Would you consider adjuvant immunotherapy for a patient with high-risk (N3 nodes) Merkel cell carcinoma following definitive surgical resection and adjuvant radiation therapy?  

The ECOG-ACRIN EA6174 study evaluated adjuvant pembro for high-risk stage III MCC. It was closed to accrual in 11/2024, so we await the result of that study to inform the role of adjuvant IO. In the meantime, I agree that surgery followed by adjuvant XRT is the current standard of care, and it may b...

Although there is no level 1 data supporting adjuvant RT in MCC, a relatively recent meta-analysis from an Italian group (Petrelli et al., PMID 31005218) showed that adjuvant RT is associated with a 75% reduction in local and locoregional relapses versus surgery alone, without a reduction in distant...

Well, pending the results of EA6174, there is really no proven standard of care. Radiation is used because this is a tradition, not a proven standard of care. It has not been tested in a randomized study. We ran a pilot study of such patients, comparing nivolumab + radiation (4 patients) versus ipi1...

The evidence is still cooking for this recommendation. Both trials with pembrolizumab and avelumab are undergoing analysis. Till then, we do not have good evidence to consider adjuvant therapy as a validated approach. In our practice, we do scans every 3-6 months and monitor closely.