OBJECTIVES : This study reports patient characteristics, treatment patterns, survival rates, and healthcare resource use (HRU) among patients with advanced Merkel cell carcinoma (aMCC) in England.

METHODS : This cohort included patients ≥18 years diagnosed with stage III/IV MCC (ICD-O: C44, 8247 morphology) between January 2013 and December 2018 in the National Cancer Registration Dataset in England and followed until December 2019. Summary and descriptive statistics were calculated for categorical and continuous variables. The Kaplan-Meier method was used to estimate median overall survival (mOS) from diagnosis date.

RESULTS : A total of 505 patients with aMCC were included. Mean age was 77.8 years (standard deviation [SD], 10.3), most patients were male (59.0%), and 14.5% were immunocompromised at baseline. At diagnosis, 67.3% and 32.7% had stage III and IV disease, respectively. The mean baseline modified Deyo-Charlson Comorbidity Index was 4.1 (SD, 1.8). 353 patients (69.9%) died during follow-up; mOS was 16.9 months (95% CI, 14.0-19.2) and 12- and 24-month survival rates were 58.6% (95% CI, 54.2%-62.8%) and 41.1% (95% CI, 36.8%-45.5%), respectively. During follow-up, 68.3% underwent ≥1 surgical resection and 61.6% received radiation therapy. Only 123 patients (24.4%) received first-line systemic therapy. Of these, 15 (12.2%) also received second-line therapy. The most frequently administered agents were platinum compounds (77.2%), other cytotoxic agents (67.5%), and immune checkpoint inhibitors (ICIs; 24.4%). Of 30 ICI-treated patients, 26 (86.7%) started treatment from March 2018 onwards. For patients receiving systemic therapy, the mean (SD) HRU per patient per year was 54.1 (55.4) outpatient visits, 26.8 (34.0) hospital admissions, and 2.6 (6.6) accident and emergency visits.

CONCLUSIONS : A low percentage of patients with aMCC received systemic treatment. Data from this cohort suggest that the treatment landscape for patients with aMCC is being shifted to ICI therapy, which was incorporated into clinical guidelines in April 2018 by the National Institute for Care and Health Excellence.