Immunotherapy Tops Chemotherapy for Improving Outcomes in Real-World Study of Merkel Cell Carcinoma

Real-world data from the SPEAR-Merkel trial has indicated that immunotherapy yields greater benefits than chemotherapy for patients with locally advanced Merkel cell carcinoma (laMCC) and metastatic Merkel cell carcinoma (mMCC).

Compared with chemotherapy, patients receiving avelumab or another immunotherapy, had higher response rates and higher rates of survival.

“The study provides insight on uses and clinical outcomes associated with innovative therapies in clinical practice, which may help clinicians understand the variety of newer treatment options for both laMCC and mMCC,” wrote the researchers about their findings, noting that real-world data is limited due to the rarity of laMCC and mMCC. “The study is of particular importance as it shows that chemotherapy is still being used as 1L treatment despite its inferior clinical and safety profile.”

The study included 94 patients with a median follow-up of 11 months, revealing overall response rates (ORR) of 64.3% among the 28 patients receiving first-line avelumab, 61.5% among the 26 patients receiving another immunotherapy, and 42.5% among the 40 patients receiving chemotherapy.

Patients receiving immunotherapy also showed superior survival, the researchers found. Median overall survival was 20.2 months among patients receiving avelumab, was not reached among patients receiving non-avelumab immunotherapy, and was 14.7 months among patients receiving chemotherapy.

The median duration of response (DOR) was 44.5 months, with a median DOR of 15.5 months among the patients receiving avelumab, a median DOR that was not reached among patients receiving non-avelumab immunotherapy, and 44.5 months among the patients receiving chemotherapy, although the researchers urged caution when interpreting these results

“rwDOR in the 1L chemotherapy cohort was longer than that for the 1L avelumab cohort (44.5 and 15.5 months, respectively), but this result was based on limited data: two patients in the 1L chemotherapy cohort had rwDOR of 40+ months,” they explained. “When these two outliers were removed, median rwDOR for the chemotherapy group was only 6.5 months. In addition, 17 patients in the 1L chemotherapy cohort had a response, and the small sample size limits conclusions about rwDOR.”

Throughout treatment, 32.1% of patients receiving avelumab, 26.9% of patients receiving non-avelumab immunotherapy, and 17.5% of patients receiving chemotherapy went to the emergency department at least once, and 42.9%, 46.2%, and 27.5%, respectively, were hospitalized at least once.

Reference

Bhanegaonkar A, Liu F, Boyd M, et al. Real-world clinical outcomes in patients with locally advanced or metastatic merkel cell carcinoma treatment in U.S. oncology clinical practices: results from SPEAR-Merkel. Oncologist. 2021;26:1-11.