21 september 2023: Zie ook dit artikel: https://kanker-actueel.nl/maretakinjecties-hoge-dosis-doen-kanker-volledig-verdwijnen-bij-vrouw-met-recidief-van-merkelcel-carcinoom-75-jaar-en-bij-vrouw-met-borstkanker-in-beide-borsten-50-jaar-zonder-andere-behandelingen-beide-vrouwen-leven-al-jaren-zonder-kanker.html

21 september 2023: Bron: The Lancet, Published:July 11, 2023

Uit een fase II studie ADMEC-O uitgevoerd in 20 verschillende ziekenhuizen in Duitsland en Nederland bij totaal 179 patiënten die volledig waren geopereerd aan een Merkelcelcarcinoom blijkt immuuntherapie met de anti-PD remmer Nivolumab de ziektevrije overleving met 11 procent te verbeteren (84 vs 73 procent) in vergelijking met de observatiegroep. 

Patiënten uit de observatiegroep hadden eerder en meer radiotherapie - bestraling nodig dan de groep die Nivolumab kreeg. Hoewel dit nog een tussenevaluatie is van de 4-jarige studie is er nog geen statistische significantie bereikt. Maar de resultaten waren zo veelbelovend en goed dat deze tussenevaluatie nu al werd gepubliceerd in The Lancet

Uit het abstract:

  • Het 1-jaars ziektevrije overlevingspercentage (DFS) voor de nivolumabgroep was 85%, en het 2-jaars DFS-percentage was 84%.
  • In de observatiegroep was het 1-jarige DFS-percentage 77% (95%-BI: 64-86) en het 2-jarige DFS-percentage 73%.
  • Behandeling met nivolumab als adjuvante therapie resulteerde in een absolute risicoreductie van 0,091 bij 1-jarige ziektevrije overleving en 0,10 bij 2-jarige ziektevrije overleving, vergeleken met alleen observatie.
  • Bijwerkingen van graad 3 tot 4 traden op bij 42% van de patiënten behandeld met nivolumab en bij 11% van de patiënten in de observatiegroep.
  • Er zijn geen behandelingsgerelateerde sterfgevallen gemeld.
Zie ook dit studierapport waarvan abstract verderop in artikel Recurrence and Mortality Risk of Merkel Cell Carcinoma by Cancer Stage and Time From Diagnosis

Het volledige studierapport van studie met Nivolumab is tegen betaling in te zien. Hier het abstract van de studie:

Adjuvant immunotherapy with nivolumab versus observation in completely resected Merkel cell carcinoma (ADMEC-O): disease-free survival results from a randomised, open-label, phase 2 trial



Merkel cell carcinoma (MCC) is an immunogenic but aggressive skin cancer. Even after complete resection and radiation, relapse rates are high. PD-1 and PD-L1 checkpoint inhibitors showed clinical benefit in advanced MCC. We aimed to assess efficacy and safety of adjuvant immune checkpoint inhibition in completely resected MCC (ie, a setting without an established systemic standard-of-care treatment).


In this multicentre phase 2 trial, patients (any stage, Eastern Cooperative Oncology Group performance status 0–1) at 20 academic medical centres in Germany and the Netherlands with completely resected MCC lesions were randomly assigned 2:1 to receive nivolumab 480 mg every 4 weeks for 1 year, or observation, stratified by stage (American Joint Committee on Cancer stages 1–2 vs stages 3–4), age (<65 vs ≥65 years), and sex. Landmark disease-free survival (DFS) at 12 and 24 months was the primary endpoint, assessed in the intention-to-treat populations. Overall survival and safety were secondary endpoints. This planned interim analysis was triggered when the last-patient-in was followed up for more than 1 year. This study is registered with ClinicalTrials.gov (NCT02196961) and with the EU Clinical Trials Register (2013-000043-78).


Between Oct 1, 2014, and Aug 31, 2020, 179 patients were enrolled (116 [65%] stage 3–4, 122 [68%] ≥65 years, 111 [62%] male). Stratification factors (stage, age, sex) were balanced across the nivolumab (n=118) and internal control group (observation, n=61); adjuvant radiotherapy was more common in the control group. At a median follow-up of 24·3 months (IQR 19·2–33·4), median DFS was not reached (between-groups hazard ratio 0·58, 95% CI 0·30–1·12); DFS rates in the nivolumab group were 85% at 12 months and 84% at 24 months, and in the observation group were 77% at 12 months and 73% at 24 months. Overall survival results were not yet mature. Grade 3–4 adverse events occurred in 48 [42%] of 115 patients who received at least one dose of nivolumab and seven [11%] of 61 patients in the observation group. No treatment-related deaths were reported.


Adjuvant therapy with nivolumab resulted in an absolute risk reduction of 9% (1-year DFS) and 10% (2-year DFS). The present interim analysis of ADMEC-O might suggest clinical use of nivolumab in this area of unmet medical need. However, overall survival events rates, with ten events in the active treatment group and six events in the half-the-size observation group, are not mature enough to draw conclusions. The explorative data of our trial support the continuation of ongoing, randomised trials in this area. ADMEC-O suggests that adjuvant immunotherapy is clinically feasible in this area of unmet medical need.


Bristol Myers Squibb.

Recurrence and Mortality Risk of Merkel Cell Carcinoma by Cancer Stage and Time From Diagnosis

Key Points

Question  What is the risk that Merkel cell carcinoma (MCC) will recur based on a patient’s cancer stage and time since diagnosis?

Findings  In this cohort study of 618 patients from a large data repository, 40% of whom experienced a recurrence, stage was a powerful prognostic factor: at 5 years, 80% of patients with pathologic stage I were without MCC recurrence vs 28% of patients with stage IV. Approximately 95% of all MCC recurrences arose within 3 years of diagnosis.

Meaning  Recurrence data can help clinicians determine which patients with MCC merit intensive surveillance and when de-escalation of surveillance is appropriate.


Importance  Merkel cell carcinoma (MCC) often behaves aggressively; however, disease-recurrence data are not captured in national databases, and it is unclear what proportion of patients with MCC experience a recurrence (estimates vary from 27%-77%). Stage-specific recurrence data that includes time from diagnosis would provide more precise prognostic information and contribute to risk-appropriate clinical surveillance.

Objective  To estimate risk of stage-specific MCC recurrence and mortality over time since diagnosis.

Design, Setting, and Participants  This prospective cohort study included 618 patients with MCC who were prospectively enrolled in a Seattle-based data repository between 2003 and 2019. Of these patients, 223 experienced a recurrence of MCC. Data analysis was performed July 2019 to November 2021.

Main Outcomes and Measures  Stage-specific recurrence and survival, as well as cumulative incidence and Kaplan-Meier analyses.

Results  Among the 618 patients included in the analysis (median age, 69 [11-98] years; 227 [37%] female), the 5-year recurrence rate for MCC was 40%. Risk of recurrence in the first year was high (11% for patients with pathologic stage I, 33% for pathologic stage IIA/IIB, 30% for pathologic stage IIIA, 45% for pathologic stage IIIB, and 58% for pathologic stage IV), with 95% of recurrences occurring within the first 3 years. Median follow-up among living patients was 4.3 years. Beyond stage, 4 factors were associated with increased recurrence risk in univariable analyses: immunosuppression (hazard ratio , 2.4; 95% CI, 1.7-3.3; P < .001), male sex (HR, 1.9; 95% CI, 1.4-2.5; P < .001), known primary lesion among patients with clinically detectable nodal disease (HR, 2.3; 95% CI, 1.4-4.0; P = .001), and older age (HR, 1.1; 95% CI, 1.0-1.3; P = .06 for each 10-year increase). Among 187 deaths in the cohort, 121 (65%) were due to MCC. The MCC-specific survival rate was strongly stage dependent (95% at 5 years for patients with pathologic stage I vs 41% for pathologic stage IV). Among patients presenting with stage I to II MCC, a local recurrence (17 arising within/adjacent to the primary tumor scar) did not appreciably diminish survival compared with patients who had no recurrence (85% vs 88% MCC-specific survival at 5 years).

Conclusions and Relevance  In this cohort study, the MCC recurrence rate (approximately 40%) was notably different than that reported for invasive melanoma (approximately 19%), squamous cell carcinoma (approximately 5%-9%), or basal cell carcinoma (approximately 1%-2%) following definitive therapy. Because more than 90% of MCC recurrences arise within 3 years, it is appropriate to adjust surveillance intensity accordingly. Stage- and time-specific recurrence data can assist in appropriately focusing surveillance resources on patients and time intervals in which recurrence risk is highest.


  1. 1.
    • Gauci ML 
    • Aristei C 
    • Becker JC 
    • et al.
    Diagnosis and treatment of Merkel cell carcinoma: European consensus-based interdisciplinary guideline—update 2022.
    Eur J Cancer. 2022; 171: 203-231
  2. 2.
    • McEvoy AM 
    • Lachance K 
    • Hippe DS 
    • et al.
    Recurrence and mortality risk of Merkel cell carcinoma by cancer stage and time from diagnosis.
    JAMA Dermatol. 2022; 158: 382-389
  3. 3.
    • Stang A 
    • Becker JC 
    • Nghiem P 
    • Ferlay J
    The association between geographic location and incidence of Merkel cell carcinoma in comparison to melanoma: an international assessment.
    Eur J Cancer. 2018; 94: 47-60
  4. 4.
    • Kaufman HL 
    • Russell J 
    • Hamid O 
    • et al.
    Avelumab in patients with chemotherapy-refractory metastatic Merkel cell carcinoma: a multicentre, single-group, open-label, phase 2 trial.
    Lancet Oncol. 2016; 17: 1374-1385
  5. 5.
    • Nghiem P 
    • Bhatia S 
    • Lipson EJ 
    • et al.
    Three-year survival, correlates and salvage therapies in patients receiving first-line pembrolizumab for advanced Merkel cell carcinoma.
    J Immunother Cancer. 2021; 9e002478
  6. 6.
    • D'Angelo SP 
    • Bhatia S 
    • Brohl AS 
    • et al.
    Avelumab in patients with previously treated metastatic Merkel cell carcinoma: long-term data and biomarker analyses from the single-arm phase 2 JAVELIN Merkel 200 trial.
    J Immunother Cancer. 2020; 8e000674
  7. 7.
    • Spassova I 
    • Ugurel S 
    • Kubat L 
    • et al.
    Clinical and molecular characteristics associated with response to therapeutic PD-1/PD-L1 inhibition in advanced Merkel cell carcinoma.
    J Immunother Cancer. 2022; 10e003198
  8. 8.
    • Topalian SL 
    • Bhatia S 
    • Amin A 
    • et al.
    Neoadjuvant nivolumab for patients with resectable Merkel cell carcinoma in the CheckMate 358 Trial.
    J Clin Oncol. 2020; 38: 2476-2487
  9. 9.
    • Bhatia S 
    • Storer BE 
    • Iyer JG 
    • et al.
    Adjuvant radiation therapy and chemotherapy in Merkel cell carcinoma: survival analyses of 6908 cases from the National Cancer Data Base.
    J Natl Cancer Inst. 2016; 108djw042
  10. 10.
    • NCCN Clinical Practice Guidelines in Oncology
    Merkel cell carcinoma; version 2.
    Date: 2022
    Date accessed: November 8, 2022
  11. 11.
    • Becker JC 
    • Beer AJ 
    • DeTemple VK 
    • et al.
    S2k Guideline—Merkel cell carcinoma (MCC, neuroendocrine carcinoma of the skin)—update 2022.
    J Dtsch Dermatol Ges. 2023; 21: 305-320
  12. 12.
    • Signorini DF 
    • Leung O 
    • Simes RJ 
    • Beller E 
    • Gebski VJ 
    • Callaghan T
    Dynamic balanced randomization for clinical trials.
    Stat Med. 1993; 12: 2343-2350
  13. 13.
    • Zhao X 
    • Shen J 
    • Ivaturi V 
    • et al.
    Model-based evaluation of the efficacy and safety of nivolumab once every 4 weeks across multiple tumor types.
    Ann Oncol. 2020; 31: 302-309
  14. 14.
    • Machin D 
    • Campbell MJ 
    • Tan SB 
    • Tan SH
    Sample size tables for clinical studies.
    3rd edn. Wiley Blackwell, New York, NY2009
  15. 15.
    • Farley CR 
    • Perez MC 
    • Soelling SJ 
    • et al.
    Merkel cell carcinoma outcomes: does AJCC8 underestimate survival?.
    Ann Surg Oncol. 2020; 27: 1978-1985
  16. 16.
    • Shalhout SZ 
    • Kaufman HL 
    • Emerick KS 
    • Miller DM
    Immunotherapy for nonmelanoma skin cancer: facts and hopes.
    Clin Cancer Res. 2022; 28: 2211-2220
  17. 17.
    • Becker JC 
    • Hassel JC 
    • Menzer C 
    • et al.
    Adjuvant ipilimumab compared with observation in completely resected Merkel cell carcinoma (ADMEC): a randomized, multicenter DeCOG/ADO study.
    J Clin Oncol. 2018; 369527
  18. 18.
    • Jouary T 
    • Leyral C 
    • Dreno B 
    • et al.
    Adjuvant prophylactic regional radiotherapy versus observation in stage I Merkel cell carcinoma: a multicentric prospective randomized study.
    Ann Oncol. 2012; 23: 1074-1080
  19. 19.
    • Kim S 
    • Wuthrick E 
    • Blakaj D 
    • et al.
    Combined nivolumab and ipilimumab with or without stereotactic body radiation therapy for advanced Merkel cell carcinoma: a randomised, open label, phase 2 trial.
    Lancet. 2022; 400: 1008-1019
  20. 20.
    • Shalhout SZ 
    • Emerick KS 
    • Kaufman HL 
    • Silk AW 
    • Thakuria M 
    • Miller DM
    A retrospective study of ipilimumab plus nivolumab in anti-PD-L1/PD-1 refractory Merkel cell carcinoma.
    J Immunother. 2022; 45: 299-302
  21. 21.
    • Glutsch V 
    • Schummer P 
    • Kneitz H 
    • et al.
    Ipilimumab plus nivolumab in avelumab-refractory Merkel cell carcinoma: a multicenter study of the prospective skin cancer registry ADOREG.
    J Immunother Cancer. 2022; 10e005930
  22. 22.
    • Poulsen M 
    • Rischin D 
    • Walpole E 
    • et al.
    High-risk Merkel cell carcinoma of the skin treated with synchronous carboplatin/etoposide and radiation: a Trans-Tasman Radiation Oncology Group Study—TROG 96:07.
    J Clin Oncol. 2003; 21: 4371-4376
  23. 23.
    • Poulsen M 
    • Walpole E 
    • Harvey J 
    • et al.
    Weekly carboplatin reduces toxicity during synchronous chemoradiotherapy for Merkel cell carcinoma of skin.
    Int J Radiat Oncol Biol Phys. 2008; 72: 1070-1074
  24. 24.
    • Becker JC 
    • Lorenz E 
    • Ugurel S 
    • et al.
    Evaluation of real-world treatment outcomes in patients with distant metastatic Merkel cell carcinoma following second-line chemotherapy in Europe.
    Oncotarget. 2017; 8: 79731-79741
  25. 25.
    • Hatswell AJ 
    • Baio G 
    • Berlin JA 
    • Irs A 
    • Freemantle N
    Regulatory approval of pharmaceuticals without a randomised controlled study: analysis of EMA and FDA approvals 1999–2014.
    BMJ Open. 2016; 6e011666
  26. 26.
    • Mishra-Kalyani PS 
    • Amiri Kordestani L 
    • Rivera DR 
    • et al.
    External control arms in oncology: current use and future directions.
    Ann Oncol. 2022; 33: 376-383
  27. 27.
    • Gross AM
    Using real world data to support regulatory approval of drugs in rare diseases: a review of opportunities, limitations & a case example.
    Curr Probl Cancer. 2021; 45100769
  28. 28.
    • Bond C 
    • Lancaster GA 
    • Campbell M 
    • et al.
    Pilot and feasibility studies: extending the conceptual framework.
    Pilot Feasibility Stud. 2023; 9: 24
  29. 29.
    • Nghiem P 
    • Kaufman HL 
    • Bharmal M 
    • Mahnke L 
    • Phatak H 
    • Becker JC
    Systematic literature review of efficacy, safety and tolerability outcomes of chemotherapy regimens in patients with metastatic Merkel cell carcinoma.
    Future Oncol. 2017; 13: 1263-1279
  30. 30.
    • Jain V 
    • Hwang WT 
    • Venigalla S 
    • et al.
    Association of age with efficacy of immunotherapy in metastatic melanoma.
    Oncologist. 2020; 25: e381-e385
  31. 31.
    • Wong SK 
    • Blum SM 
    • Sun X 
    • et al.
    Efficacy and safety of immune checkpoint inhibitors in young adults with metastatic melanoma.
    Eur J Cancer. 2023; 181: 188-197
  32. 32.
    • Clegg A 
    • Young J 
    • Iliffe S 
    • Rikkert MO 
    • Rockwood K
    Frailty in elderly people.
    Lancet. 2013; 381: 752-762
  33. 33.
    • Eigentler TK 
    • Hassel JC 
    • Berking C 
    • et al.
    Diagnosis, monitoring and management of immune-related adverse drug reactions of anti-PD-1 antibody therapy.
    Cancer Treat Rev. 2016; 45: 7-18
  34. 34.
    • Nebhan CA 
    • Cortellini A 
    • Ma W 
    • et al.
    Clinical outcomes and toxic effects of single-agent immune checkpoint inhibitors among patients aged 80 years or older with cancer: a multicenter international cohort study.
    JAMA Oncol. 2021; 7: 1856-1861
  35. 35.
    • Handforth C 
    • Clegg A 
    • Young C 
    • et al.
    The prevalence and outcomes of frailty in older cancer patients: a systematic review.
    Ann Oncol. 2015; 26: 1091-1101
  36. 36.
    • Anscher MS 
    • Arora S 
    • Weinstock C 
    • et al.
    Association of radiation therapy with risk of adverse events in patients receiving immunotherapy: a pooled analysis of trials in the US Food and Drug Administration database.
    JAMA Oncol. 2022; 8: 232-240

Linked Articles

Related Specialty Collections

This article can be found in the following collections:

Paulson  KG, Iyer  JG, Blom  A,  et al.  Systemic immune suppression predicts diminished Merkel cell carcinoma-specific survival independent of stage.   J Invest Dermatol. 2013;133(3):642-646. doi:10.1038/jid.2012.388PubMedGoogle ScholarCrossref
Paulson  KG, Park  SY, Vandeven  NA,  et al.  Merkel cell carcinoma: current US incidence and projected increases based on changing demographics.   J Am Acad Dermatol. 2018;78(3):457-463. doi:10.1016/j.jaad.2017.10.028PubMedGoogle ScholarCrossref
Albores-Saavedra  J, Batich  K, Chable-Montero  F, Sagy  N, Schwartz  AM, Henson  DE.  Merkel cell carcinoma demographics, morphology, and survival based on 3870 cases: a population based study.   J Cutan Pathol. 2010;37(1):20-27. doi:10.1111/j.1600-0560.2009.01370.xPubMedGoogle ScholarCrossref
Becker  JC.  Merkel cell carcinoma.   Ann Oncol. 2010;21(suppl 7):vii81-vii85. doi:10.1093/annonc/mdq366PubMedGoogle ScholarCrossref
Allen  PJ, Bowne  WB, Jaques  DP, Brennan  MF, Busam  K, Coit  DG.  Merkel cell carcinoma: prognosis and treatment of patients from a single institution.   J Clin Oncol. 2005;23(10):2300-2309. doi:10.1200/JCO.2005.02.329PubMedGoogle ScholarCrossref
Soult  MC, Feliberti  EC, Silverberg  ML, Perry  RR.  Merkel cell carcinoma: high recurrence rate despite aggressive treatment.   J Surg Res. 2012;177(1):75-80. doi:10.1016/j.jss.2012.03.067PubMedGoogle ScholarCrossref
Santamaria-Barria  JA, Boland  GM, Yeap  BY, Nardi  V, Dias-Santagata  D, Cusack  JC  Jr.  Merkel cell carcinoma: 30-year experience from a single institution.   Ann Surg Oncol. 2013;20(4):1365-1373. doi:10.1245/s10434-012-2779-3PubMedGoogle ScholarCrossref
Gillenwater  AM, Hessel  AC, Morrison  WH,  et al.  Merkel cell carcinoma of the head and neck: effect of surgical excision and radiation on recurrence and survival.   Arch Otolaryngol Head Neck Surg. 2001;127(2):149-154. doi:10.1001/archotol.127.2.149
ArticlePubMedGoogle ScholarCrossref
Harms  KL, Healy  MA, Nghiem  P,  et al.  Analysis of prognostic factors from 9387 Merkel cell carcinoma cases forms the basis for the new 8th Edition AJCC Staging System.   Ann Surg Oncol. 2016;23(11):3564-3571. doi:10.1245/s10434-016-5266-4PubMedGoogle ScholarCrossref
Bichakjian  CK, Olencki  T, Alam  M,  et al; National Comprehensive Cancer Network.  Merkel cell carcinoma, version 1.2014.   J Natl Compr Canc Netw. 2014;12(3):410-424. doi:10.6004/jnccn.2014.0041PubMedGoogle ScholarCrossref
Fields  RC, Busam  KJ, Chou  JF,  et al.  Recurrence after complete resection and selective use of adjuvant therapy for stage I through III Merkel cell carcinoma.   Cancer. 2012;118(13):3311-3320. doi:10.1002/cncr.26626PubMedGoogle ScholarCrossref
Mattavelli  I, Patuzzo  R, Torri  V,  et al.  Prognostic factors in Merkel cell carcinoma patients undergoing sentinel node biopsy.   Eur J Surg Oncol. 2017;43(8):1536-1541. doi:10.1016/j.ejso.2017.05.013PubMedGoogle ScholarCrossref
Eng  TY, Naguib  M, Fuller  CD, Jones  WE  III, Herman  TS.  Treatment of recurrent Merkel cell carcinoma: an analysis of 46 cases.   Am J Clin Oncol. 2004;27(6):576-583. doi:10.1097/01.coc.0000135926.93116.c7PubMedGoogle ScholarCrossref
Farley  CR, Perez  MC, Soelling  SJ,  et al.  Merkel cell carcinoma outcomes: does AJCC8 underestimate survival?   Ann Surg Oncol. 2020;27(6):1978-1985. doi:10.1245/s10434-019-08187-wPubMedGoogle ScholarCrossref
Liang  E, Brower  JV, Rice  SR, Buehler  DG, Saha  S, Kimple  RJ.  Merkel cell carcinoma analysis of outcomes: a 30-year experience.   PLoS One. 2015;10(6):e0129476. doi:10.1371/journal.pone.0129476PubMedGoogle Scholar
Dalal  KM, Patel  A, Brady  MS, Jaques  DP, Coit  DG.  Patterns of first-recurrence and post-recurrence survival in patients with primary cutaneous melanoma after sentinel lymph node biopsy.   Ann Surg Oncol. 2007;14(6):1934-1942. doi:10.1245/s10434-007-9357-0PubMedGoogle ScholarCrossref
Tarhini  A, Ghate  SR, Ionescu-Ittu  R,  et al.  Postsurgical treatment landscape and economic burden of locoregional and distant recurrence in patients with operable nonmetastatic melanoma.   Melanoma Res. 2018;28(6):618-628. doi:10.1097/CMR.0000000000000507PubMedGoogle ScholarCrossref
Lansbury  L, Bath-Hextall  F, Perkins  W, Stanton  W, Leonardi-Bee  J.  Interventions for non-metastatic squamous cell carcinoma of the skin: systematic review and pooled analysis of observational studies.   BMJ. 2013;347:f6153. doi:10.1136/bmj.f6153PubMedGoogle ScholarCrossref
Brantsch  KD, Meisner  C, Schönfisch  B,  et al.  Analysis of risk factors determining prognosis of cutaneous squamous-cell carcinoma: a prospective study.   Lancet Oncol. 2008;9(8):713-720. doi:10.1016/S1470-2045(08)70178-5PubMedGoogle ScholarCrossref
Schmults  CD, Karia  PS, Carter  JB, Han  J, Qureshi  AA.  Factors predictive of recurrence and death from cutaneous squamous cell carcinoma: a 10-year, single-institution cohort study.   JAMA Dermatol. 2013;149(5):541-547. doi:10.1001/jamadermatol.2013.2139
ArticlePubMedGoogle ScholarCrossref
Thissen  MR, Neumann  MH, Schouten  LJ.  A systematic review of treatment modalities for primary basal cell carcinomas.   Arch Dermatol. 1999;135(10):1177-1183. doi:10.1001/archderm.135.10.1177
ArticlePubMedGoogle ScholarCrossref
Rowe  DE, Carroll  RJ, Day  CL  Jr.  Long-term recurrence rates in previously untreated (primary) basal cell carcinoma: implications for patient follow-up.   J Dermatol Surg Oncol. 1989;15(3):315-328. doi:10.1111/j.1524-4725.1989.tb03166.xPubMedGoogle ScholarCrossref
Walker  P, Hill  D.  Surgical treatment of basal cell carcinomas using standard postoperative histological assessment.   Australas J Dermatol. 2006;47(1):1-12. doi:10.1111/j.1440-0960.2006.00216.xPubMedGoogle ScholarCrossref
Griffiths  RW, Suvarna  SK, Stone  J.  Do basal cell carcinomas recur after complete conventional surgical excision?   Br J Plast Surg. 2005;58(6):795-805. doi:10.1016/j.bjps.2005.02.010PubMedGoogle ScholarCrossref
Francken  AB, Shaw  HM, Accortt  NA, Soong  SJ, Hoekstra  HJ, Thompson  JF.  Detection of first relapse in cutaneous melanoma patients: implications for the formulation of evidence-based follow-up guidelines.   Ann Surg Oncol. 2007;14(6):1924-1933. doi:10.1245/s10434-007-9347-2PubMedGoogle ScholarCrossref
Paulson  KG, Lewis  CW, Redman  MW,  et al.  Viral oncoprotein antibodies as a marker for recurrence of Merkel cell carcinoma: a prospective validation study.   Cancer. 2017;123(8):1464-1474. doi:10.1002/cncr.30475PubMedGoogle ScholarCrossref
Tam  M, Luu  M, Barker  CA,  et al.  Improved survival in women versus men with Merkel cell carcinoma.   J Am Acad Dermatol. 2021;84(2):321-329. doi:10.1016/j.jaad.2020.02.034PubMedGoogle ScholarCrossref
Vandeven  N, Lewis  CW, Makarov  V,  et al.  Merkel cell carcinoma patients presenting without a primary lesion have elevated markers of immunity, higher tumor mutation burden, and improved survival.   Clin Cancer Res. 2018;24(4):963-971. doi:10.1158/1078-0432.CCR-17-1678PubMedGoogle ScholarCrossref
Kirchberger  MC, Heppt  MV, Schuler  G, Berking  C, Heinzerling  L.  Merkel cell carcinoma of the head and neck compared to other anatomical sites in a real-world setting: importance of surgical therapy for facial tumors.   Facial Plast Surg. 2020;36(3):249-254. doi:10.1055/s-0039-3401805PubMedGoogle Scholar
Takagishi  SR, Marx  TE, Lewis  C,  et al.  Postoperative radiation therapy is associated with a reduced risk of local recurrence among low risk Merkel cell carcinomas of the head and neck.   Adv Radiat Oncol. 2016;1(4):244-251. doi:10.1016/j.adro.2016.10.003PubMedGoogle ScholarCrossref
Foote  M, Veness  M, Zarate  D, Poulsen  M.  Merkel cell carcinoma: the prognostic implications of an occult primary in stage IIIB (nodal) disease.   J Am Acad Dermatol. 2012;67(3):395-399. doi:10.1016/j.jaad.2011.09.009PubMedGoogle ScholarCrossref
Chen  KT, Papavasiliou  P, Edwards  K,  et al.  A better prognosis for Merkel cell carcinoma of unknown primary origin.   Am J Surg. 2013;206(5):752-757. doi:10.1016/j.amjsurg.2013.02.005PubMedGoogle ScholarCrossref
Asgari  MM, Sokil  MM, Warton  EM, Iyer  J, Paulson  KG, Nghiem  P.  Effect of host, tumor, diagnostic, and treatment variables on outcomes in a large cohort with Merkel cell carcinoma.   JAMA Dermatol. 2014;150(7):716-723. doi:10.1001/jamadermatol.2013.8116
ArticlePubMedGoogle ScholarCrossref
Fields  RC, Busam  KJ, Chou  JF,  et al.  Five hundred patients with Merkel cell carcinoma evaluated at a single institution.   Ann Surg. 2011;254(3):465-473. doi:10.1097/SLA.0b013e31822c5fc1PubMedGoogle ScholarCrossref
Heath  M, Jaimes  N, Lemos  B,  et al.  Clinical characteristics of Merkel cell carcinoma at diagnosis in 195 patients: the AEIOU features.   J Am Acad Dermatol. 2008;58(3):375-381. doi:10.1016/j.jaad.2007.11.020PubMedGoogle ScholarCrossref
Saxena  A, Rubens  M, Ramamoorthy  V, Khan  H.  Risk of second cancers in Merkel cell carcinoma: a meta-analysis of population based cohort studies.   J Skin Cancer. 2014;2014:184245. doi:10.1155/2014/184245PubMedGoogle Scholar
Koljonen  V, Kukko  H, Pukkala  E,  et al.  Chronic lymphocytic leukaemia patients have a high risk of Merkel-cell polyomavirus DNA-positive Merkel-cell carcinoma.   Br J Cancer. 2009;101(8):1444-1447. doi:10.1038/sj.bjc.6605306PubMedGoogle ScholarCrossref
Brewer  JD, Shanafelt  TD, Otley  CC,  et al.  Chronic lymphocytic leukemia is associated with decreased survival of patients with malignant melanoma and Merkel cell carcinoma in a SEER population-based study.   J Clin Oncol. 2012;30(8):843-849. doi:10.1200/JCO.2011.34.9605PubMedGoogle ScholarCrossref
Fields  RC, Busam  KJ, Chou  JF,  et al.  Recurrence and survival in patients undergoing sentinel lymph node biopsy for Merkel cell carcinoma: analysis of 153 patients from a single institution.   Ann Surg Oncol. 2011;18(9):2529-2537. doi:10.1245/s10434-011-1662-yPubMedGoogle ScholarCrossref
Jain  R, Menzin  J, Lachance  K, McBee  P, Phatak  H, Nghiem  PT.  Travel burden associated with rare cancers: the example of Merkel cell carcinoma.   Cancer Med. 2019;8(5):2580-2586. doi:10.1002/cam4.2085PubMedGoogle ScholarCrossref
Nghiem  P, Park  SY.  Less toxic, more effective treatment—a win-win for patients with Merkel cell carcinoma.   JAMA Dermatol. 2019;155(11):1223-1224. doi:10.1001/jamadermatol.2019.2584
ArticlePubMedGoogle ScholarCrossref

Plaats een reactie ...

Reageer op "Merkelcel carcinoom: Immuuntherapie met Nivolumab na volledige operatie van Merkelcelcarcinoom verbetert ziektevrije overleving met 11 procent op 2 jaars meting."

Gerelateerde artikelen