MCC First-line ICI — SCE Medical Oncology MCQ

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ModerateMelanoma & SkinMCC First-line ICISCE Medical Oncology

A 62-year-old man with advanced Merkel cell carcinoma (MCC) progresses after surgery and radiotherapy. He has distant metastases. What is the standard first-line systemic therapy?

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Correct answer: B — Avelumab (anti-PD-L1) or pembrolizumab (anti-PD-1)

Advanced MCC: ICI is preferred first-line over chemotherapy because: (1) similar/higher ORR, (2) dramatically more durable responses (chemo responses rarely last >6 months), (3) MCC is often MCPyV-driven (viral antigen = good ICI target) and has high TMB in virus-negative cases. Avelumab (JAVELIN Merkel 200) and pembrolizumab (KEYNOTE-017) both approved.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cancer