Highlights
- •Analysis of durability of response after ICI discontinuation in mMCC patients (n = 40).
- •Patients stopped ICI for any reason other than progression.
- •mPFS from discontinuation for entire cohort was 21 months (95% CI 18 – NR).
- •Overall considerable rate of progression, but lower if in a CR.
- •Response rate of 75% (6 of 8) to retreatment with same ICI upon progression.
Abstract
Background
Metastatic Merkel cell carcinoma (mMCC) is highly responsive to immune checkpoint
inhibitors (ICIs); however, durability of response after treatment cessation and response
to retreatment in the setting of progression is unknown.
Methods
Patients (pts) having mMCC from 10 centres who discontinued ICI treatment for a reason
other than progression were studied.
Results
Forty patients were included. Median time on treatment was 13.5 months (range 1–35).
Thirty-one patients (77.5%) stopped treatment electively while 9 patients (22.5%)
stopped due to treatment-related toxicity. After median of 12.3 months from discontinuation,
14 pts (35%) have progressed (PD). Disease progression rate following ICI discontinuation
was 26% (8 of 31) in patients who discontinued in complete response (CR), 57% (4 of
7) in patients in partial response and 100% (2 of 2) in those with stable disease.
Median progression-free survival (PFS) after treatment cessation was 21 months (95%
confidence interval [CI], 18- not reached [NR]), with a third of patients progressing
during their first year off treatment. PFS was longer for patients who discontinued
ICI electively (median PFS 29 months; 95% CI, 21-NR) compared to those who stopped
due to toxicity (median PFS 11 months; 95% CI, 10-NR). ICI was restarted in 8 of 14 pts
(57%) with PD, with response rate of 75% (4 CR, 2 partial response, 1 stable disease,
1 PD).
Conclusion
ICI responses in mMCC do not appear durable off treatment, including in patients who
achieve a CR, though response to retreatment is promising. Extended duration of treatment
needs to be investigated to optimise long-term outcomes.
Keywords
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Article info
Publication history
Published online: January 28, 2023
Accepted:
January 17,
2023
Received in revised form:
January 14,
2023
Received:
October 22,
2022
Identification
Copyright
© 2023 Elsevier Ltd. All rights reserved.
