Evidence map›Paper›PMID 37241012›Full record

ArticleJournal of personalized medicine2023

Introducing Radiotherapy in Metastatic Merkel Cell Carcinoma Patients with Limited Progression on Avelumab: An Effective Step against Primary and Secondary Immune Resistance?

Gianluca Ferini, Valentina Zagardo, Paola Critelli, Anna Santacaterina, Serena Sava, Mandara Muralidhar Harikar, Tejas Venkataram, Giuseppe Emmanuele Umana, Anna Viola, Vito Valenti and 1 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of personalized medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. Review
  5. Review
  6. Article
  7. Article
  8. Article
  9. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Gianluca FeriniREM Radioterapia srl, Via Penninazzo 11, 95029 Viagrande, Italy.ORCID 0000-0002-2305-5544
Valentina ZagardoREM Radioterapia srl, Via Penninazzo 11, 95029 Viagrande, Italy.
Paola CritelliDepartment of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, 98122 Messina, Italy.ORCID 0000-0003-1381-7012
Anna SantacaterinaRadiation Oncology Unit, Papardo Teaching Hospital, 98158 Messina, Italy.
Serena SavaIstituto Oncologico del Mediterraneo, 95029 Viagrande, Italy.
Mandara Muralidhar HarikarDepartment of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, 95126 Catania, Italy.
Tejas VenkataramDepartment of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, 95126 Catania, Italy.
Giuseppe Emmanuele UmanaDepartment of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, 95126 Catania, Italy.ORCID 0000-0002-1573-431X
Anna ViolaIstituto Oncologico del Mediterraneo, 95029 Viagrande, Italy.
Vito ValentiREM Radioterapia srl, Via Penninazzo 11, 95029 Viagrande, Italy.
Stefano ForteIstituto Oncologico del Mediterraneo, 95029 Viagrande, Italy.ORCID 0000-0001-5746-7451

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo investigate the ability of radiotherapy (RT) to prolong progression-free survival (PFS) and to report treatment-related toxicities among oligoprogressive metastatic Merkel cell carcinoma (mMCC) patients on avelumab.

methodsWe retrospectively collected clinical data on mMCC patients who underwent radiotherapy for limited progression on avelumab. Patients were categorized as primary or secondary immune refractory depending on the time of onset of resistance to immunotherapy (at the first or subsequent follow-up visits after avelumab initiation). Pre- and post-RT PFS were calculated. Overall survival (OS) from the first progression treated with RT was also reported. Radiological responses and toxicities were evaluated according to the irRECIST criteria and RTOG scoring system, respectively.

resultsEight patients, including five females, with a median age of 75 years, met our inclusion criteria. The median gross tumor and clinical target volumes at first progression on avelumab were 29.85 cc and 236.7 cc, respectively. The treatment sites included lymph node, skin, brain, and spine metastases. Four patients received more than one course of RT. Most patients were treated with palliative radiation doses (mainly 30 Gy in 3 Gy/day fractions). Two patients were treated with stereotactic RT. Five/eight patients were primary immune refractory. The objective response rate at the first post-RT assessment was 75%, whereas no local failure was reported. The median pre-RT PFS was 3 months. The pre-RT PFS was 37.5% at 6 months and 12.5% at 1 year. The median post-RT PFS was not reached. The post-RT PFS was 60% at 6 months and 1 year. The post-RT OS was 85.7% at 1 year and 64.3% at 2 years. No relevant treatment-related toxicity was observed. After a median follow-up of 18.5 months, 6/8 patients are still alive and continuing on avelumab therapy.

conclusionsAdding radiotherapy to mMCC patients with limited progression on avelumab seems to be safe and effective in prolonging the successful use of immunotherapy, regardless of the type of immune refractoriness.

Indexed as

immune resistanceimmunotherapyMerkel cell carcinomaoligometastasisoligoprogressiveradiotherapystereotactic radiotherapy

Identifiers

PMID37241012
PMCPMC10224079

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.