Merkel Cell Carcinoma — SCE Medical Oncology MCQ

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ModerateMelanoma & SkinMerkel Cell CarcinomaSCE Medical Oncology

A 67-year-old man with advanced Merkel cell carcinoma is being considered for first-line systemic therapy. ECOG PS 0. What is the recommended first-line approach?

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Correct answer: D — Pembrolizumab or avelumab

First-line immunotherapy (pembrolizumab or avelumab) is now preferred over cytotoxic chemotherapy for advanced Merkel cell carcinoma. Checkpoint inhibitors demonstrate higher response rates (>50%) and more durable responses than platinum-etoposide chemotherapy. While chemotherapy has high initial response rates, responses are typically short-lived (median 3-6 months). The JAVELIN Merkel 200 cohort for first-line avelumab and KEYNOTE-017 for first-line pembrolizumab support this approach.

Reference: ESMO 2024 Non-melanoma Skin Cancer Guidelines; KEYNOTE-017; JAVELIN Merkel 200