Immunotherapy for Merkel Cell Carcinoma

Immunotherapy is the use of medicines that help a person’s own immune system find and destroy cancer cells. This is a promising new form of treatment for Merkel cell carcinoma (MCC), especially if it has spread to other parts of the body.

Immune checkpoint inhibitors

An important part of the immune system is its ability to keep itself from attacking normal cells in the body. To do this, it uses “checkpoints.” These are proteins on immune cells that need to be turned on (or off) to start an immune response. Cancer cells sometimes use these checkpoints to keep the immune system from attacking them. 

For example, PD-1 is a checkpoint protein on immune cells called T cells. It normally acts as an “on/off switch” that can help keep the T cells from attacking other cells in the body. It switches “off” when it attaches to PD-L1, a protein on some normal (and cancer) cells. This tells the T cell to leave the other cell alone. Some cancer cells have large amounts of PD-L1, which helps keep the immune system from attacking them. 

Drugs that block either PD-1 or PD-L1 can stop this binding and boost the immune response against cancer cells. Examples of such drugs include:

  • Avelumab (Bavencio®), which targets PD-L1
  • Pembrolizumab (Keytruda®) and nivolumab (Opdivo®), which block PD-1

These drugs are given as an intravenous (IV) infusion into a vein. They're usually given every 2 or 3 weeks. They've been shown to shrink or slow the growth of some advanced MCC tumors, sometimes even after other treatments have not worked. 

Other immune checkpoint inhibitors are being studied for use against MCC as well.

Possible side effects of immunotherapy for MCC

Side effects of these types of drugs can include: 

  • Fatigue
  • Cough
  • Nausea
  • Rash or itchy skin
  • Joint pain
  • Loss of appetite
  • Diarrhea
  • Constipation

Other, more serious side effects occur less often: 

Infusion reactions: Some people might have an infusion reaction while getting one of these drugs. This is like an allergic reaction. It can include fever, chills, flushing of the face, rash, itchy skin, wheezing, and trouble breathing. You might be given medicines before each infusion to help lower the risk of this happening.

Autoimmune reactions: These drugs work by basically removing the brakes on the body’s immune system. Sometimes the immune system starts attacking other parts of the body, which can cause serious or even life-threatening problems in the lungs, intestines, liver, hormone-making glands, kidneys, or other organs.

It’s very important to report any changes or new side effects to your health care team right away. If serious side effects do occur, treatment may need to be stopped.

 

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Chan IS, Bhatia S, Kaufman HL, Lipson EJ. Immunotherapy for Merkel cell carcinoma: a turning point in patient care. J Immunother Cancer. 2018;6(1):23. 

Merkelcell.org. Seattle Multidisciplinary MCC Team, University of Washington MCC Research, Fred Hutchinson Cancer Research Center, and the Seattle Cancer Care Alliance/Skin Cancer. Immunotherapy. Accessed at www.merkelcell.org/treatment/immunotherapy/ on Sept. 19, 2018.

National Cancer Institute. Merkel Cell Carcinoma Treatment (PDQ®)–Health Professional Version. February 1, 2018. Accessed at www.cancer.gov/types/skin/hp/merkel-cell-treatment-pdq on Sept. 19, 2018.

National Comprehensive Cancer Network, Clinical Practice Guidelines in Oncology (NCCN Guidelines®), Merkel Cell Carcinoma, Version 2.2018 -- June 15, 2018. Accessed at www.nccn.org/professionals/physician_gls/pdf/mcc.pdf on Sept. 19, 2018.

Uchi H. Merkel Cell Carcinoma: An Update and Immunotherapy. Front. Oncol. 2018;8(48):1-5.

Last Medical Review: October 9, 2018 Last Revised: October 9, 2018

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