Chemotherapy for patients with locally advanced or metastatic Merkel cell carcinoma

BACKGROUND. Merkel cell carcinoma (MCC) is a highly malignant skin neoplasm . Regional lymph node and distant metastasis occur in 20-52% of patients. T he role of chemotherapy in the treatment of patients with this rare tumor i s unclear. METHODS. An exhaustive analysis of the literature (1980-1995) describing ch emotherapy for patients with locally advanced or metastatic MCC was perform ed. All available published medical records (n = 101 patients) were entered in a database. In addition, data on six additional patients given chemothe rapy during this time frame in Lyon, France, were included in the database. RESULTS. For the 107 patients, the overall objective response rate to first -line chemotherapy was 61% (61 of 101 evaluable patients). The response rat e was 57% (41 of 72) for patients with metastasis and 69% (20 of 29) for pa tients with locally advanced tumors. No clinical parameter was found to be correlated to response to chemotherapy. A high rate of toxic death during f irst-line treatment (n = 7.7%) was reported for these patients. The median overall survival from the date of chemotherapy initiation was 9 months for patients with metastasis and 24 months for patients with locally advanced t umors. The projected overall survival at 3 years was 17% for patients with metastasis and 35% for patients with locally advanced tumors. Progression a fter first-line chemotherapy was associated with significantly worse surviv al for patients with metastasis. Rates of response to second-line (n = 33) and third-line (n = 10) chemotherapy were 45% and 20%, respectively. CONCLUSIONS. MCC is chemosensitive but rarely chemocurable in patients with metastasis or locally advanced tumors. A high incidence of toxic death due to chemotherapy is reported in the literature. (C) 1999 American Cancer So ciety.