The innovative drug is a type of immune therapy called a programmed death-ligand 1 (PD)-L1 inhibitor. The therapy is given intravenously every two weeks to eligible patients with advanced Merkel cell carcinoma (MCC)—a rare, but serious type of skin cancer that can be fatal.
“This PD-L1 inhibitor acts like it is letting off the brakes on the body’s ability to fight off the cancer,” explains Nathalie Zeitouni, MD, skin cancer expert at St. Joseph’s cancer center. A Mohs and reconstructive surgeon, Dr. Zeitouni serves as the Section Leader of Dermatology, Mohs Surgery and Melanoma at St. Joseph’s cancer center. “This promising new drug gives the immune system’s cells a chance to wake up and help fight the cancer.”
MCC is predominantly seen in older adults, most often in their mid-70s, who have lighter pigmented skin. However, it can also occur at a younger age and has a higher incidence in individuals with suppressed immune systems, such as organ transplant recipients. Debra Wong, MD, a medical oncologist specializing in cutaneous malignancies at St. Joseph’s cancer center, says vigilance and regular follow up with your primary doctor, and possibly referral to a skin cancer specialist, are recommended upon noticing any concerning skin changes.
“If the primary MCC tumor is localized and can be surgically removed, prognosis can be good. Radiation therapy can also be given after surgery or, in certain circumstances, in place of surgery,” says Dr. Zeitouni.
However, Dr. Wong adds, if the disease has spread (metastasize)d to the lymph nodes, or to other parts of the body, prognosis is much worse. “This highlights the need for new therapies,” she says.
For many years, skin cancer experts have used standard chemotherapy drugs for metastatic MCC without robust scientific evidence supporting its use in patients with this type of cancer. A new drug proven to be effective in metastatic MCC was much needed.
“We now have a better treatment option beyond chemotherapy for this fatal disease,” Dr. Wong says. “It offers the hope that patients will respond to the drug in terms of tumor regression or stability, and that that response will be long-lasting.”
The new drug is called avelumab. It is the very first FDA-approved drug for advanced MCC that has progressed during or after chemotherapy. In the clinical trial which led to the drug’s FDA approval, 32 percent of patients had meaningful responses to this treatment with majority of them continuing to respond to treatment for six months or longer. — St. Joseph’s