title: Chemotherapy in neuroendocrine/Merkel cell carcinoma of the skin: case series and review of 204 cases.
abstract: OBJECTIVE
  To study the use of chemotherapy for Merkel cell carcinoma (MCC) of the skin.
  
  
  METHODS
  Twenty-five cases of MCC were treated at the London Regional Cancer Center between 1987 and 1997. Thirteen cases treated with chemotherapy were reviewed with 191 cases from the literature.
  
  
  RESULTS
  At presentation, 24 patients had localized skin lesions (stage I) and one had locoregional involvement (stage II). Among the nine cases with recurrent nodal disease, six had chemotherapy as a component of salvage treatment. They were all free of disease at a median of 19 months (range, 12 to 37 months). In contrast, two patients who had salvage radiotherapy alone died of disease. Overall survival (OS) and disease-free survival (DFS) were 59% and 43%, respectively, at two years. Median OS and DFS were 29 months (range, 1 to 133 months) and 9 months (range, 1 to 133 months), respectively. Nodal disease developed in 12 (50%) of 24 patients with stage I disease, and distant metastases developed in six (25%) of 24. Including those from the literature, there were 204 cases treated with chemotherapy. Cyclophosphamide/doxorubicin (or epirubicin)/vincristine combination +/- prednisone was the most commonly used chemotherapy regimen (47 cases), with an overall response rate of 75.7% (35.1% complete, 35. 1% partial, and 5.4% minor responses). Etoposide/cisplatin (or carboplatin) was the next most commonly used regimen (27 cases), with an overall response rate of 60% (36% complete and 24% partial responses). The difference in response rate was not statistically significant (P =.19). Among the 204 cases, there were seven (3.4%) toxic deaths.
  
  
  CONCLUSIONS
  Chemoradiation for locally recurrent or advanced disease may be an option for patients with a good performance status.
authors.affiliation: London Regional Cancer Center, Ontario, Canada. ptai@scf.sk.ca
authors.forename: P T
authors.initials: PT
authors.lastname: Tai
authors.forename: E
authors.initials: E
authors.lastname: Yu
authors.forename: E
authors.initials: E
authors.lastname: Winquist
authors.forename: A
authors.initials: A
authors.lastname: Hammond
authors.forename: L
authors.initials: L
authors.lastname: Stitt
authors.forename: J
authors.initials: J
authors.lastname: Tonita
authors.forename: J
authors.initials: J
authors.lastname: Gilchrist
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015266:Carcinoma, Merkel Cell / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy; D016896:Treatment Outcome