Treatment of Advanced Merkel Cell Carcinoma: Current Therapeutic Options and Novel Immunotherapy Approaches

摘要: Advanced Merkel cell carcinoma (MCC) is a very aggressive, rare neuroendocrine tumor of the skin with high frequency locoregional recurrence and metastasis, mortality rate. Surgical resection, sentinel lymph node biopsy, radiotherapy represent gold standard treatment in patients localized disease, while chemotherapy has significant role advanced disease. However, no definitive evidence on survival impact stages been provided to date, response remains brief majority cases, indicating an urgent need for alternative approaches. Biological genome sequencing studies have implicated multiple molecular pathways MCC, thus leading development new agents that target angiogenic factors, anti-apoptosis molecules, poly-ADP ribose polymerase, intracellular signal proteins such as PI3K/AKT/mTOR pathway, peptide receptors somatostatin receptors. More recently, immunotherapy avelumab, pembrolizumab, nivolumab, which act by blocking programmed cell-death (PD)-1/PD-L1 immune checkpoint, shown promising results, especially setting, should now be considered care metastatic MCC. Current research focusing developing immunotherapeutic strategies, identifying predictive biomarker aid selection responsive immunotherapy, defining combination approaches increase efficacy refractory patients.