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Combined radio-immunotherapy leads to complete clinical regression of stage IV Merkel cell carcinoma
  1. Daniel R Principe1,
  2. Joseph I Clark2,3,
  3. Bahman Emami4 and
  4. Stanley Borowicz2,3
  1. 1 Medical Scientist Training Program, University of Illinois College of Medicine, Chicago, Illinois, USA
  2. 2 Division of Hematology-Oncology, Department of Medicine, Cardinal Bernardin Cancer Center, Loyola University Medical Center, Hines, Illinois, USA
  3. 3 Medical Service, Edward Hines, Jr. Hines VA Hospital, Hines, Illinois, USA
  4. 4 Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Loyola University Medical Center, Hines, Illinois, USA
  1. Correspondence to Dr Stanley Borowicz, Stanley.Borowicz2{at}


Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine tumour of the skin. While localised disease carries an overall favourable prognosis, metastatic disease is associated with poor clincal outcomes. Most cases of metastatic MCC are managed with systemic chemotherapy or immunotherapy, though 5-year survival for these patients remains a dismal 17%. Here, we present the case of a 79-year-old man with MCC of the right ear with metastases to regional lymph nodes, ipsilateral parotid gland and thoracic spine. He was treated with a combination of first-line radiotherapy and concurrent immune checkpoint inhibition (avelumab), which led to complete clinical regression of disease with minimal adverse effects. This observation suggests that combined radio-immunotherapy warrants larger-scale investigation for use in patients with unresectable MCC.

  • oncology
  • radiotherapy
  • skin cancer
  • immunological products and vaccines
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  • Contributors DRP assimilated patient information, assembled figures and drafted the manuscript. JIC and BE consulted with the patient, provided treatment and edited the manuscript. SB was the primary care provider, consented the patient and edited the manuscript.

  • Funding This study was funded by National Cancer Institute (1F30CA236031) to DP.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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