Merkel cell carcinoma associated with TNF inhibitor therapy: a systematic review of case reports

Area of Science:

• Oncology
• Dermatology
• Immunology

Background:

• Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine skin cancer predominantly affecting older individuals.
• Immunosuppressive medications, particularly TNF inhibitors, are increasingly used for autoimmune diseases.
• The association between TNF inhibitor therapy and MCC development requires thorough investigation.

Approach:

• A systematic literature search was conducted across major databases including PubMed, Web of Science, Science Direct, and Cochrane Library.
• Articles were initially screened by title and abstract, followed by a comprehensive full-text assessment.
• Eight case reports involving nine patients were included in this review.

Key Points:

• The review identified nine cases of MCC associated with TNF inhibitor use.
• Rheumatoid arthritis was the most common indication for TNF inhibitor therapy in these patients.
• All patients received TNF inhibitors, including infliximab, adalimumab, etanercept, and golimumab, which were linked to MCC induction.

Conclusions:

• TNF inhibitors are associated with an increased risk of Merkel cell carcinoma development.
• Physicians must inform patients about potential cancer risks before initiating long-term immunosuppressive therapy.
• Regular monitoring for MCC and other adverse effects is crucial for patients on TNF inhibitors, with a notable prevalence in women.