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Multimodal Strategy in Localized Merkel Cell Carcinoma: Where Are We and Where Are We Heading?
Gianluca Ricco1,2, Elisa Andrini1,2, Giambattista Siepe3
1Department of Experimental Diagnostic and Specialized Medicine (DIMES), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy.
Abstract:
Merkel cell carcinoma (MCC) is an aggressive neuroendocrine tumor of the skin whose incidence is rising. Multimodal treatment is crucial in the non-metastatic, potentially curable setting. However, the optimal management of patients with non-metastatic MCC is still unclear. In addition, novel insights into tumor biology and newly developed treatments (e.g., immune checkpoint inhibitors) that dramatically improved outcomes in the advanced setting are being investigated in earlier stages with promising results. Nevertheless, the combination of new strategies with consolidated ones needs to be clarified. We reviewed available evidence supporting the current treatment recommendations of localized MCC with a focus on potentially ground-breaking future strategies. Advantages and disadvantages of the different treatment modalities, including surgery, radiotherapy, chemotherapy, and immunotherapy in the non-metastatic setting, are analyzed, as well as those of different treatment modalities (adjuvant as opposed to neoadjuvant). Lastly, we provide an outlook of remarkable ongoing studies and of promising agents and strategies in the treatment of patients with non-metastatic MCC.
Insights
Merkel cell carcinoma (MCC) treatment for non-metastatic disease requires multimodal approaches. This review analyzes current strategies and future directions, including immunotherapy, for localized MCC management.
Area of Science:
- Oncology
- Dermatology
- Surgical Oncology
Background:
- Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine skin cancer with increasing incidence.
- Optimal management for non-metastatic MCC remains under investigation, despite its potentially curable nature.
Purpose of the Study:
- To review current treatment recommendations for localized MCC.
- To evaluate the role of surgery, radiotherapy, chemotherapy, and immunotherapy.
- To explore emerging strategies and ongoing trials for non-metastatic MCC.
Main Methods:
- Systematic review of available evidence on localized MCC treatment.
- Analysis of multimodal treatment modalities (surgery, radiotherapy, chemotherapy, immunotherapy).
- Comparison of adjuvant versus neoadjuvant treatment approaches.
Main Results:
- Multimodal treatment is essential for potentially curable, non-metastatic MCC.
- Novel therapies like immune checkpoint inhibitors show promise in earlier stages.
- Optimal combination of new and established strategies requires further clarification.
Conclusions:
- Current evidence supports multimodal treatment for localized MCC.
- Investigating novel agents and treatment combinations is crucial for improving outcomes.
- Ongoing studies will shape future management of non-metastatic MCC.
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