Chemotherapy for Merkel cell carcinoma
Chemotherapy (chemo) uses anti-cancer drugs that are typically injected into a vein or given by mouth. These drugs travel through the bloodstream to all parts of the body, which makes chemo useful for treating cancers that have spread to other organs.
Merkel cell carcinoma (MCC) is not common, so it’s been hard to study the use of chemotherapy for MCC in clinical trials.
Chemo is most likely to be helpful for MCC that has spread to other organs. So far it’s not clear if it can be helpful for cancers that are still just in the skin or that have only spread to nearby lymph nodes, but some doctors might still recommend it for these cancers (see “Intralesional chemotherapy” below for an example).
It has also been hard to do large enough studies to show which chemo drugs work best against MCC. Because of this, doctors often use chemo drugs that are useful against other types of neuroendocrine tumors. The most commonly used drugs for MCCs that have spread include:
Most often, either cisplatin or carboplatin is used, sometimes along with etoposide. Topotecan tends to have fewer serious side effects, so it might be a better option for some people who are older or have serious health problems.
These drugs are given intravenously (IV or into a vein), usually once every few weeks. They can often shrink MCC tumors for a time (or at least slow their growth and spread) and help relieve some symptoms. But usually these cancers will start growing again.
Intralesional chemotherapy: For some early skin tumors, some doctors have tried injecting small amounts of a chemo drug such as bleomycin directly into the site of the tumor, sometimes after surgery. This seems to help some people, although it hasn’t been studied enough to be sure. One advantage of this approach is that it’s unlikely to cause the side effects often seen with chemo that goes through the whole body.
Possible side effects of chemotherapy
Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells can also be affected by chemo, which can lead to side effects.
The side effects of chemo depend on the type and dose of the drugs and how long they are given. Side effects may include:
- Hair loss
- Mouth sores
- Loss of appetite
- Nausea and vomiting
- Diarrhea or constipation
- Increased risk of infection (from too few white blood cells)
- Easy bruising or bleeding (from too few blood platelets)
- Fatigue (from too few red blood cells)
These side effects usually go away once treatment is finished. Some drugs may have specific effects that are not listed above, so be sure to talk with your cancer care team about what to expect.
There are often ways to lessen these side effects. For example, drugs can be given to help prevent or reduce nausea and vomiting. Tell your medical team about any side effects or changes you notice while getting chemotherapy so they can be treated promptly.
Last Medical Review: 04/13/2015
Last Revised: 02/09/2016