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Merkel Cell Carcinoma and Interstitial Lung Disease: Case Report on Use of Pembrolizumab

By: Lauren Harrison, MS
Posted: Monday, January 18, 2021

A case report of a patient with Merkel cell carcinoma and underlying interstitial lung disease treated with pembrolizumab was reported in the Journal for ImmunoTherapy of Cancer by Richard Carvajal, MD, of Columbia University Irving Medical Center, New York, and colleagues. The team used active surveillance and a multidisciplinary approach to ensure treatment efficacy without exacerbating the patients underlying lung disease.

“As further studies expand the indications for immune checkpoint blockade therapy, it will remain important to ensure that patients with comorbid conditions are not excluded from these beneficial treatment modalities,” suggested the authors.

A 71-year-old man with fibrotic interstitial lung disease on 2 liters of oxygen presented with progressively enlarging skin nodules on his right ankle and foot in May 2019. On initial exam, there was one 3-cm erythematous nodule on his right lateral foot and several smaller (< 1 cm) nodules on his posterior ankle without appreciable lymphadenopathy. Pathologic analysis of these nodules revealed a pattern consistent with multifocal Merkel cell carcinoma without evidence of metastatic disease.

The patient was treated with two cycles of pembrolizumab and remained on maintenance fluticasone proprionate and salmeterol twice daily. Follow-up imaging demonstrated an improvement in his disease. After this initial therapy, the patient had no decreases in ambulatory oxygen saturations and was continually monitored with serial pulmonary function testing.

Treatment was held in early 2020 due to increased dyspnea with exertion and a slight decrease in carbon monoxide's diffusing capacity. Imaging at that time showed unchanged stable fibrotic disease and persistent response to anticancer therapy. Treatment was resumed with delay due to the COVID-19 pandemic. Further imaging studies through June 2020 suggested no evidence of disease, although the patient’s treatment course was complicated by myocardial infarction in April 2020, leading to final discontinuation of anticancer therapy.

Disclosure: The authors reported no conflicts of interest.



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