Avelumab in the Treatment of Advanced Merkel Cell Carcinoma: A Systematic Review

Dermatol Surg. 2024 May 1;50(5):407-411. doi: 10.1097/DSS.0000000000004107. Epub 2024 Feb 13.


Background: Avelumab, a programmed death ligand-1 inhibitor, has shown success in providing durable responses for difficult-to-treat Merkel cell carcinomas (MCCs).

Objective: Evaluate the efficacy and safety of avelumab in the treatment of advanced MCC.

Methods: Studies reporting the use of avelumab as a monotherapy or in combination with other agents in the treatment of stage III or IV (advanced) MCC were included. The primary outcomes were overall response rate, overall survival (OS), and treatment-related adverse events.

Results: A total of 48 studies were included, involving 1,565 patients with advanced MCC. Most patients were male (1,051, 67.3%) with stage IV MCC (517, 97.0%). The overall response rate was 46.1% (partial response-25.4% and complete response-20.7%) after a mean follow-up period of 9.5 months. Kaplan-Meier survival curves for the pooled stage III and IV group demonstrated OS rates of 58% at 1 year, 47% at 2 years, and 28% at 5 years after completion of treatment with avelumab (median OS: 23.1 months). The most common treatment-related adverse events consisted of constitutional (44%), gastrointestinal (19%), and dermatologic (12%) symptoms.

Conclusion: Avelumab monotherapy and combination therapy have shown success in the overall response rate and survival for patients with advanced MCC.

Publication types

  • Systematic Review

MeSH terms

  • Antibodies, Monoclonal, Humanized* / administration & dosage
  • Antibodies, Monoclonal, Humanized* / adverse effects
  • Antibodies, Monoclonal, Humanized* / therapeutic use
  • Antineoplastic Agents, Immunological / adverse effects
  • Antineoplastic Agents, Immunological / therapeutic use
  • Carcinoma, Merkel Cell* / drug therapy
  • Carcinoma, Merkel Cell* / pathology
  • Humans
  • Neoplasm Staging
  • Skin Neoplasms* / drug therapy
  • Skin Neoplasms* / mortality
  • Skin Neoplasms* / pathology
  • Survival Rate
  • Treatment Outcome


  • avelumab
  • Antibodies, Monoclonal, Humanized
  • Antineoplastic Agents, Immunological