Introducing Radiotherapy in Metastatic Merkel Cell Carcinoma Patients with Limited Progression on Avelumab: An Effective Step against Primary and Secondary Immune Resistance?
Purpose: To investigate the ability of radiotherapy (RT) to prolong progression-free survival (PFS) and to report treatment-related toxicities among oligoprogressive metastatic Merkel cell carcinoma (mMCC) patients on avelumab. Methods: We retrospectively collected clinical data on mMCC patients who...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-05-01
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| Series: | Journal of Personalized Medicine |
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| Online Access: | https://www.mdpi.com/2075-4426/13/5/841 |
| _version_ | 1797599464933818368 |
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| author | Gianluca Ferini Valentina Zagardo Paola Critelli Anna Santacaterina Serena Sava Mandara Muralidhar Harikar Tejas Venkataram Giuseppe Emmanuele Umana Anna Viola Vito Valenti Stefano Forte |
| author_facet | Gianluca Ferini Valentina Zagardo Paola Critelli Anna Santacaterina Serena Sava Mandara Muralidhar Harikar Tejas Venkataram Giuseppe Emmanuele Umana Anna Viola Vito Valenti Stefano Forte |
| author_sort | Gianluca Ferini |
| collection | DOAJ |
| description | Purpose: To investigate the ability of radiotherapy (RT) to prolong progression-free survival (PFS) and to report treatment-related toxicities among oligoprogressive metastatic Merkel cell carcinoma (mMCC) patients on avelumab. Methods: We retrospectively collected clinical data on mMCC patients who underwent radiotherapy for limited progression on avelumab. Patients were categorized as primary or secondary immune refractory depending on the time of onset of resistance to immunotherapy (at the first or subsequent follow-up visits after avelumab initiation). Pre- and post-RT PFS were calculated. Overall survival (OS) from the first progression treated with RT was also reported. Radiological responses and toxicities were evaluated according to the irRECIST criteria and RTOG scoring system, respectively. Results: Eight patients, including five females, with a median age of 75 years, met our inclusion criteria. The median gross tumor and clinical target volumes at first progression on avelumab were 29.85 cc and 236.7 cc, respectively. The treatment sites included lymph node, skin, brain, and spine metastases. Four patients received more than one course of RT. Most patients were treated with palliative radiation doses (mainly 30 Gy in 3 Gy/day fractions). Two patients were treated with stereotactic RT. Five/eight patients were primary immune refractory. The objective response rate at the first post-RT assessment was 75%, whereas no local failure was reported. The median pre-RT PFS was 3 months. The pre-RT PFS was 37.5% at 6 months and 12.5% at 1 year. The median post-RT PFS was not reached. The post-RT PFS was 60% at 6 months and 1 year. The post-RT OS was 85.7% at 1 year and 64.3% at 2 years. No relevant treatment-related toxicity was observed. After a median follow-up of 18.5 months, 6/8 patients are still alive and continuing on avelumab therapy. Conclusions: Adding radiotherapy to mMCC patients with limited progression on avelumab seems to be safe and effective in prolonging the successful use of immunotherapy, regardless of the type of immune refractoriness. |
| first_indexed | 2024-03-11T03:35:49Z |
| format | Article |
| id | doaj.art-bc4a61deca674299804bd9f909ae28d0 |
| institution | Directory Open Access Journal |
| issn | 2075-4426 |
| language | English |
| last_indexed | 2024-03-11T03:35:49Z |
| publishDate | 2023-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Personalized Medicine |
| spelling | doaj.art-bc4a61deca674299804bd9f909ae28d02023-11-18T02:04:54ZengMDPI AGJournal of Personalized Medicine2075-44262023-05-0113584110.3390/jpm13050841Introducing Radiotherapy in Metastatic Merkel Cell Carcinoma Patients with Limited Progression on Avelumab: An Effective Step against Primary and Secondary Immune Resistance?Gianluca Ferini0Valentina Zagardo1Paola Critelli2Anna Santacaterina3Serena Sava4Mandara Muralidhar Harikar5Tejas Venkataram6Giuseppe Emmanuele Umana7Anna Viola8Vito Valenti9Stefano Forte10REM Radioterapia srl, Via Penninazzo 11, 95029 Viagrande, ItalyREM Radioterapia srl, Via Penninazzo 11, 95029 Viagrande, ItalyDepartment of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, 98122 Messina, ItalyRadiation Oncology Unit, Papardo Teaching Hospital, 98158 Messina, ItalyIstituto Oncologico del Mediterraneo, 95029 Viagrande, ItalyDepartment of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, 95126 Catania, ItalyDepartment of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, 95126 Catania, ItalyDepartment of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, 95126 Catania, ItalyIstituto Oncologico del Mediterraneo, 95029 Viagrande, ItalyREM Radioterapia srl, Via Penninazzo 11, 95029 Viagrande, ItalyIstituto Oncologico del Mediterraneo, 95029 Viagrande, ItalyPurpose: To investigate the ability of radiotherapy (RT) to prolong progression-free survival (PFS) and to report treatment-related toxicities among oligoprogressive metastatic Merkel cell carcinoma (mMCC) patients on avelumab. Methods: We retrospectively collected clinical data on mMCC patients who underwent radiotherapy for limited progression on avelumab. Patients were categorized as primary or secondary immune refractory depending on the time of onset of resistance to immunotherapy (at the first or subsequent follow-up visits after avelumab initiation). Pre- and post-RT PFS were calculated. Overall survival (OS) from the first progression treated with RT was also reported. Radiological responses and toxicities were evaluated according to the irRECIST criteria and RTOG scoring system, respectively. Results: Eight patients, including five females, with a median age of 75 years, met our inclusion criteria. The median gross tumor and clinical target volumes at first progression on avelumab were 29.85 cc and 236.7 cc, respectively. The treatment sites included lymph node, skin, brain, and spine metastases. Four patients received more than one course of RT. Most patients were treated with palliative radiation doses (mainly 30 Gy in 3 Gy/day fractions). Two patients were treated with stereotactic RT. Five/eight patients were primary immune refractory. The objective response rate at the first post-RT assessment was 75%, whereas no local failure was reported. The median pre-RT PFS was 3 months. The pre-RT PFS was 37.5% at 6 months and 12.5% at 1 year. The median post-RT PFS was not reached. The post-RT PFS was 60% at 6 months and 1 year. The post-RT OS was 85.7% at 1 year and 64.3% at 2 years. No relevant treatment-related toxicity was observed. After a median follow-up of 18.5 months, 6/8 patients are still alive and continuing on avelumab therapy. Conclusions: Adding radiotherapy to mMCC patients with limited progression on avelumab seems to be safe and effective in prolonging the successful use of immunotherapy, regardless of the type of immune refractoriness.https://www.mdpi.com/2075-4426/13/5/841Merkel cell carcinomaoligometastasisoligoprogressiveradiotherapystereotactic radiotherapyimmunotherapy |
| spellingShingle | Gianluca Ferini Valentina Zagardo Paola Critelli Anna Santacaterina Serena Sava Mandara Muralidhar Harikar Tejas Venkataram Giuseppe Emmanuele Umana Anna Viola Vito Valenti Stefano Forte Introducing Radiotherapy in Metastatic Merkel Cell Carcinoma Patients with Limited Progression on Avelumab: An Effective Step against Primary and Secondary Immune Resistance? Journal of Personalized Medicine Merkel cell carcinoma oligometastasis oligoprogressive radiotherapy stereotactic radiotherapy immunotherapy |
| title | Introducing Radiotherapy in Metastatic Merkel Cell Carcinoma Patients with Limited Progression on Avelumab: An Effective Step against Primary and Secondary Immune Resistance? |
| title_full | Introducing Radiotherapy in Metastatic Merkel Cell Carcinoma Patients with Limited Progression on Avelumab: An Effective Step against Primary and Secondary Immune Resistance? |
| title_fullStr | Introducing Radiotherapy in Metastatic Merkel Cell Carcinoma Patients with Limited Progression on Avelumab: An Effective Step against Primary and Secondary Immune Resistance? |
| title_full_unstemmed | Introducing Radiotherapy in Metastatic Merkel Cell Carcinoma Patients with Limited Progression on Avelumab: An Effective Step against Primary and Secondary Immune Resistance? |
| title_short | Introducing Radiotherapy in Metastatic Merkel Cell Carcinoma Patients with Limited Progression on Avelumab: An Effective Step against Primary and Secondary Immune Resistance? |
| title_sort | introducing radiotherapy in metastatic merkel cell carcinoma patients with limited progression on avelumab an effective step against primary and secondary immune resistance |
| topic | Merkel cell carcinoma oligometastasis oligoprogressive radiotherapy stereotactic radiotherapy immunotherapy |
| url | https://www.mdpi.com/2075-4426/13/5/841 |
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