Real-World Evidence on Treatment Patterns and Guidelines in Patients With Advanced Merkel Cell Carcinoma Across the US and Europe

Author(s)

Ankita Sood, PharmD, Gagandeep Kaur, M.Pharm, Barinder Singh, RPh.
Pharmacoevidence Pvt. Ltd., Mohali, India.
OBJECTIVES: The advent of immunotherapies has transformed the therapeutic landscape for Merkel cell carcinoma (MCC), necessitating a comprehensive evaluation of their impact on treatment patterns; however, over 50% of patients with advanced MCC (aMCC) do not experience sustained benefits from immunotherapy. This systematic literature review aimed to identify treatment recommendations based on guidelines and to examine real-world patterns of care for aMCC across the US and Europe.
METHODS: Key biomedical databases, including Embase® and MEDLINE®, were searched for relevant English-language publications, focusing on guidelines and real-world treatment patterns in aMCC patients. This study adhered to National Institute for Health and Care Excellence (NICE) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, employing a transparent and unbiased approach.
RESULTS: A total of 13 studies (US: N=10, Europe: N=3) were included. Immunotherapies (avelumab, pembrolizumab, retifanlimab, and nivolumab) are the first-line agents recommended for aMCC by both NCCN and ESMO guidelines. In patients with contraindications or treatment failure, palliative radiotherapy and/or chemotherapy are recommended. Across the US, immunotherapy was the most utilised first-line treatment option (27%-71%), which increased from 37.4% in 2017 to 54.5% in 2018, 59.6% in 2019, and 54.9% in 2020. On the other hand, utilisation of chemotherapy (5%-73%) declined from 23.9% in 2017 to 12.4% in 2020. Similar trends were observed in Europe, with immunotherapy used as 1L treatment in 89%-100% of patients across studies, and chemotherapy (cisplatin/carboplatin + etoposide) used in 11%-59.6% of cases prior to avelumab. Disease progression and toxicity were the major factors responsible for treatment discontinuations.
CONCLUSIONS: Real-world treatment patterns for aMCC are largely consistent with guidelines across the US and Europe, reflecting increased use of immunotherapy as a first-line treatment option. High rates of discontinuation and therapy switching underscore the need for personalized treatment strategies and further evaluation of optimal sequencing in clinical practice.

Conference/Value in Health Info

2025-11, ISPOR Europe 2025, Glasgow, Scotland

Value in Health, Volume 28, Issue S2

Code

HSD94

Topic

Health Service Delivery & Process of Care, Real World Data & Information Systems, Study Approaches

Disease

No Additional Disease & Conditions/Specialized Treatment Areas, Oncology

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