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Radiation superior to chemotherapy in Merkel cell carcinoma
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Radiation therapy reduced recurrence in patients with Merkel cell carcinoma by 70%, whereas chemotherapy did not appear to have any effect on recurrence or survival, according to study findings.
Merkel cell carcinoma (MCC) is a rare, aggressive, neuroendocrine-derived skin cancer most frequently diagnosed in white men (median age, 75 years). MCC is associated with high rates of recurrence and disease-associated mortality, but the factors that predict long-term outcomes are unclear, according to background information provided in the study.
Maryam M. Asgari
Maryam M. Asgari, MD, MPH, of the division of research at Kaiser Permanente Northern California, and colleagues sought to characterize MCC, as well as analyze predictors of disease recurrence and survival, in 218 patients included in the cancer registry of Kaiser Permanente Northern California. All patients were diagnosed between 2005 and 2009.
Locoregional and distant recurrence, as well as OS and MCC-specific survival, served as the primary outcomes.
“The electronic records allowed us to identify patients with MCC, see how they were diagnosed and treated and then follow them over time to see how their care affected their outcomes,” Asgari said in a press release.
Tumor extent (local, regional or distant) remained significantly associated with all outcomes even after adjustments for host, tumor, diagnostic and treatment variables.
Researchers observed a higher rate of MCC-specific mortality among patients who were immunosuppressed (adjusted HR=4.9; 95% CI, 1.7-14.4). Patients with a tumor of unknown primary site demonstrated improved survival (adjusted HR=0.4; 95% CI, 0.2-0.9) and a lower risk for distant metastasis (adjusted HR=0.1; 95% CI, 0-0.7).
Pathological nodal evaluation correlated with lower risk for metastasis (adjusted HR=0.2; 95%CI, 0-1.0) and improved survival.
Radiation therapy was associated with a decreased risk for locoregional recurrence (adjusted HR=0.3; 95%CI, 0.1-0.6), chemotherapy was not associated with any differences in outcomes.
“Our findings may help to inform diagnostic and therapeutic management of MCCs,” Asgari and colleagues wrote.
Disclosure: Asgari reports grants from Genentech, Pfizer and Valeant. The study was funded in part by grants from the NCI and the Michael Piepkorn Endowment, and by the University of Washington MCC Patient Gift Fund.
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