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Case Reports
. 2019 Aug 21;12(8):e230518.
doi: 10.1136/bcr-2019-230518.

Combined radio-immunotherapy leads to complete clinical regression of stage IV Merkel cell carcinoma

Daniel R Principe  1 , Joseph I Clark  2   3 , Bahman Emami  4 , Stanley Borowicz  2   3
Affiliations
Case Reports

Combined radio-immunotherapy leads to complete clinical regression of stage IV Merkel cell carcinoma

Daniel R Principe et al. BMJ Case Rep. .

Abstract

Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine tumour of the skin. While localised disease carries an overall favourable prognosis, metastatic disease is associated with poor clincal outcomes. Most cases of metastatic MCC are managed with systemic chemotherapy or immunotherapy, though 5-year survival for these patients remains a dismal 17%. Here, we present the case of a 79-year-old man with MCC of the right ear with metastases to regional lymph nodes, ipsilateral parotid gland and thoracic spine. He was treated with a combination of first-line radiotherapy and concurrent immune checkpoint inhibition (avelumab), which led to complete clinical regression of disease with minimal adverse effects. This observation suggests that combined radio-immunotherapy warrants larger-scale investigation for use in patients with unresectable MCC.

Keywords: immunological products and vaccines; oncology; radiotherapy; skin cancer.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Image of the patient’s right ear lesion at the time of diagnosis.
Figure 2
Figure 2
Initial positron-emission tomography (PET) scan showing the primary tumour in the right ear, as well as metastatic lesions in the ipsilateral parotid gland and spine.
Figure 3
Figure 3
Image of the patient’s right ear 12 months after treatment.
Figure 4
Figure 4
CT imaging 12 months after starting combined radiation therapy and avelumab.
See this image and copyright information in PMC

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