Merkel Cell Carcinoma: Evolving Therapeutics, Continued Challenges

Cancer research · Merkel cell carcinoma · TP53

First-line immune checkpoint inhibitors such as avelumab and pembrolizumab significantly improve overall survival in metastatic Merkel cell carcinoma.

Background Merkel Cell Carcinoma (MCC) is a rare, aggressive neuroendocrine malignancy with rising incidence, influenced by ultraviolet (UV) radiation and Merkel cell polyomavirus (MCPyV). Methods This review summarizes recent advances in MCC management, based on an analysis of current literature, focusing on immune checkpoint inhibitors (ICIs), viral status implications, and evolving multimodal treatment strategies. Results MCPyV‑positive MCC has a median overall survival (OS) of 6.6years compared to 1.2years for virus‑negative cases. The 5-year OS rate for localized MCC is approximately 50%. Historically, the 5-year OS for metastatic MCC was ~14%, but has significantly improved with ICIs. First‑line treatment with avelumab achieved a median OS of 20.3months and a 5-year OS of approximately 26%. Pembrolizumab demonstrated a median OS of 24.3months, a median progression‑free survival (PFS) of 9.3months, and a durable response with a median duration of response (DOR) of 39.8months. Conclusion Despite advances, MCC recurrence rates remain high (16.4% local, 32.1% regional, 9.5% distant), necessitating vigilant long‑term surveillance. Future research should focus on optimizing combination therapies, identifying predictive biomarkers, and refining treatment sequencing to further improve survival and quality of life.

Merkel cell carcinoma is an uncommon but highly aggressive skin cancer with historically poor survival outcomes. Recent advances in immunotherapy have markedly improved overall survival for metastatic disease, yet high recurrence rates and limited biomarkers present ongoing challenges. Understanding these therapeutic gains and persisting gaps is critical for advancing patient care and guiding further research.

Evidence level: Számítógépes vagy elméleti. Modellből vagy adatbányászatból származó jel.

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