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Effects of Immunosuppression in Merkel Cell Carcinoma

By: Melissa Steele-Ogus
Posted: Tuesday, September 1, 2020

Immunogenicity seems to play a role in Merkel cell carcinoma, as it has been linked to polyomavirus, and recurrence is linked to chronic T-cell suppression. A relationship between immunosuppression and both recurrence and mortality in patients with this aggressive type of skin cancer was recently explored in a retrospective, observational cohort study published in the Journal of Surgical Oncology by Shachar Laks, MD, of Sheba Medical Center, Ramat Gan, Israel.

“When stratifying by immunosuppression status, the immunocompromised population had higher 5‐year cumulative risks of both cancer‐specific mortality and recurrence than the nonimmunocompromised population,” noted the study investigators.

Researchers obtained data of patients diagnosed with Merkel cell carcinoma between 2003 and 2017 from two tertiary academic institutions. A total of 90 patients were included in the retrospective study; patients with stage IV cancer were excluded. Participants were categorized as immunosuppressed if they were taking an immunomodulating or chemotherapeutic medication for at least 3 months. Recurrence, overall survival, and disease-specific survival were quantified in both immunosuppressed and nonimmunosuppressed patients.

The 5-year overall mortality was 44%, and disease-specific mortality was 19% in the entire cohort. Of the total study participants, 13 were immunosuppressed. Recurrence was observed in 31 patients; patients with any recurrence were significantly more likely to be immunosuppressed than those without any recurrence (32% vs. 5%, P = .001). Furthermore, cancer-specific mortality was significantly higher in immunosuppressed patients (hazard ratio = 6.11, P = .008); this hazard ratio was similar to the hazard ratio for increasing Tstage (hazard ratio = 6.15).

“With diverse tumor characteristics and responses to therapies, treatment regimens are difficult to standardize for the heterogenous Merkel cell carcinoma population,” the investigators noted. “Immunosuppression should be strongly considered when assessing prognosis and deciding on treatment and surveillance options.”

Disclosure: The study authors reported no conflicts of interest.



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