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Case Reports
. 2020 May 12;13(2):501-507.
doi: 10.1159/000507279. eCollection 2020 May-Aug.

Challenges of New Approaches in Metastatic Merkel Cell Carcinoma

Ana Monteiro  1 , Emanuel Gouveia  1 , Daniela Garcez  2 , Sara Donato  3 , Diogo Martins-Branco  1 , Joana Marques  1 , Hugo Nunes  1 , Maria José Passos  1 , Ana Isabel Clara  1 , António Moreira  1
Affiliations
Case Reports

Challenges of New Approaches in Metastatic Merkel Cell Carcinoma

Ana Monteiro et al. Case Rep Oncol. .

Abstract

Merkel cell carcinoma is a rare and aggressive cutaneous tumor, and the use of checkpoint inhibitors immunotherapy is a recent indication in its metastatic setting, both first and second line. However, the widespread use of immunotherapy is associated with an increase of acute and late immune-mediated adverse events. We present a case of an elderly fit patient with metastatic Merkel cell carcinoma treated with pembrolizumab who developed diabetic ketoacidosis, a severe immune-mediated adverse event. A multidisciplinary approach was crucial to overcome the life-threatening event. Even with early treatment stop, the patient had a significant and durable response to the treatment for 15 months. Meanwhile, a progressive pan-cerebellar syndrome emerged, possible due to a paraneoplastic syndrome with a negative onco-neuronal antibody panel, although an autoimmune etiology associated with immunotherapy could not be excluded. Unfortunately, the situation was irreversible and refractory to immunomodulatory treatment. Despite the unpredictable toxicity, it is important to note the efficacy profile, with a progression-free survival of 15 months, which is higher than the one reported in reference clinical trials in this setting.

Keywords: Diabetic ketoacidosis; Immune-related adverse events; Immunotherapy; Merkel cell carcinoma; Pan-cerebellar syndrome.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Thoracic computed tomography before treatment start.
Fig. 2
Fig. 2
Upper digestive endoscopy showed gastric metastasis, confirmed by pathologic report, 15 months after ICI treatment start.
See this image and copyright information in PMC

References

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