The changing paradigm of managing Merkel cell carcinoma in Australia: An expert commentary

David L. Kok, Annie Wang, Wen Xu, Margaret S.T. Chua, Alexander Guminski, Michael Veness, Julie Howle, Richard Tothill, Ganessan Kichendasse, Michael Poulsen, Shahneen Sandhu, Gerald Fogarty

Research output: Contribution to journalReview ArticleResearchpeer-review

12 Citations (Scopus)

Abstract

Merkel cell carcinoma (MCC) is a highly aggressive neuroendocrine tumor of the skin with an estimated disease-associated mortality of 15–33%. Australia has a higher incidence of MCC compared to the rest of the world, thought to be due to a higher ultraviolet index. The Australian MCC population is distinct from the MCC population of the Northern hemisphere, characterized by a predominantly viral negative etiology with high tumor mutational burden. The optimal management of MCC and the choice of treatment modality vary significantly across the world and even between institutions within Australia. Historically, the treatment for MCC has been resection followed by radiotherapy (RT), though definitive RT is an alternative treatment used commonly in Australia. The arrival of immune checkpoint inhibitors and the mounting evidence that MCC is a highly immunogenic disease is transforming the treatment landscape for MCC. Australia is playing a key role in the further development of treatment options for MCC with two upcoming Australian/New Zealand investigator-initiated clinical trials that will explore the interplay of RT and immunotherapy in the treatment of early and late stage MCC.

Original languageEnglish
Pages (from-to)312-319
Number of pages8
JournalAsia-Pacific Journal of Clinical Oncology
Volume16
Issue number6
DOIs
Publication statusPublished - Dec 2020
Externally publishedYes

Keywords

  • clinical trials
  • immunotherapy
  • management
  • Merkel cell carcinoma
  • radiotherapy

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