Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2007 Jul;57(1):166-9.
doi: 10.1016/j.jaad.2007.03.011. Epub 2007 May 7.

Merkel cell carcinoma adjuvant therapy: current data support radiation but not chemotherapy

Kelly M Garneski  1 , Paul Nghiem
Affiliations

Merkel cell carcinoma adjuvant therapy: current data support radiation but not chemotherapy

Kelly M Garneski et al. J Am Acad Dermatol. 2007 Jul.

Abstract

Merkel cell carcinoma (MCC) is a skin cancer with 30% mortality and an incidence that has tripled in the past 15 years. There is agreement that surgical excision with negative margins is an appropriate therapeutic first step and that sentinel lymph node biopsy is a powerful prognostic indicator. After excision of detectable cancer, optimal adjuvant therapy is not well established. A role for adjuvant radiotherapy is increasingly supported by observational data. These data suggest that a regimen of surgery plus adjuvant radiotherapy is associated with both a lower loco-regional recurrence rate and longer overall survival when compared with surgery alone. In contrast, a role for adjuvant chemotherapy is not well supported. The rationale for chemotherapy in this disease is based on small-cell lung cancer, a more common neuroendocrine tumor for which chemotherapy is the primary treatment modality. Several issues call into question the routine use of adjuvant chemotherapy in MCC: lack of evidence for improved survival; the associated morbidity and mortality; important differences between small-cell lung cancer and MCC; and rapid development of resistance to chemotherapy. Importantly, chemotherapy suppresses immune function that plays an unusually large role in defending the host from the development and progression of MCC. Taken together, these arguments suggest that adjuvant radiation may be indicated for many MCC patients while adjuvant chemotherapy should largely be restricted to clinical trials.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosure: We declare no conflicts of interest.

Figures

Figure 1
Figure 1. Adjuvant radiation therapy and local recurrence of Merkel cell carcinoma
The fraction of patients who are free of local relapse is plotted for five years after diagnosis. Numbers in parentheses indicate the number of patients in each group that were at risk at that time point. All patients received surgery and those who also received radiation (solid line) are plotted separately from those who did not (dashed line; p
Figure 2
Figure 2. Adjuvant chemotherapy and survival in patients with Merkel cell carcinoma spread to lymph nodes
The group that received adjuvant chemotherapy had lower survival, although this was not statistically significant. (From Allen, P. J. et al. J Clin Oncol; 23:2300, reprinted with permission from the American Society of Clinical Oncology).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Hodgson NC. Merkel cell carcinoma: changing incidence trends. J Surg Oncol. 2005;89:1–4. - PubMed
    1. Gupta S, Wang L, Nghiem P. Merkel cell carcinoma: information for patients and their physicians, 6/06 update. http://www.merkelcell.org.
    1. Gupta SG, Wang LC, Penas PF, et al. Sentinel lymph node biopsy for evaluation and treatment of patients with Merkel cell carcinoma: The Dana-Farber experience and meta-analysis of the literature. Arch Dermatol. 2006;142:685–690. - PubMed
    1. Allen PJ, Bowne WB, Jaques DP, et al. Merkel cell carcinoma: prognosis and treatment of patients from a single institution. J Clin Oncol. 2005;23:2300–2309. - PubMed
    1. Lewis KG, Weinstock MA, Weaver AL, et al. Adjuvant local irradiation for Merkel cell carcinoma. Arch Dermatol. 2006;142:693–700. - PubMed

Publication types