BACKGROUND Merkel cell carcinoma(MCC)is a rare and aggressive cutaneous neuroendocrine neoplasia,with high risk of recurrence and metastasis and poor survival.Immune checkpoint inhibitors,like the anti-programmed deat...BACKGROUND Merkel cell carcinoma(MCC)is a rare and aggressive cutaneous neuroendocrine neoplasia,with high risk of recurrence and metastasis and poor survival.Immune checkpoint inhibitors,like the anti-programmed death-ligand 1 agent avelumab,were recently approved for the treatment of advanced MCC.We,herein,report the first case of advanced MCC with oligoprogression managed with avelumab and local radical treatment.CASE SUMMARY A 61-year-old man was presented to the hospital with sporadic fever and an exudative malodorous mass(10 cm of diameter),located on the right gluteal region.The final diagnosis was MCC,cT4N3M1c(AJCC,TNM staging 8th edition,2017),with invasion of adjacent muscle,in-transit metastasis,and bone lesions.Patient started chemotherapy(cisplatin and etoposide),and after six cycles,the main tumor increased,evidencing disease progression.Two months later,the patient started second line treatment with avelumab(under an early access program).After two cycles of treatment,the lesion started to decrease,achieving a major response.Local progression was documented after 16 cycles.However,as the tumor became resectable,salvage surgery was performed,while keeping the systemic treatment with avelumab.Since the patient developed bilateral pneumonia,immunotherapy was suspended.More than 2.5 years after surgery(last 19 mo without systemic therapy),the patient maintains complete local response and stable bone lesions.CONCLUSION This report highlights the efficacy and long-term response of avelumab on the management of a chemotherapy resistant advanced MCC,with evidence of oligoprogression,in combination with local radical treatment.展开更多
Local consolidative therapy(LCT)has been demonstrated to enhance the survival benefits of immunotherapy in non-small cell lung cancer(NSCLC)patients with oligometastatic or oligoprogressive disease.This randomized,pha...Local consolidative therapy(LCT)has been demonstrated to enhance the survival benefits of immunotherapy in non-small cell lung cancer(NSCLC)patients with oligometastatic or oligoprogressive disease.This randomized,phase 2 trial investigated the efficacy and safety of ablation combining continuous immunotherapy in NSCLC patients with oligo-residual disease(ORD)after anti-PD-1/L1 therapy(ChiCTR,identifier:ChiCTR2000032479).From March 2021 to March 2024,65 patients were randomly assigned(2:1)to ablation combination group(n=43)and immunotherapy maintenance group(n=22),and the full analysis set finally included 42 patients in ablation plus immunotherapy group and 20 patients in immunotherapy maintenance group.With a median follow-up duration of 17.8 months,patients receiving ablation combination were associated with significantly longer PFS(median 26.7 vs.11.7 months,p<0.001,HR=0.213,95%CI 0.099–0.461)and a trend of longer OS(p=0.036,HR=0.242,95%CI 0.057–1.019)than those without ablation.Subgroup analysis showed that cryoablation(n=13)yielded potentially superior survival than thermal ablation(n=31)(mPFS:NA vs.22.4 months,p=0.011),which might induced by the elevated level of IFN-αafter cryotherapy compared to thermal ablation(p=0.078).Additionally,ablation combination group showed a decreased rate of systemic progression pattern compared with immunotherapy maintenance group.Regarding safety,the combination of ablation and immunotherapy was well tolerated,with only 1 patient experiencing grade 3 pneumothorax after ablation.In conclusion,the addition of ablation is well-tolerated and prolongs the survival of immunotherapy in patients with advanced NSCLC who develop ORD after anti-PD-1/L1 therapy,while cryoablation showing potentially superior survival benefit compared to thermal ablation.展开更多
文摘BACKGROUND Merkel cell carcinoma(MCC)is a rare and aggressive cutaneous neuroendocrine neoplasia,with high risk of recurrence and metastasis and poor survival.Immune checkpoint inhibitors,like the anti-programmed death-ligand 1 agent avelumab,were recently approved for the treatment of advanced MCC.We,herein,report the first case of advanced MCC with oligoprogression managed with avelumab and local radical treatment.CASE SUMMARY A 61-year-old man was presented to the hospital with sporadic fever and an exudative malodorous mass(10 cm of diameter),located on the right gluteal region.The final diagnosis was MCC,cT4N3M1c(AJCC,TNM staging 8th edition,2017),with invasion of adjacent muscle,in-transit metastasis,and bone lesions.Patient started chemotherapy(cisplatin and etoposide),and after six cycles,the main tumor increased,evidencing disease progression.Two months later,the patient started second line treatment with avelumab(under an early access program).After two cycles of treatment,the lesion started to decrease,achieving a major response.Local progression was documented after 16 cycles.However,as the tumor became resectable,salvage surgery was performed,while keeping the systemic treatment with avelumab.Since the patient developed bilateral pneumonia,immunotherapy was suspended.More than 2.5 years after surgery(last 19 mo without systemic therapy),the patient maintains complete local response and stable bone lesions.CONCLUSION This report highlights the efficacy and long-term response of avelumab on the management of a chemotherapy resistant advanced MCC,with evidence of oligoprogression,in combination with local radical treatment.
基金supported by the National Key R&D Program of China(2023YFC2414000)National Natural Science Foundation of China(No.82373319,No.82172869)+3 种基金Noncommunicable Chronic Diseases-National Science and Technology Major Project(2024ZD0520200,2024ZD0520206)the Science and Technology Commission of Shanghai Municipality(24Y12800300)Shanghai Anticancer Association EYAS PROJECT(SACA-CY23A01)the National Key Clinical Specialty Discipline Construction Program of China:Establishment and Application of a Precision Diagnosis and Treatment System for Chest Tumors.
文摘Local consolidative therapy(LCT)has been demonstrated to enhance the survival benefits of immunotherapy in non-small cell lung cancer(NSCLC)patients with oligometastatic or oligoprogressive disease.This randomized,phase 2 trial investigated the efficacy and safety of ablation combining continuous immunotherapy in NSCLC patients with oligo-residual disease(ORD)after anti-PD-1/L1 therapy(ChiCTR,identifier:ChiCTR2000032479).From March 2021 to March 2024,65 patients were randomly assigned(2:1)to ablation combination group(n=43)and immunotherapy maintenance group(n=22),and the full analysis set finally included 42 patients in ablation plus immunotherapy group and 20 patients in immunotherapy maintenance group.With a median follow-up duration of 17.8 months,patients receiving ablation combination were associated with significantly longer PFS(median 26.7 vs.11.7 months,p<0.001,HR=0.213,95%CI 0.099–0.461)and a trend of longer OS(p=0.036,HR=0.242,95%CI 0.057–1.019)than those without ablation.Subgroup analysis showed that cryoablation(n=13)yielded potentially superior survival than thermal ablation(n=31)(mPFS:NA vs.22.4 months,p=0.011),which might induced by the elevated level of IFN-αafter cryotherapy compared to thermal ablation(p=0.078).Additionally,ablation combination group showed a decreased rate of systemic progression pattern compared with immunotherapy maintenance group.Regarding safety,the combination of ablation and immunotherapy was well tolerated,with only 1 patient experiencing grade 3 pneumothorax after ablation.In conclusion,the addition of ablation is well-tolerated and prolongs the survival of immunotherapy in patients with advanced NSCLC who develop ORD after anti-PD-1/L1 therapy,while cryoablation showing potentially superior survival benefit compared to thermal ablation.
