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Updated: Jan 20, 2026
Merkel Cell Polyomavirus Infection and Detection
Published on: February 7, 2019
[Immune checkpoint inhibition in Merkel cell carcinoma]
P Terheyden1, A Mohr2, E A Langan2,3
1Klinik für Dermatologie, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland. Patrick.Terheyden@uksh.de.
Background:
Merkel cell carcinoma (MCC) is a rare but aggressive form of skin cancer in which Merkel cell polyomavirus infection and chronic exposure to ultraviolet radiation are key risk factors. Immune checkpoint inhibition has revolutionized the treatment of locally advanced, inoperable and metastatic MCC.
Aim:
To outline the modern management of MCC based on advances in our understanding of MCC tumour biology and the development of immune checkpoint inhibitors, namely inhibitors of programmed cell death protein (PD)-1- and PD‑1 ligand 1 (PD-L1).
Methods:
A review of the scientific literature listed in PubMed.
Results:
First line therapy with the PD-L1 blocking antibody avelumab is associated with a response rate of 62%. In the second line setting, for example after chemotherapy, the response rate only reaches 33%. However, in patients who responded in the second line setting, 69% remained relapse free after 2 years. Treatment responses occurred on average after 6.1 weeks of therapy. First line treatment with pembrolizumab (anti-PD‑1 antibody) is associated with a 2-year survival rate of 69% and the median survival rate has not been reached. Whilst the various chemotherapy regimens are associated with similar response rates, these are typically short lived.
Discussion:
Checkpoint inhibition offers an effective treatment option for patients with MCC. Avelumab is currently licensed as a treatment for metastatic disease. Chemotherapy remains an option to reduce tumor load, or in the context of resistance and/or contraindications to immune checkpoint therapy. Adjuvant and neoadjuvant use of checkpoint inhibition in MCC may represent a future treatment strategy pending the results of on-going clinical trials.
Insights
Immune checkpoint inhibitors offer effective treatment for Merkel cell carcinoma (MCC), a rare skin cancer. Avelumab and pembrolizumab show promising response rates and survival benefits, revolutionizing MCC management.
Area of Science:
- Oncology
- Dermatology
- Immunology
Background:
- Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer.
- Key risk factors include Merkel cell polyomavirus infection and UV exposure.
- Immune checkpoint inhibitors have transformed MCC treatment.
Purpose of the Study:
- To review modern MCC management strategies.
- Focus on MCC tumor biology and immune checkpoint inhibitors (PD-1/PD-L1).
Main Methods:
- Systematic review of scientific literature.
- PubMed database search.
Main Results:
- First-line avelumab (PD-L1 inhibitor) shows a 62% response rate.
- Second-line therapy yields a 33% response rate, with 69% relapse-free at 2 years.
- Pembrolizumab (anti-PD-1) offers a 69% 2-year survival rate; chemotherapy response is transient.
Conclusions:
- Checkpoint inhibition is an effective MCC treatment.
- Avelumab is approved for metastatic MCC; chemotherapy is an alternative for resistance/contraindications.
- Adjuvant/neoadjuvant checkpoint inhibition is a potential future strategy.
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