Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH.
Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA.
Am J Clin Oncol. 2024 Aug 1;47(8):357-362. doi: 10.1097/COC.0000000000001098. Epub 2024 Apr 8.
Immune checkpoint inhibitors are a promising new therapy for advanced Merkel Cell Carcinoma (MCC). We investigated real-world utilization and survival outcomes of first-line immunotherapies in a contemporary cohort.
Using the National Cancer Database (NCDB), we identified 759 patients with MCC between 2015 and 2020 with stage IV disease and known status of first-line systemic therapy. Univariable and multivariable analyses were used to determine predictors of immunotherapy usage. Overall survival (OS) was compared for patients receiving immunotherapy, chemotherapy, or no systemic therapies.
We identified 759 patients meeting our inclusion criteria: 329 patients received immunotherapy, 161 received chemotherapy, and 269 received no systemic therapy. Adjusting for demographic, clinical, and facility factors, high facility volume significantly predicted first-line immunotherapy use (OR 1.99; P =0.017). Median OS was 16.2, 12.3, and 8.7 months, among patients who received immunotherapy, chemotherapy, or no systemic therapy, respectively ( P <0.001). On Cox multivariable survival analysis, first-line immunotherapy treatment (HR=0.79, P =0.041) and treatment at high-volume centers (HR=0.58, P =0.004) were associated with improved OS.
Consistent with clinical trial results, first-line immunotherapy associated with improvement in median overall survival for patients with stage IV MCC, significantly outperforming chemotherapy in this real-world cohort. Treatment at high-volume centers associated with first-line immunotherapy utilization suggesting that familiarity with this rare disease is important to achieving optimal outcomes for metastatic MCC.
免疫检查点抑制剂是治疗晚期 Merkel 细胞癌（MCC）的一种有前途的新疗法。我们研究了在当代队列中一线免疫疗法的实际应用和生存结果。
我们使用国家癌症数据库（NCDB），确定了 2015 年至 2020 年间患有 IV 期疾病且已知一线全身治疗状况的 759 例 MCC 患者。使用单变量和多变量分析来确定免疫治疗使用的预测因素。比较接受免疫治疗、化疗或无全身治疗的患者的总生存率（OS）。
我们确定了 759 例符合纳入标准的患者：329 例接受免疫治疗，161 例接受化疗，269 例未接受全身治疗。调整人口统计学、临床和医疗机构因素后，高医疗机构数量显著预测了一线免疫治疗的使用（OR 1.99；P =0.017）。接受免疫治疗、化疗或无全身治疗的患者的中位 OS 分别为 16.2、12.3 和 8.7 个月（P <0.001）。在 Cox 多变量生存分析中，一线免疫治疗治疗（HR=0.79，P =0.041）和在高容量中心治疗（HR=0.58，P =0.004）与 OS 改善相关。
与临床试验结果一致，一线免疫疗法与 IV 期 MCC 患者的中位总生存期改善相关，在该真实世界队列中明显优于化疗。在高容量中心接受治疗与一线免疫治疗的使用相关，这表明熟悉这种罕见疾病对于转移性 MCC 的最佳治疗结果很重要。
