Chemotherapy Versus Radiotherapy for Merkel Cell Carcinoma
Posted: Thursday, December 3, 2020
A study conducted by Aleksander Vayntraub, MD, of Beaumont Health, Royal Oak, Michigan, and colleagues examined overall survival among patients with Merkel cell carcinoma treated with chemotherapy versus radiotherapy. Their work, presented during the virtual edition of the 2020 American Society for Radiation Oncology (ASTRO) Annual Meeting (Abstract 2029), seemed to challenge outcomes of traditional treatment of resection combined with chemoradiotherapy.
“The current study provides further support that radiotherapy is associated with improved survival for patients with Merkel cell carcinoma,” stated the investigators. “Chemotherapy was associated with worse overall survival, and subgroup analysis did not reveal any conditional benefit to chemotherapy.”
The Surveillance, Epidemiology, and End Results database was the source of Merkel cell carcinoma cases where radiotherapy and chemotherapy status, single primary tumor location, and surgery treatment type were listed. A total of 5,042 cases, 2,068 (41%) female and 2,934 (59%) male, were identified for the analysis. Kaplan-Meier and Cox proportional hazard regression modeling was performed for univariate and multivariable analyses.
A total of 13% of patients underwent chemotherapy, whereas 51% had radiotherapy. Among the independent prognostic factors identified in multivariate analysis were age, unknown insurance status, male sex, year of diagnosis, stage, radiotherapy status, and chemotherapy status. At the median follow-up of 178 months, it was discovered that chemotherapy was associated with a decreased overall survival (hazard ratio = 1.22, P < .001). In contrast, improved overall survival was determined with radiotherapy (hazard ratio = 0.9, P = .008). Of the 5,042 patients, 2,898 (58%) died of their disease. According to the investigators, “ongoing trials are needed to identify more effective systemic regimens.”
Disclosure: The study authors reported no conflicts of interest.