Keytruda Shows Promise in Patients with Merkel Cell Carcinoma, A Rare Form of Skin Cancer

April 19, 2016

KEYTRUDA is a medicine that contains the humanized antibody pembrolizumab and it treats cancer types such as melanoma and lung cancer by working with the immune system. A new study showed that more than half of the patients responded to a rare but aggressive form of skin cancer known as Merkel cell carcinoma.

It was a small clinical trial in which 26 patients were given the treatment with pembrolizumab and the objective response rate among the 25 patients who could be evaluated was 56%. 4 patients showed complete response and 10 patients had a partial response.
About 80 percent of Merkel cell carcinoma are caused by the viral infection by Merkel cell polyomavirus (MCPyV). This study is very important as it demonstrates that virus-driven cancers may be treated with immunotherapy. Merkel cell carcinoma may also be caused by the exposure to ultraviolet radiation from the sun. Merkel cell carcinoma is more aggressive than melanoma and is several times more lethal.
Right now there’s no drug approved for Merkel cell carcinoma but this study has shed a light on the new action of pembrolizumab, more studies and evidence are required for the better understanding of important questions, such as how long patients should be treated after responding, which patients are most likely to respond to immunotherapy, whether other virus-associated cancers can be treated with immunotherapy. These are some open questions that require more research and findings.
This study was funded by the National Cancer Institute and Merck.

Reference:

PD-1 Blockade with Pembrolizumab in Advanced Merkel-Cell Carcinoma
Paul T. Nghiem, M.D., Ph.D., Shailender Bhatia, M.D., Evan J. Lipson, M.D., Ragini R. Kudchadkar, M.D., Natalie J. Miller, B.A., Lakshmanan Annamalai, D.V.M., Ph.D, Sneha Berry, M.S., Elliot K. Chartash, M.D., Adil Daud, M.B., B.S., Steven P. Fling, Ph.D., Philip A. Friedlander, M.D., Harriet M. Kluger, M.D., Holbrook E. Kohrt, M.D., Ph.D., Lisa Lundgren, M.S., Kim Margolin, M.D., Alan Mitchell, M.Sc., Thomas Olencki, D.O., Drew M. Pardoll, M.D., Ph.D., Sunil A. Reddy, M.D., Erica M. Shantha, M.D., William H. Sharfman, M.D., Elad Sharon, M.D., M.P.H., Lynn R. Shemanski, Ph.D., Michi M. Shinohara, M.D., Joel C. Sunshine, M.D., Ph.D., Janis M. Taube, M.D., John A. Thompson, M.D., Steven M. Townson, Ph.D., Jennifer H. Yearley, D.V.M., Ph.D., Suzanne L. Topalian, M.D., and Martin A. Cheever, M.D.
April 19, 2016 DOI: 10.1056/NEJMoa1603702

Liver cancer: increasing death rate in the US – Highlights of an annual report

The Annual Report to the Nation on the status of Cancer has been created by the collaboration of four such dedicated organizations of the United States:  the National Cancer Institute (NCI), the American Cancer Society (ACS), the Centers for Disease control and prevention (CDC) and the North American Association of Central Cancer registries (NAACCR). Recently, a yearly report has been published by the cooperation of these agencies regarding the growing misfortunes of liver cancer and intra-hepatic bile duct cancers.  The following summary of the report that was published on-line in March 2016 refers to the incidences in the United States.

The purpose and method of study:

The key statistics that were devised by the American Cancer Society for primary liver cancer cases as well as for intra-hepatic bile duct cancer are as follows:

• In the year 2016, approximately 39,230 new cases shall be diagnosed out of which, 28, 410 shall be those in males and 10,280 incidences shall be discovered in women
• Approximately 27,170 people shall die owing to these cancers

Hence, in order to find the increasing prevalence and mortalities due liver and intra-hepatic bile duct cancers, data was obtained from NCI, CDC and NAACCR. The time duration that was included in the study is given as follows:

1. Long-term trends:

• Incidences: from 1992-2012
• Mortalities: from 1975-2012

2. Short-term trends: from 2008-2012

The data in above mentioned time period was used for calculation of annual percent advancements of occurrence and mortality for all types of cancers. However, incidence-based evaluation of person-years of life lost by the disease and an age-period cohort analysis were the two methods applied in order to carry out a deep investigation for liver cancer incidences.

Results:
The results that showed up after a thorough analysis of the details of this study revealed that there has been a continuous decline in death incidences due to all types of cancers among all racial groups and irrespective of the gender bars. In the time period from 2003-2012, there has been a 1.5% decline in the overall death-rates due to cancer.

However, the same improvement was not observed for liver cancer and intra-hepatic bile duct cancers.

Taking into account the non-Hispanic whites, non-Hispanic blacks, as well as Hispanic men and women, the incidences of liver cancer in people born between the years 1938-1947 were increased. Men belonging to the Hispanic and non-Hispanic racial groups have the lowest median age at death due to liver cancer, that is, 60 years and 62 years respectively. They also have the greatest median person-years of life lost per death rate due to the same disease, that is, 21 years and 20 years respectively.

 

The study analysis has also revealed that liver cancer incidences among both the genders and all racial groups have risen sharply during these years, and now the disease ranks second in number, next to thyroid cancer. Mortality due to liver cancer among men has risen by 2.8% per annum, whereas that in the female gender has elevated by 2.2% annually.

Hence, by assessing the study results, it has been concluded that the overall incidences of cancer of all types, as well as deaths related to cancer has declined significantly. However, the burden of liver cancer and intra-hepatic bile duct cancer is increasing, and is not equally distributed among the affected individuals. Moreover, statistics claim that there is a greater misfortune of this disease in the male population of the United States. Men are three times more likely to be affected as compared to the female population.
Keeping into consideration the rising burden of the disease, attempts are being formulated in order to ward-off the risk factors leading to increasing development of liver cancer. Such preventive measurements include vaccination against hepatitis B and C infections, early management of metabolic liver disease, alcoholic liver disease and cirrhosis.

 

Reference:

Ryerson, A. B., Eheman, C. R., Altekruse, S. F., Ward, J. W., Jemal, A., Sherman, R. L., Henley, S. J., Holtzman, D., Lake, A., Noone, A.-M., Anderson, R. N., Ma, J., Ly, K. N., Cronin, K. A., Penberthy, L. and Kohler, B. A. (2016), Annual Report to the Nation on the Status of Cancer, 1975-2012, featuring the increasing incidence of liver cancer. Cancer. doi: 10.1002/cncr.29936