Int Ophthalmol Clin. 2020 Spring;60(2):91-102. doi: 10.1097/IIO.0000000000000306.
Merkel cell carcinoma (MCC) is a highly aggressive cutaneous malignancy, with a high metastasis rate and a significant proportion of cases affecting the eyelid or periocular region. Current treatments for periocular MCC include wide local excision (WLE) with or without adjuvant radiotherapy and can result in profound morbidity and visual deficit. Metastatic disease has been traditionally treated with chemotherapy, though durable responses are typically poor and toxicity is high. Avelumab (Bavencio®, Merck KgaA, Darmstadt, Germany and Pfizer Inc., New York, NY, USA), the first FDA-approved human anti-programmed death-ligand 1 (PD-L1) antibody for the treatment of metastatic MCC (mMCC), has demonstrated safety and efficacy as first-line treatment and in chemotherapy-refractory cases. This review summarizes pivotal clinical trial data for avelumab in the treatment of mMCC, including efficacy, safety and tolerability, and describes the efficacy of two other immune checkpoint inhibitors, pembrolizumab (Keytruda®, Merck & Co., Inc., Kenilworth, NJ, USA) and nivolumab (Opdivo®, Bristol‐Myers Squibb, New York, NY, USA and Ono Pharmaceuticals, Trenton, NJ, USA) for the treatment of advanced MCC. Our purpose is to provide the rationale to further investigate avelumab as a potential therapy for advanced or metastatic eyelid and periocular MCC.
默克尔细胞癌（Merkel cell carcinoma，MCC）是一种高度侵袭性的皮肤恶性肿瘤，转移率高，且相当一部分病例累及眼睑或眼周区域。目前，针对眼周 MCC 的治疗方法包括广泛局部切除术（wide local excision，WLE）联合或不联合辅助放疗，这可能导致严重的发病率和视力缺损。转移性疾病传统上采用化疗治疗，但持久缓解通常较差，且毒性较高。avelumab（Bavencio®，德国默克公司和辉瑞公司，美国纽约州纽约市）是首个获美国食品药品监督管理局（FDA）批准用于治疗转移性 MCC（mMCC）的人源抗程序性死亡配体 1（PD-L1）抗体，作为一线治疗和化疗耐药病例均显示出疗效和安全性。本综述总结了 avelumab 治疗 mMCC 的关键性临床试验数据，包括疗效、安全性和耐受性，并描述了另外两种免疫检查点抑制剂 pembrolizumab（Keytruda®，默克公司，新泽西州肯尼沃斯）和 nivolumab（Opdivo®，百时美施贵宝公司和小野制药株式会社，新泽西州特伦顿）治疗晚期 MCC 的疗效。我们的目的是提供进一步研究 avelumab 作为晚期或转移性眼睑和眼周 MCC 潜在治疗药物的依据。
