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New Guide Helps Clinicians Navigate Immunotherapy in Merkel Cell Carcinoma

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Fred Hutchinson Cancer Research Center researchers have published a new guide to help clinicians navigate a recent revolution in care for advanced Merkel cell carcinoma. The guide was published in JNCCNJournal of the National Comprehensive Cancer Network, and it accompanies NCCN’s new clinical practice guidelines for Merkel cell carcinoma.

A series of clinical trials have made checkpoint inhibitors the preferred choice for treating many patients with advanced Merkel cell carcinoma, explained Kelly Paulson, MD, PhD, Senior Hematology/Oncology Fellow at Fred Hutch, who wrote the new guide with Shailender Bhatia, MD, medical oncologist at the Seattle Cancer Care Alliance, Associate Professor in the University of Washington Department of Oncology, and Assistant Member in the Clinical Research Division at Fred Hutch.

“About half of patients treated with immunotherapies get nice, long-term responses, and this is changing the way we manage Merkel cell carcinoma. When faced with a patient with metastatic Merkel cell, we no longer turn to chemotherapy—it’s the wrong choice in many cases,” Dr. Paulson said.

With its comprehensive review of current evidence, Dr. Paulson said the “real-world guide” provides a practical FAQ list for clinicians who are learning how to use immunotherapy appropriately to treat patients with this cancer.

Drs. Paulson and Bhatia provide evidence-based answers for questions like: Does immunotherapy typically work quickly enough for patients with fast-growing tumors? (Yes.) Do patients usually need chemotherapy first? (No.) And how should we treat patients who are not medically eligible for immunotherapy? (It’s complicated, and there are no good answers yet.)

In addition to discussing the evidence for using checkpoint inhibitors in metastatic Merkel cell carcinoma, the guide puts special focus on three particular groups of patients: geriatric patients, people with immunotherapy-resistant metastatic Merkel cell carcinoma, and those with localized Merkel cell carcinoma that is likely to recur after surgery. Other topics include the cancer’s presentation, incidence, historical survival rates, and its two distinct causal pathways (mutation-inducing ultraviolet radiation and viral infection), both of which make the cancer visible to immune cells and therefore a good candidate for immunotherapy.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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