Surgery and Radiation Therapy
If you have more advanced MCC that has spread to nearby lymph nodes but not to other parts of your body (stage III), you are likely to have surgery to remove the cancer followed by radiation to the main site as well as the regional lymph nodes.
Immunotherapy
If your cancer has spread to distant parts of your body (stage IV), you are likely to needsystemic therapy. Until recently, the standard systemic option waschemotherapy, which would shrink many tumors but provide only about three months of cancer control. Many recent clinical trials have led to a major shift toward treatments designed to stimulate your own immune system to fight your disease.
The most promising emerging option for MCC is a class of drugs called immune checkpoint inhibitors (ICIs).
In March 2017, the U.S. Food and Drug Administration approved the first treatment formetastaticMCC: the ICI avelumab (Bavencio). Fred Hutch was one of the leading sites for aclinical trialtesting this medicine.
In the study, avelumab was used to treat 88 patients who had metastatic MCC that had come back despite at least one round of chemotherapy. Twenty-eight of those patients’ tumors shrank or disappeared in response to avelumab. Among patients who initially responded to the medicine, over 80% had responses lasting more than a year.
Many patients not only did well, without evidence of active cancer, but also had very good quality of life while receiving this therapy.
Another ICI, pembrolizumab (Keytruda), has also shown promise. The National Comprehensive Cancer Network (NCCN), which publishes treatment guidelines based on expert opinion, added pembrolizumab to its list of MCC treatment options in 2017 after research showed it shrunk many patients’ tumors and provided long-lasting results. NCCN has also listed the ICIs avelumab and nivolumab (Opdivo) as preferred treatments over chemotherpay for metastatic MCC.
Other ICIs, including ipilimumab (Yervoy), are being studied in clinical trials for people with advanced MCC. In addition, several otherimmunotherapyapproaches are being investigated, including intra-tumoral injections andinfusionof immune cells (T-cells orNatural Killer cells). Initial results suggest a promising future forimmunotherapiesin treating MCC.
Learn more about Immunotherapy
Chemotherapy
In general,chemotherapyis reserved for late stages of MCC, when immune therapies are not an option. For people who do not have problems with their immune system (no autoimmune disease and no major immunosuppressive medications), physicians typically recommend first trying an immune-stimulating therapy (such as an immune checkpoint inhibitor) before using chemotherapy.
