School of Human Health Sciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
Department of Health Sciences, University of Florence, viale Pieraccini, 6, 50139, Florence, Italy.
BMC Cancer. 2018 Oct 22;18(1):1024. doi: 10.1186/s12885-018-4919-z.
Merkel cell carcinoma (MCC) is a rare neuroendocrine malignancy of the skin characterized by high aggressiveness. Four main factors are implicated in its development: immunosuppression, ultraviolet radiation, age and the Merkel cell polyomavirus (MCPyV). In recent years, immune checkpoint inhibitors have shown clinical activity in MCC treatment.
We report the case of an 82-year-old man with a lung adenocarcinoma diagnosis, who underwent immunotherapy with nivolumab as second-line treatment. Seven months after the diagnosis of lung cancer during the nivolumab treatment, the patient developed an eyelid MCC, initially misdiagnosed as a chalazion. A palliative radiotherapy was performed with clinical benefit. After a total of seven cycles of nivolumab, computed tomography showed a lung and cerebral disease progression. In addition, clinical conditions worsened leading to the patient's death 13 months after the initial lung cancer diagnosis.
Cases of co-occurrence of MCC and non-small cell lung cancer (NSCLC) have rarely been reported. Interestingly, common risk factors may be postulated for both cancers. Considering the rarity of this adverse event, its short-term temporal relation with the administration of the drug, which makes a relation improbable, and the coexistence of other risk factors, which may provide plausible explanations, it is possible to conclude according to the WHO Adverse Reaction Terminology that a causal relation between the occurrence of this serious adverse event and the exposure to the drug is unlikely. However, the case deserves to be reported in the literature.
Merkel 细胞癌（MCC）是一种罕见的皮肤神经内分泌恶性肿瘤，其侵袭性较强。有四个主要因素与它的发展有关：免疫抑制、紫外线辐射、年龄和 Merkel 细胞多瘤病毒（MCPyV）。近年来，免疫检查点抑制剂在 MCC 治疗中显示出了临床活性。
我们报告了一例 82 岁男性的病例，他被诊断患有肺腺癌，接受了 nivolumab 的免疫治疗作为二线治疗。在接受 nivolumab 治疗期间，肺癌诊断后 7 个月，患者出现了眼睑 Merkel 细胞癌，最初误诊为霰粒肿。进行了姑息性放疗，取得了临床获益。在接受了总共 7 个周期的 nivolumab 治疗后，计算机断层扫描显示肺部和脑部疾病进展。此外，临床状况恶化，导致患者在最初诊断为肺癌后 13 个月死亡。
MCC 和非小细胞肺癌（NSCLC）同时发生的病例很少见。有趣的是，这两种癌症可能有共同的危险因素。考虑到这种不良事件的罕见性，它与药物治疗的短期时间关系，使两者不太可能存在关联，以及其他危险因素的共存，这可能提供了合理的解释，因此可以根据世界卫生组织不良反应术语得出结论，这种严重不良事件的发生与药物暴露之间不太可能存在因果关系。然而，该病例值得在文献中报告。
