Chemotherapy in neuroendocrine/Merkel cell carcinoma of the skin: case series and review of 204 cases

J Clin Oncol. 2000 Jun;18(12):2493-9. doi: 10.1200/JCO.2000.18.12.2493.


Purpose: To study the use of chemotherapy for Merkel cell carcinoma (MCC) of the skin.

Patients and methods: Twenty-five cases of MCC were treated at the London Regional Cancer Center between 1987 and 1997. Thirteen cases treated with chemotherapy were reviewed with 191 cases from the literature.

Results: At presentation, 24 patients had localized skin lesions (stage I) and one had locoregional involvement (stage II). Among the nine cases with recurrent nodal disease, six had chemotherapy as a component of salvage treatment. They were all free of disease at a median of 19 months (range, 12 to 37 months). In contrast, two patients who had salvage radiotherapy alone died of disease. Overall survival (OS) and disease-free survival (DFS) were 59% and 43%, respectively, at two years. Median OS and DFS were 29 months (range, 1 to 133 months) and 9 months (range, 1 to 133 months), respectively. Nodal disease developed in 12 (50%) of 24 patients with stage I disease, and distant metastases developed in six (25%) of 24. Including those from the literature, there were 204 cases treated with chemotherapy. Cyclophosphamide/doxorubicin (or epirubicin)/vincristine combination +/- prednisone was the most commonly used chemotherapy regimen (47 cases), with an overall response rate of 75.7% (35.1% complete, 35. 1% partial, and 5.4% minor responses). Etoposide/cisplatin (or carboplatin) was the next most commonly used regimen (27 cases), with an overall response rate of 60% (36% complete and 24% partial responses). The difference in response rate was not statistically significant (P =.19). Among the 204 cases, there were seven (3.4%) toxic deaths.

Conclusion: Chemoradiation for locally recurrent or advanced disease may be an option for patients with a good performance status.

Publication types

  • Review

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Carcinoma, Merkel Cell / drug therapy*
  • Carcinoma, Merkel Cell / pathology
  • Carcinoma, Merkel Cell / radiotherapy
  • Combined Modality Therapy
  • Disease-Free Survival
  • Female
  • Humans
  • Karnofsky Performance Status
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Prognosis
  • Skin Neoplasms / drug therapy*
  • Skin Neoplasms / pathology
  • Skin Neoplasms / radiotherapy
  • Treatment Outcome