Chemotherapy in Merkel Cell Carcinoma with Distant Metastasis — Proposal of a Pan-European Clinical Trial

Abstract

Merkel cell carcinoma (MCC) is a rare and highly malignant neuroendocrine skin tumour characterized by a high frequency of metastases (Helmbold et al. 2001). The 5-year survival rate is stage-dependent and ranges from 30 to 74% (Morrison et al. 1990; Meeuwissen et al. 1995; Skelton et al. 1997; Allen et al. 1999). While the combination of surgery and subsequent adjuvant radiotherapy appears to provide optimal local control in stages I (primary) and II (local metastasis), the therapy of stage III (distant metastasis) remains to be defined. The prognosis in stage III MCC is poor. Chemotherapy appears to be the most successful approach in stage III MCC. Nevertheless, a standard chemotherapy for MCC remains to be identified. A variety of different chemotherapy protocols have been used in the treatment of advanced MCC. However, even the few larger studies in this field have the character of extended case reports. Currently, there is no ongoing trial on chemotherapy or other systemic drugs in MCC. Experience is available for cytostatic drugs like cyclophosphamide, doxorubicin, epirubicin, vincristine, etoposide, cisplatin, carboplatin, 5-fluorouracil, dacarbazine, mitoxantrone, bleomycin, and ifosfamide (Voog et al. 1999; Tai et al. 2000).