, which were then presented to a national MCC specialists panel for review. Sixty-five panelists answered both rounds of the questionnaire. The statements were divided into five areas: a high level of agreement was reached in the area of guidelines and multidisciplinary management, even if in real life the multidisciplinary team was not always represented by all the specialists. In the diagnostic pathway area, imaging played a crucial role in diagnosis and initial staging, planning for surgery or radiation therapy, assessment of treatment response and surveillance of recurrence and metastases. Concerning diagnosis, the usefulness of Merkel cell polyomavirus is recognized, but the agreement and consensus regarding the need for cytokeratin evaluation appears greater. Regarding the areas of clinical management and follow-up, patients with MCC require customized treatment. There was a wide dispersion of results and the suggestion to increase awareness about the adjuvant radiation therapy. The panelists unanimously agreed that the information concerning avelumab provided by the JAVELIN Merkel 200 study is adequate and reliable and that the expanded access program data could have concrete clinical implications. An immunocompromised patient with advanced MCC can be treated with immunotherapy after multidisciplinary risk/benefit assessment, as evidenced by real-world analysis and highlighted in the guidelines. A very high consensus regarding the addition of radiotherapy to treat the ongoing focal progression of immunotherapy was observed. This paper emphasizes the importance of collaboration and communication among the interprofessional team members and encourages managing patients with MCC within dedicated multidisciplinary teams. New insights in the treatment of this challenging cancer needs the contribution of many and different experts.
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Affiliation(s)
- Francesca Spada
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO) IRCCS, Milano, Italy
| | - Paolo Bossi
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health-Medical Oncology, University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - Corrado Caracò
- Melanoma and Skin Cancers Surgery Unit, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Napoli, Italy
| | | | | | - Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO) IRCCS, Milano, Italy
| | - Giovanni Grignani
- Division of Medical Oncology, Candiolo Cancer Institute FPO IRCCS, Candiolo, Italy
| | - Michele Maio
- Center for Immuno-Oncology, Department of Oncology, University Hospital of Siena, Siena, Italy
| | - Pietro Quaglino
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Torino, Italy
| | - Paola Queirolo
- Melanoma and Sarcoma Medical Treatment, European Institute of Oncology (IEO), Milano, Italy
| | - Paolo Antonio Ascierto
- Melanoma Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione "G.Pascale", Napoli, Italy
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Immune Checkpoint Inhibitors-Associated Cardiotoxicity. Cancers (Basel) 2022; 14:cancers14051145. [PMID: 35267453 PMCID: PMC8909315 DOI: 10.3390/cancers14051145] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/17/2022] [Accepted: 02/19/2022] [Indexed: 12/19/2022] Open
Abstract
Large population-based studies examining differences in ICI-associated cardiotoxicity across cancer types and agents are limited. Data of 5518 cancer patients who received at least one cycle of ICIs were extracted from a large network of health care organizations. ICI treatment groups were classified by the first ICI agent(s) (ipilimumab, nivolumab, pembrolizumab, cemiplimab, avelumab, atezolizumab, or durvalumab) or its class (PD-1 inhibitors, PD-L1 inhibitors, CTLA4-inhibitors, or their combination (ipilimumab + nivolumab)). Time to first cardiac adverse event (CAE) (arrhythmia, acute myocardial infarction, myocarditis, cardiomyopathy, or pericarditis) developed within one year after ICI initiation was analyzed using a competing-risks regression model adjusting for ICI treatment groups, patient demographic and clinical characteristics, and cancer sites. By month 12, 12.5% developed cardiotoxicity. The most common cardiotoxicity was arrhythmia (9.3%) and 2.1% developed myocarditis. After adjusting for patient characteristics and cancer sites, patients who initiated on monotherapy with ipilimumab (adjusted Hazard Ratio (aHR): 2.00; 95% CI: 1.49−2.70; p < 0.001) or pembrolizumab (aHR: 1.21; 95% CI: 1.01−1.46; p = 0.040) had a higher risk of developing CAEs within one year compared to nivolumab monotherapy. Ipilimumab and pembrolizumab use may increase the risk of cardiotoxicity compared to other agents. Avelumab also estimated a highly elevated risk (aHR: 1.92; 95% CI: 0.85−4.34; p = 0.117) compared to nivolumab and other PD-L1 agents, although the estimate did not reach statistical significance, warranting future studies.
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18
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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.
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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
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19
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Soler-Sempere MJ, Alvárez-Fernández MO, Padilla-Navas I, Cabezas-Macián M, Sánchez-Hernández JF, García-Pachón E. Merkel cell carcinoma with pleural effusion. Arch Bronconeumol 2021; 57:715-717. [PMID: 35699019 DOI: 10.1016/j.arbr.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/22/2021] [Indexed: 06/15/2023]
Affiliation(s)
- María J Soler-Sempere
- Sección de Neumología, Hospital General Universitario de Elche, Elche, Alicante, Spain.
| | | | - Isabel Padilla-Navas
- Sección de Neumología, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - María Cabezas-Macián
- Sección de Anatomía Patológica, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | | | - Eduardo García-Pachón
- Sección de Neumología, Hospital General Universitario de Elche, Elche, Alicante, Spain
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20
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Albertelli M, Dotto A, Nista F, Veresani A, Patti L, Gay S, Sciallero S, Boschetti M, Ferone D. "Present and future of immunotherapy in Neuroendocrine Tumors". Rev Endocr Metab Disord 2021; 22:615-636. [PMID: 33851319 PMCID: PMC8346388 DOI: 10.1007/s11154-021-09647-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 12/13/2022]
Abstract
Immunotherapy, so promising in many neoplasms, still does not have a precise role in the treatment of neuroendocrine neoplasms (NENs). In this article, we provide an overview on the current knowledge about immunotherapy with immune checkpoint inhibitors (ICIs) applied to NENs, evaluating future perspectives in this setting of tumors.Evidence so far available for ICIs in gastroenteropancreatic (GEP)-NENs is definitively not as robust as for other tumors such as Small Cell Lung Cancer or Merkel Cell Carcinoma. In fact, with regard to the well-differentiated forms of NENs (NETs), the results obtained nowadays have been disappointing. However, the near future, might reserve interesting results for ICIs in GEP-NEN from a total of nine different ICI drugs, used throughout 19 randomised controlled trials. Such numbers highlight the growing attention gathering around NENs and ICIs, in response to the need of stronger evidences supporting such therapy.For the future, the most important aspect will be to study strategies that can make NETs more susceptible to response to ICI and, thus, enhance the effectiveness of these treatments. Therefore, the combination of conventional therapy, target therapy and immunotherapy deserve attention and warrant to be explored. A sequential chemotherapy, possibly inducing an increase in tumor mutational burden and tested before immunotherapy, could be a hypothesis deserving more consideration. A radiation treatment that increases tumor-infiltrating lymphocytes, could be another approach to explore before ICIs in NENs. Equally essential will be the identification of biomarkers useful for selecting patients potentially responsive to this type of treatment.
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Affiliation(s)
- Manuela Albertelli
- Endocrinology Unit, IRCCS AOU San Martino, Genoa, Italy.
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy.
| | - Andrea Dotto
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Federica Nista
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Alessandro Veresani
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Luca Patti
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Stefano Gay
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | | | - Mara Boschetti
- Endocrinology Unit, IRCCS AOU San Martino, Genoa, Italy
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Diego Ferone
- Endocrinology Unit, IRCCS AOU San Martino, Genoa, Italy
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
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21
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Garza-Davila VF, Valdespino-Valdes J, Barrera FJ, Ocampo-Candiani J, Garza-Rodríguez V. Clinical impact of immunotherapy in Merkel cell carcinoma patients: A systematic review and meta-analysis. J Am Acad Dermatol 2021; 87:121-130. [PMID: 33887421 DOI: 10.1016/j.jaad.2021.04.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 03/26/2021] [Accepted: 04/03/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Immunotherapy is emerging as an alternative treatment for Merkel cell carcinoma, but its long-term effects on response, survival, and safety are not well established. High-quality evidence is needed to estimate the efficacy of this treatment and to review the characteristics of patients and tumors that might improve outcomes. OBJECTIVE To summarize efficacy and safety of immunotherapy in patients with Merkel cell carcinoma. METHODS A systematic review was performed for studies published in MEDLINE, Web of Science, Scopus, and EMBASE. Two reviewers examined the literature and data extraction in duplicate. We estimated the proportions for objective responses, progression-free survival, overall survival, and treatment-related adverse events. Associations between objective response rate and immunobiologic markers were analyzed. RESULTS Six clinical trials of 201 patients treated with immunotherapy were included. The objective response rate was 51% (95% confidence interval, 0.40-0.62; I2 = 37.1%) and grade ≥3 treatment-related adverse events were observed in 18% (95% confidence interval, 0.11-0.29; I2 = 49.5%) of patients. No significant difference was observed between response rates and immunobiologic characteristics. CONCLUSIONS A significantly reduced tumor diameter with durable response rates and a safe profile are obtained with immunotherapy. Similar response rates achieved on either subgroup of viral status or programmed death ligand 1 expression suggests that it might act on multiple, unexplored pathways.
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Affiliation(s)
- Valeria F Garza-Davila
- Department of Dermatology, University Hospital "Dr. José Eleuterio González" Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Jorge Valdespino-Valdes
- Department of Dermatology, University Hospital "Dr. José Eleuterio González" Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Francisco J Barrera
- Plataforma INVEST UANL-KER Unit Mayo Clinic (KER Unit Mexico), School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, México
| | - Jorge Ocampo-Candiani
- Department of Dermatology, University Hospital "Dr. José Eleuterio González" Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Veronica Garza-Rodríguez
- Department of Dermatology, University Hospital "Dr. José Eleuterio González" Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México.
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22
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Emanuele Liardo RL, Borzì AM, Spatola C, Martino B, Privitera G, Basile F, Biondi A, Vacante M. Effects of infections on the pathogenesis of cancer. Indian J Med Res 2021; 153:431-445. [PMID: 34380789 PMCID: PMC8354054 DOI: 10.4103/ijmr.ijmr_339_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Several studies have shown an inverse relationship between acute infections and cancer development. On the other hand, there is a growing evidence that chronic infections may contribute significantly to the carcinogenesis. Factors responsible for increased susceptibility to infections may include modifications of normal defence mechanisms or impairment of host immunity due to altered immune function, genetic polymorphisms, ageing and malnourishment. Studies have demonstrated that children exposed to febrile infectious diseases show a subsequent reduced risk for ovarian cancer, melanoma and many other cancers, while common acute infections in adults are associated with reduced risks for melanoma, glioma, meningioma and multiple cancers. Chronic inflammation associated with certain infectious diseases has been suggested as a cause for the development of tumours. Mechanisms of carcinogenesis due to infections include cell proliferation and DNA replication by mitogen-activated protein kinase pathway, production of toxins that affect the cell cycle and lead to abnormal cell growth and inhibition of apoptosis. This review was aimed to summarize the available evidence on acute infections as a means of cancer prevention and on the role of chronic infections in the development and progression of cancer.
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Affiliation(s)
- Rocco Luca Emanuele Liardo
- Radiodiagnostic & Oncological Radiotherapy Unit, University of Catania, ‘Policlinico G. Rodolico – San Marco’ Catania, Italy
| | - Antonio Maria Borzì
- Department of General Surgery & Medical-Surgical Specialties, University of Catania, ‘Policlinico G. Rodolico – San Marco‘ Catania, Italy
| | - Corrado Spatola
- Radiodiagnostic & Oncological Radiotherapy Unit, University of Catania, ‘Policlinico G. Rodolico – San Marco’ Catania, Italy
| | - Barbara Martino
- Department of General Surgery & Medical-Surgical Specialties, University of Catania, ‘Policlinico G. Rodolico – San Marco‘ Catania, Italy
| | - Giuseppe Privitera
- Radiodiagnostic & Oncological Radiotherapy Unit, University of Catania, ‘Policlinico G. Rodolico – San Marco’ Catania, Italy
| | - Francesco Basile
- Department of General Surgery & Medical-Surgical Specialties, University of Catania, ‘Policlinico G. Rodolico – San Marco‘ Catania, Italy
| | - Antonio Biondi
- Department of General Surgery & Medical-Surgical Specialties, University of Catania, ‘Policlinico G. Rodolico – San Marco‘ Catania, Italy
| | - Marco Vacante
- Department of General Surgery & Medical-Surgical Specialties, University of Catania, ‘Policlinico G. Rodolico – San Marco‘ Catania, Italy
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23
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Soler-Sempere MJ, Alvárez-Fernández MO, Padilla-Navas I, Cabezas-Macián M, Sánchez-Hernández JF, García-Pachón E. Merkel Cell Carcinoma with Pleural Effusion. Arch Bronconeumol 2021; 57:S0300-2896(21)00074-0. [PMID: 33773839 DOI: 10.1016/j.arbres.2021.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 11/18/2022]
Affiliation(s)
- María J Soler-Sempere
- Sección de Neumología, Hospital General Universitario de Elche, Elche, Alicante, España.
| | | | - Isabel Padilla-Navas
- Sección de Neumología, Hospital General Universitario de Elche, Elche, Alicante, España
| | - María Cabezas-Macián
- Sección de Anatomía Patológica, Hospital General Universitario de Elche, Elche, Alicante, España
| | | | - Eduardo García-Pachón
- Sección de Neumología, Hospital General Universitario de Elche, Elche, Alicante, España
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24
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Walsh N. Merkel cell carcinoma of the eyelid and periocular region: A review. Saudi J Ophthalmol 2021; 35:186-192. [PMID: 35601863 PMCID: PMC9116095 DOI: 10.4103/sjopt.sjopt_55_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 03/17/2021] [Accepted: 04/22/2021] [Indexed: 11/08/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare primary cutaneous neuroendocrine carcinoma with a high mortality rate. It typically affects elderly Caucasians, with a slight predilection for males. It is associated with chronic sun exposure and/or immunosuppression. Almost half of all cases occur on the head or neck and an estimated 2.5%–10% arise on the eyelids or periocular skin. It ranks as the 5th most common malignant tumor at these sites, preceded in frequency by basal cell, squamous cell and sebaceous carcinoma, as well as melanoma. Its clinical presentation as a violaceous nodule/plaque lacks specificity, and it can be mistaken for cysts, chalazia or basal cell carcinomas. Sub-specialized histopathological and immunohistochemical evaluations are required for diagnosis. Clinical staging defines the extent of disease and governs management. This includes surgery and adjuvant radiotherapy for localized tumors and of late, immunotherapy for metastatic disease. Significant advances in our understanding of the dual etiopathogenesis (Merkel cell polyomavirus- and Ultraviolet radiation-induced) and the biology of the neoplasm have been achieved in recent years. Issuing from the tumor's known susceptibility to host immunity, a recent therapeutic breakthrough has occurred whereby immune checkpoint inhibition has been shown to mitigate advanced disease. These factors and the increased global incidence of the tumor have brought it to the forefront of medical attention. This review provides a clinically relevant update on MCC, with special reference to cases arising on the eyelid/periocular region.
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25
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Walsh NM, Cerroni L. Merkel cell carcinoma: A review. J Cutan Pathol 2020; 48:411-421. [PMID: 33128463 DOI: 10.1111/cup.13910] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/16/2020] [Accepted: 10/25/2020] [Indexed: 12/17/2022]
Abstract
Merkel cell carcinoma has been a focus of active scientific investigation in recent years and new information on the topic has emerged. Although uncommon, this primary cutaneous neuroendocrine carcinoma, usually involving the head/neck of elderly individuals, has a poor prognosis. Within the past two decades, an increase in the incidence of the tumor and the discovery of its link to the Merkel cell polyomavirus have focused medical attention on the lesion. The resulting studies have improved our understanding of the biology of the neoplasm and contributed to clinical care. Specifically, two pathogenic subsets of the tumor have come to light, the majority due to Merkel cell polyomavirus and the minority caused by ultraviolet radiation-induced genetic damage. This dichotomy carries prognostic implications favoring the former subset. In addition, having capitalized on the known susceptibility of the tumor to immune influences, investigators have recently discovered its responsiveness to immune checkpoint inhibition. This revelation has constituted a therapeutic milestone at the clinical level. Herein we provide an overview of the topic, outline updates in the field and place an emphasis on dermatopathologic aspects of Merkel cell carcinoma.
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Affiliation(s)
- Noreen M Walsh
- Department of Pathology, Queen Elizabeth II Health Sciences Center, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, Canada.,Departments of Pathology and Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lorenzo Cerroni
- Research Unit of Dermatopathology, Department of Dermatology, Medical University of Graz, Graz, Austria
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26
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Structure of Merkel Cell Polyomavirus Capsid and Interaction with Its Glycosaminoglycan Attachment Receptor. J Virol 2020; 94:JVI.01664-19. [PMID: 32699083 PMCID: PMC7527053 DOI: 10.1128/jvi.01664-19] [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: 10/08/2019] [Accepted: 07/07/2020] [Indexed: 11/20/2022] Open
Abstract
The MCPyV genome was found to be clonally integrated in 80% of cases of Merkel cell carcinoma (MCC), a rare but aggressive form of human skin cancer, strongly suggesting that this virus is tumorigenic. In the metastasizing state, the course of the disease is often fatal, especially in immunocompromised individuals, as reflected by the high mortality rate of 33 to 46% and the low 5-year survival rate (<45%). The high seroprevalence of about 60% makes MCPyV a serious health care burden and illustrates the need for targeted treatments. In this study, we present the first high-resolution structural data for this human tumor virus and demonstrate that the full capsid is required for the essential interaction with its GAG receptor(s). Together, these data can be used as a basis for future strategies in drug development. Merkel cell polyomavirus (MCPyV) is a human double-stranded DNA tumor virus. MCPyV cell entry is unique among members of the polyomavirus family as it requires the engagement of two types of glycans, sialylated oligosaccharides and sulfated glycosaminoglycans (GAGs). Here, we present crystallographic and cryo-electron microscopic structures of the icosahedral MCPyV capsid and analysis of its glycan interactions via nuclear magnetic resonance (NMR) spectroscopy. While sialic acid binding is specific for α2-3-linked sialic acid and mediated by the exposed apical loops of the major capsid protein VP1, a broad range of GAG oligosaccharides bind to recessed regions between VP1 capsomers. Individual VP1 capsomers are tethered to one another by an extensive disulfide network that differs in architecture from previously described interactions for other PyVs. An unusual C-terminal extension in MCPyV VP1 projects from the recessed capsid regions. Mutagenesis experiments show that this extension is dispensable for receptor interactions. IMPORTANCE The MCPyV genome was found to be clonally integrated in 80% of cases of Merkel cell carcinoma (MCC), a rare but aggressive form of human skin cancer, strongly suggesting that this virus is tumorigenic. In the metastasizing state, the course of the disease is often fatal, especially in immunocompromised individuals, as reflected by the high mortality rate of 33 to 46% and the low 5-year survival rate (<45%). The high seroprevalence of about 60% makes MCPyV a serious health care burden and illustrates the need for targeted treatments. In this study, we present the first high-resolution structural data for this human tumor virus and demonstrate that the full capsid is required for the essential interaction with its GAG receptor(s). Together, these data can be used as a basis for future strategies in drug development.
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27
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Primary Merkel Cell Carcinoma: A Retrospective Analysis of 31 Cases in Poland. Dermatol Ther (Heidelb) 2020; 10:1003-1012. [PMID: 32654000 PMCID: PMC7477030 DOI: 10.1007/s13555-020-00424-5] [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: 06/07/2020] [Indexed: 11/08/2022] Open
Abstract
Introduction Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous neuroendocrine cancer that typically arises in sun-exposed areas of the skin, especially in the elderly. Significant advances have recently been made regarding skin cancers, but data on cases of MCC are rather limited as these patients are frequently grouped together with other non-melanoma skin cancers (NMSC). Here, we performed an analysis of the clinical profile of patients with MCC in Poland to identify major factors influencing the prognosis. Methods Approximately 13,000 pathology and medical records were examined to identify patients with MCC diagnosed between 2010 and 2019. The management and outcomes of patients with histologically confirmed MCC were retrospectively evaluated. Results Thirty-one patients diagnosed with MCC were identified. The tumor occurred predominantly in women (61.3%) and in the elderly (mean 75.6 years). Twenty-nine patients had locoregional MCC and two had metastatic MCC at the time of diagnosis. Patients in stage I disease had excellent prognosis. In stages II and III, respectively 22.2% and 50.0% of patients developed metastases. Among patients who received chemotherapy with cisplatin and etoposide, 17% achieved partial remission with progression-free survival (PFS) of 8.0 months, and a further 50% achieved stable disease with PFS of 4.0, 4.5, and 4.5 months respectively. In 6 (19.4%) patients MCC coexisted with chronic lymphocytic leukemia (CLL). In all six cases CLL preceded MCC development. Conclusions Female gender, tumor-free resection margins, and local disease were found to be independent prognostic factors in MCC progression. Patients with hematological malignancies, immunosuppression, and those with immune deficiencies should be closely followed up as they are predisposed to develop MCC. Electronic supplementary material The online version of this article (10.1007/s13555-020-00424-5) contains supplementary material, which is available to authorized users.
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28
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Foci of Programmed Cell Death-Ligand 1 (PD-L1)-positive Tumor Areas With Tumor-infiltrating Leukocytes (TILs) Evocative of a PD-1/PD-L1-related Adaptive Immune Resistance are Frequent in Merkel Cell Carcinoma. Appl Immunohistochem Mol Morphol 2020; 28:17-22. [DOI: 10.1097/pai.0000000000000792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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29
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Mulchan N, Cayton A, Asarian A, Xiao P. Merkel cell carcinoma: a case report and literature review. J Surg Case Rep 2019; 2019:rjz322. [PMID: 31768244 PMCID: PMC6865343 DOI: 10.1093/jscr/rjz322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/21/2019] [Accepted: 10/07/2019] [Indexed: 12/18/2022] Open
Abstract
Merkel cell carcinoma (MCC) is an aggressive cutaneous malignancy of neuroendocrine origin presenting as a painless, rapidly growing nodule. MCC often presents in elderly, fair-skinned individuals in sun-exposed areas. Diagnosis is often overlooked at time of presentation due to its rarity, but MCC is twice as deadly as malignant melanoma. There has been bigger interest in the disease due to increasing incidence and an association with the prevalent virus Merkel cell polyomavirus. This study describes an uncommon presentation of MCC as a right gluteal lesion in an Afro-Panamanian patient. The tumor was suspected to be fibrolipoma, but Immunohistochemistry revealed the diagnosis of MCC, as stains for CD56 and CK20 were positive. In addition to surgical excision, the patient was referred for adjuvant radiotherapy. This case report and literature review elucidates the clinical, histopathologic and management aspects of MCC, which will help in recognizing and treating these tumors.
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Affiliation(s)
- Nicholas Mulchan
- St George's University School of Medicine, True Blue, Grenada, WI, USA
| | - Alberto Cayton
- Department of Surgery, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY 11201, USA
| | - Armand Asarian
- Department of Surgery, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY 11201, USA
| | - Philip Xiao
- Department of Pathology, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY 11201, USA
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30
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Bullement A, Nathan P, Willis A, Amin A, Lilley C, Stapelkamp C, Hatswell A, Pescott C, Bharmal M. Cost Effectiveness of Avelumab for Metastatic Merkel Cell Carcinoma. PHARMACOECONOMICS - OPEN 2019; 3:377-390. [PMID: 30680676 PMCID: PMC6710317 DOI: 10.1007/s41669-018-0115-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Metastatic Merkel cell carcinoma (mMCC) is a rare and aggressive skin cancer. Until recently, there were no licensed treatment options for patients with mMCC, and prognosis was poor. A cost-effectiveness analysis was conducted for avelumab, a newly available treatment option for mMCC, versus standard care (SC), from a UK National Health Service perspective. METHODS A partitioned survival model was developed to assess the lifetime costs and effects of avelumab versus SC. Data from the JAVELIN Merkel 200 trial (NCT02155647) were used to inform estimates of quality-adjusted life-years (QALYs). Unit costs and associated frequencies of use were informed by published literature and clinical expert opinion. Results were presented as incremental cost-effectiveness ratios (ICERs, i.e. the cost per QALY gained) for treatment-experienced (TE) and treatment-naïve (TN) patients. Uncertainty was explored through a range of sensitivity analyses. RESULTS Discounting costs and QALYs at 3.5% per annum, avelumab was associated with ICERs of £35,274 (TE)/£39,178 (TN) per QALY gained. Probabilistic sensitivity analysis results demonstrated that avelumab was associated with an 88.3% (TE)/69.3% (TN) probability of being cost effective at a willingness-to-pay threshold for end-of-life treatments of £50,000 per QALY gained. Results were most sensitive to alternative survival extrapolations and dosing assumptions. CONCLUSIONS The analysis results suggest that avelumab is likely to be a cost-effective treatment option for UK mMCC patients. The results for TN patients are subject to some uncertainty, and a confirmatory analysis will be conducted with more mature data.
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Affiliation(s)
| | | | | | | | | | | | - Anthony Hatswell
- Delta Hat, Nottingham, UK
- Department of Statistical Science, University College London, London, UK
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31
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Bassas Freixas P, Aparicio Español G, García-Patos Briones V. Immunotherapy in Nonmelanoma Skin Cancer. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2019.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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32
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Inmunoterapia en cáncer cutáneo no melanoma. ACTAS DERMO-SIFILIOGRAFICAS 2019; 110:353-359. [DOI: 10.1016/j.ad.2018.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/01/2018] [Accepted: 09/03/2018] [Indexed: 12/14/2022] Open
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33
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Cavalieri S, Perrone F, Milione M, Bianco A, Alfieri S, Locati LD, Bergamini C, Resteghini C, Galbiati D, Platini F, Licitra L, Bossi P. PD-L1 Expression in Unresectable Locally Advanced or Metastatic Skin Squamous Cell Carcinoma Treated with Anti-Epidermal Growth Factor Receptor Agents. Oncology 2019; 97:112-118. [PMID: 31112973 DOI: 10.1159/000500246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 03/27/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recurrent or metastatic (R/M) skin squamous cell carcinoma (sSCC) not amenable of surgery or irradiation may benefit from systemic therapies. Epidermal growth factor receptor (EGFR) inhibitors and, more recently, immune checkpoint blockers (ICBs) showed activity in R/M sSCC. In this study, we aimed at exploring the possible role of PD-L1 expression in predicting response to anti-EGFR agents. METHODS Patients affected by R/M sSCC, treated with pan-HER inhibitor dacomitinib or with platinum-based chemotherapy with cetuximab (CT-cet) from 2010 to 2016, were considered. PD-L1 expression was assessed with immunohistochemistry on tumor cells (TCs) and on microenvironment (TC and tumor-infiltrating lymphocyte [IC] scores, respectively). Prognostic role of PD-L1 and the correlation with response to EGFR inhibitors and survival were analyzed. RESULTS Twenty-eight R/M sSCCs were analyzed (19 treated with dacomitinib, 9 with CT-cet). TC and IC were negative in 82 and 45% of cases, respectively; 15% sSCCs were both TC and IC positive. Progression-free survival (PFS) was longer in IC-positive cases (median 7.5 months vs. 2.1 in IC0, p = 0.02). No statistically significant differences were observed between PD-L1 expression and both overall survival and response rates. CONCLUSION PD-L1 expression in microenvironment predicted better PFS. The combination of EGFR inhibitors and ICB could help deepening the knowledge about the interrelations between the EGFR and PD-1/PD-L1 pathways.
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Affiliation(s)
- Stefano Cavalieri
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Federica Perrone
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Massimo Milione
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Alba Bianco
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Salvatore Alfieri
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Laura D Locati
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Cristiana Bergamini
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Carlo Resteghini
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Donata Galbiati
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Francesca Platini
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Lisa Licitra
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.,University of Milan, Milan, Italy
| | - Paolo Bossi
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy,
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Vaiciunaite D, Beddell G, Ivanov N. Merkel cell carcinoma: an aggressive cutaneous carcinoma with rare metastasis to the thyroid gland. BMJ Case Rep 2019; 12:12/4/e228273. [PMID: 31015241 DOI: 10.1136/bcr-2018-228273] [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: 11/04/2022] Open
Abstract
Merkel cell carcinoma (MCC) is an aggressive and rare neuroendocrine cutaneous carcinoma with poor prognosis and with increasing morbidity and mortality in cases of distant metastasis. Given the rarity of MCC, optimal treatment is not well established. Treatment usually consists of multidisciplinary management with local excision of the primary tumour. Imaging studies are essential for accurate staging and monitoring of disease progression. The incidence of local recurrence is highest in the first 2 years and ranges from 27% to 60%. Distant metastasis is most common in the skin, liver, bone, lung/pleura, brain or distant lymph nodes. The thyroid gland is a rare site of metastasis for MCC with only two case reports published to date. Our patient had a repeat 2-[18F]-fluoro-2-deoxy-d-glucose-postiron emission tomography/CT after the discovery of recurrence of MCC. The high-intensity maximal standardised uptake value of 10.9 in the thyroid isthmus is consistent with malignancy. This case report describes an exceedingly rare thyroid metastasis secondary to MCC.
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Affiliation(s)
- Donata Vaiciunaite
- Department of GME, Summa Western Reserve Hospital, Cuyahoga Falls, Ohio, USA
| | - Gregory Beddell
- Department of GME, Summa Western Reserve Hospital, Cuyahoga Falls, Ohio, USA
| | - Nedyalko Ivanov
- Department of GME, Summa Western Reserve Hospital, Cuyahoga Falls, Ohio, USA
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35
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Keller N, Haemmerle B, Schmid S. A rare case of Merkel cell carcinoma with ovarian metastasis. Gynecol Oncol Rep 2019; 28:76-78. [PMID: 30963085 PMCID: PMC6434058 DOI: 10.1016/j.gore.2019.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/10/2019] [Accepted: 03/18/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Merkel cell carcinoma (MCC) is a rare cutaneous malignancy that normally occurs in sun-exposed areas of the skin. Risk factors are immundeficency and Merkel cell polyomavirus. Treatment options are surgery, radiotherapy, chemotherapy and immunotherapy in clinical trials. Case report We describe a case of an 80-year-old woman with ovarian metastasis of MCC six years after excision of a cutaneous MCC on the cheek. Discussion To our knowledge only three cases with ovarian metastasis of MCC have been described so far. Our case is the second with distant metastasis to the ovary spreading from a primary tumor in the skin of the head, in the other two cases the primary tumor was in the inguinal skin. Conculsion MCC is a highly aggressive cutaneous and mucosal malignancy with frequent recurrence, lymph node and distant metastases. There is no clear consensus how to treat metastatic disease. MCC is a rare malignancy. Recurrence and metastases are frequent. There is little knowledge of treatments for metastatic MCC.
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Affiliation(s)
- Nicole Keller
- Gynecology and Obstetrics, Hospital Grabs, Spitalstrasse 44, CH-9472 Grabs, Switzerland
| | - Beatrix Haemmerle
- Gynecology and Obstetrics, Hospital Grabs, Spitalstrasse 44, CH-9472 Grabs, Switzerland
| | - Seraina Schmid
- Gynecology and Obstetrics, Hospital Grabs, Spitalstrasse 44, CH-9472 Grabs, Switzerland
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36
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Bloom BC, Augustyn A, Pezzi TA, Menon H, Mayo LL, Shah SJ, Schwartz DL, Chmura SJ, Johnson FM, Welsh JW, Chun SG. Rescue of Immunotherapy-Refractory Metastatic Merkel Cell Carcinoma With Conventionally Fractionated Radiotherapy and Concurrent Pembrolizumab. Front Oncol 2019; 9:223. [PMID: 31024834 PMCID: PMC6459944 DOI: 10.3389/fonc.2019.00223] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/13/2019] [Indexed: 01/01/2023] Open
Abstract
Merkel cell carcinoma has historically had dismal prognosis with limited cytotoxic chemotherapy options that provide durable control of metastatic disease. The advent of anti-programmed death protein (anti-PD1)/anti-programmed death-ligand 1 (anti-PD-L1) directed immunotherapy has shown initial promise in Merkel cell carcinoma and radiation might augment immune responses. We present a case report of a 70-year-old male who underwent resection of Merkel cell carcinoma of the right thigh with a close margin and positive right inguinal involvement. Due to high-risk features, the patient was treated with adjuvant radiation to the right groin and with systemic carboplatin/etoposide, but developed local failure requiring salvage surgical resection. The patient then developed metastatic disease with biopsy proven retroperitoneal involvement refractory to doxorubicin/cyclophosphamide chemotherapy. The patient was then transitioned to single-agent pembrolizumab with a partial response for 10 months until developing progressive disease involving the left inguinal and left external iliac nodal regions. The progressive left inguinal/pelvic disease was treated with conventionally fractionated intensity modulated radiation therapy to a dose of 45 Gy delivered in 25 fractions. Following radiation therapy, the patient had complete response of all sites of disease throughout the body on imaging by RECIST criteria including retroperitoneal and mediastinal disease outside the radiation field. At 20 months post-radiation, the patient remains on pembrolizumab without evidence of disease on imaging. Herein, we present a case of durable response of metastatic Merkel cell carcinoma treated with concurrent radiation and pembrolizumab, providing evidence that radiation might improve systemic responses to anti-PD1/PD-L1 directed immune therapy. Ongoing prospective trials evaluating the utility of radiation in conjunction with immunotherapy for Merkel cell carcinoma are anticipated to provide clarity on the frequency and durability of abscopal responses when radiation is combined with immune checkpoint inhibitors.
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Affiliation(s)
| | - Alexander Augustyn
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - Todd A Pezzi
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - Hari Menon
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - Lauren L Mayo
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - Shalin J Shah
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - David L Schwartz
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, United States.,Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Steven J Chmura
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, United States
| | - Faye M Johnson
- Division of Cancer Medicine, Department of Thoracic, Head and Neck Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, United States.,The University of Texas Graduate School of Biomedical Sciences, Houston, TX, United States
| | - James W Welsh
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - Stephen G Chun
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, United States
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37
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Gallo M, Guarnotta V, De Cicco F, Rubino M, Faggiano A, Colao A. Immune checkpoint blockade for Merkel cell carcinoma: actual findings and unanswered questions. J Cancer Res Clin Oncol 2019; 145:429-443. [PMID: 30617553 DOI: 10.1007/s00432-019-02839-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/02/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine carcinoma arising from the skin. We aimed to review and deal with some of the most relevant controversial topics on the correct use of immunotherapy for the treatment of MCC. METHODS The primary search was carried out via PubMed, EMBASE, and the Cochrane Library (until 31st May, 2018), while other articles and guidelines were retrieved from related papers or those referenced in these papers. Additionally, we performed an extensive search on ClinicalTrials.gov to gather information on the ongoing clinical trials related to this specific topic. RESULTS We performed an up-to-date critical review taking into account the results of both retrospective and prospective published studies evaluating these issues: Are there any predictive criteria of response to immunotherapy? What is the correct place of immunotherapy in the treatment algorithm of MCC? What is the best choice after immunotherapy failure? What to do with patients for whom immunotherapy is not been feasible or contraindicated? How long should immunotherapy be prolonged, and what follow-up should be offered after complete response? CONCLUSION The therapeutic landscape of MCC is rapidly evolving: many open issues will probably be resolved, and many other questions are likely to arise in the next few years. The results of ongoing prospective clinical trials and of several other studies on these issues are eagerly awaited.
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Affiliation(s)
- Marco Gallo
- Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Turin, Italy.
| | - Valentina Guarnotta
- Section of Endocrine-Metabolic Diseases, Biomedical Department of Internal and Specialist Medicine (DIBIMIS), University of Palermo, Palermo, Italy
| | - Federica De Cicco
- Department of Clinical Medicine and Surgery, University "Federico II", Naples, Italy
| | - Manila Rubino
- Unit of Gastrointestinal Medical Oncology and Neuroendocrine Tumours, European Institute of Oncology, IEO, Milan, Italy
| | - Antongiulio Faggiano
- Department of Clinical Medicine and Surgery, University "Federico II", Naples, Italy
| | - Annamaria Colao
- Department of Clinical Medicine and Surgery, University "Federico II", Naples, Italy
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38
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Rastrelli M, Ferrazzi B, Cavallin F, Chiarion Sileni V, Pigozzo J, Fabozzi A, Tropea S, Vecchiato A, Costa A, Parisi A, Rossi CR, Del Fiore P, Alaibac M. Prognostic Factors in Merkel Cell Carcinoma: A Retrospective Single-Center Study in 90 Patients. Cancers (Basel) 2018; 10:cancers10100350. [PMID: 30249978 PMCID: PMC6210570 DOI: 10.3390/cancers10100350] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 12/21/2022] Open
Abstract
Merkel Cell Carcinoma (MCC) is a rare but highly aggressive neuroendocrine neoplasm of the skin. This study aimed at describing characteristics, treatment, and prognosis of a series of consecutive cases of MCC patients, in order to contribute to the investigation of this rare malignancy and provide better patient care. This is a retrospective cohort study including all 90 patients diagnosed and/or treated for MCC between 1991 and 2018 at the Veneto Institute of Oncology in Padua (Italy). Patient and tumor characteristics, treatment, and immunohistochemical data were extracted from a prospectively collected local database. There were 68 primary (76%) and 22 non-primary (15 occult primary, three metastatic, four recurrence) tumors (24%). CK20 expression was associated with reduced overall (HR 2.92, 95% CI 1.04–8.16) and disease-specific (HR 4.62, 95% CI 1.31–16.28) survival. Immunomodulatory regimens for treatment of other comorbidities were associated with reduced disease-specific ((HR 2.15, 95% CI 1.06–4.36) and recurrence-free (HR 3.08, 95% CI 1.44–6.57) survival. Iatrogenic immunomodulation resulted as the main factor associated with impaired prognosis. Lack of CK20 expression was associated with better survival.
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Affiliation(s)
- Marco Rastrelli
- Surgical Oncology Unit, Veneto Institute of Oncology IOV⁻IRCCS, 35121 Padua, Italy.
| | - Beatrice Ferrazzi
- Dermatology Unit and Pathology Unit, Department of Medicine (DIMED), University of Padua, 35121 Padua, Italy.
| | | | - Vanna Chiarion Sileni
- Melanoma and Esophagus Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 35121 Padua, Italy.
| | - Jacopo Pigozzo
- Melanoma and Esophagus Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 35121 Padua, Italy.
| | - Alessio Fabozzi
- Melanoma and Esophagus Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 35121 Padua, Italy.
| | - Saveria Tropea
- Surgical Oncology Unit, Veneto Institute of Oncology IOV⁻IRCCS, 35121 Padua, Italy.
| | - Antonella Vecchiato
- Surgical Oncology Unit, Veneto Institute of Oncology IOV⁻IRCCS, 35121 Padua, Italy.
| | - Alessandra Costa
- Surgical Oncology Unit, Veneto Institute of Oncology IOV⁻IRCCS, 35121 Padua, Italy.
| | - Alessandro Parisi
- Radiotherapy Unit, Veneto Institute of Oncology, IOV⁻IRCCS, 35121 Padua, Italy.
| | - Carlo Riccardo Rossi
- Surgical Oncology Unit, Veneto Institute of Oncology IOV⁻IRCCS, 35121 Padua, Italy.
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35121 Padua, Italy.
| | - Paolo Del Fiore
- Surgical Oncology Unit, Veneto Institute of Oncology IOV⁻IRCCS, 35121 Padua, Italy.
| | - Mauro Alaibac
- Dermatology Unit, Department of Medicine (DIMED), University of Padova, 35128 Padua, Italy.
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39
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Cellular sheddases are induced by Merkel cell polyomavirus small tumour antigen to mediate cell dissociation and invasiveness. PLoS Pathog 2018; 14:e1007276. [PMID: 30188954 PMCID: PMC6143273 DOI: 10.1371/journal.ppat.1007276] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 09/18/2018] [Accepted: 08/10/2018] [Indexed: 02/07/2023] Open
Abstract
Merkel cell carcinoma (MCC) is an aggressive skin cancer with a high propensity for recurrence and metastasis. Merkel cell polyomavirus (MCPyV) is recognised as the causative factor in the majority of MCC cases. The MCPyV small tumour antigen (ST) is considered to be the main viral transforming factor, however potential mechanisms linking ST expression to the highly metastatic nature of MCC are yet to be fully elucidated. Metastasis is a complex process, with several discrete steps required for the formation of secondary tumour sites. One essential trait that underpins the ability of cancer cells to metastasise is how they interact with adjoining tumour cells and the surrounding extracellular matrix. Here we demonstrate that MCPyV ST expression disrupts the integrity of cell-cell junctions, thereby enhancing cell dissociation and implicate the cellular sheddases, A disintegrin and metalloproteinase (ADAM) 10 and 17 proteins in this process. Inhibition of ADAM 10 and 17 activity reduced MCPyV ST-induced cell dissociation and motility, attributing their function as critical to the MCPyV-induced metastatic processes. Consistent with these data, we confirm that ADAM 10 and 17 are upregulated in MCPyV-positive primary MCC tumours. These novel findings implicate cellular sheddases as key host cell factors contributing to virus-mediated cellular transformation and metastasis. Notably, ADAM protein expression may be a novel biomarker of MCC prognosis and given the current interest in cellular sheddase inhibitors for cancer therapeutics, it highlights ADAM 10 and 17 activity as a novel opportunity for targeted interventions for disseminated MCC.
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