Treatment of Merkel cell carcinoma in organ transplant recipients—A systematic review

JAAD International Pub Date : 2025-01-31 DOI:10.1016/j.jdin.2025.01.007

Darryl Chin Kai Xian , Choon Chiat Oh MBBS, MSc

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Abstract

Background

There are no clear treatment guidelines for solid organ transplantation (SOT) patients with Merkel cell carcinoma (MCC) despite increased incidence rates.

Objective

To review treatment outcomes of MCC patients with prior SOT.

Methods

A systematic review (Prospective Register of Systematic Reviews CRD42024569200) of studies that reported treatment modalities and outcomes for MCC patients with SOT were selected. Databases screened included PubMed, Web of Science, Scopus, and Embase.

Results

Thirty articles comprising 21 case reports, 8 cohort studies, and 1 clinical trial were included. Treatment modalities reported in case reports and clinical trials included surgery (77.7%), radiotherapy (62.9%), and chemotherapy (25.9%), with 3 patients receiving immune checkpoint inhibitors and 1 patient receiving an oncolytic virus. Cohort studies reported varying usage of surgery, radiotherapy, chemotherapy, and immunosuppression regime modifications.

Limitations

Heterogeneity in methodologies and data reporting of studies included impeded meaningful comparisons. Lack of stratification of immunosuppressed populations in the excluded studies reduced the available patient data for comparison.

Conclusion

Oncolytic virotherapy has the potential to mediate a localized, targeted response with minimal side effects in SOT patients. Inclusion of SOT patients with MCC into future clinical trials involving immunotherapy and immunosuppression combination therapies is needed to establish future treatment guidelines.

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器官移植受者默克尔细胞癌的治疗——系统综述

背景：尽管默克尔细胞癌（MCC）的发病率有所上升，但实体器官移植（SOT）患者的治疗尚无明确的指南。目的探讨MCC合并SOT患者的治疗效果。方法选择一项系统评价（前瞻性系统评价登记册CRD42024569200），对报道MCC合并SOT患者的治疗方式和结果的研究进行系统评价。筛选的数据库包括PubMed、Web of Science、Scopus和Embase。结果共纳入30篇文献，包括21篇病例报告、8项队列研究和1项临床试验。病例报告和临床试验报告的治疗方式包括手术（77.7%）、放疗（62.9%）和化疗（25.9%），其中3例患者接受免疫检查点抑制剂治疗，1例患者接受溶瘤病毒治疗。队列研究报告了手术、放疗、化疗和免疫抑制方案改变的不同用法。局限性研究方法和数据报告的异质性阻碍了有意义的比较。在被排除的研究中缺乏免疫抑制人群的分层减少了可用的患者数据进行比较。结论溶瘤病毒治疗有可能介导SOT患者的局部，靶向反应和最小的副作用。需要将SOT合并MCC的患者纳入未来的临床试验，包括免疫治疗和免疫抑制联合治疗，以建立未来的治疗指南。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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