Exciting Updates from Research in Merkel Cell Carcinoma

I recently attended a fascinating discussion in conjunction with the University of Washington Medical School and Fred Hutchinson Cancer Research Center. One of the speakers was Dr. Paul Nghiem, who spoke about his research on treating Merkel cell carcinoma. Merkel cell carcinoma (MCC) is a rare and difficult-to-treat skin cancer that is more likely to recur and is typically deadly in one-third of cases.¹ Dr. Nghiem is one of the leading researchers and experts on how to treat this aggressive cancer, and he and his team are leading a clinical trial that is studying how to leverage the patient’s own immune system to fight the cancer.

A blood test to detect Merkel cell polymavirus

In 2008, two researchers from the University of Pittsburgh – Dr. Patrick Moore and Dr. Yuan Chang – discovered that a common virus, named the Merkel cell polyomavirus, was found in 8 out of 10 tumors tested. In addition, the virus was found to have infiltrated the DNA of the cancer cells, suggesting that it was involved in the development of MCC. Additional research has determined that while most people are exposed to the virus in childhood, it is only in rare individuals that it leads to MCC.²

Dr. Nghiem and his team have developed a blood test that can detect antibodies to the virus. Not everyone with MCC that has the polyomavirus has antibodies, but through his research, Dr. Nghiem has found that the presence of antibodies acts as a biomarker. Approximately half of patients with MCC don’t make the antibodies, and they are more likely to have their cancers recur. This has important treatment implications, as these patients should have more frequent scanning.

The other half of patients who do have antibodies to the virus can be easily monitored with a routine blood test to check their levels of antibodies. If the antibodies go up, this can be an early marker that the cancer recurring. Both patient groups can benefit from having any cancer recurrence detected earlier when treatment options like immunotherapy may be more effective.³

Immunotherapy for Merkel cell carcinoma

Immunotherapy is the branch of medicine that aims to boost a patient’s immune system to attack the cancer cells. Dr. Nghiem said that by using immunotherapy, they have increased the longevity of people with MCC ten-fold. He likened cancer treatment to a chair with four legs with immunotherapy being one important leg. The other legs are surgery, chemotherapy, and radiation. He believes that one of the ways treatment will advance in the near future is unique combinations of immunotherapy and these other treatments.

Dr. Nghiem described how MCC typically have more mutations than some other cancers. These are mutations that the immune system should catch, but the cancer cells are evading the natural immune response. One way to help the immune system recognize the cancer cells is to identify all the mutations in the individual’s MCC and give this blueprint to the body’s T-cells, almost like giving a “Wanted” poster to the immune system. The modified T-cells are then given back to the patient through an infusion, and they go throughout the body looking for the cancer cells. Once they find them, they mark them for destruction by the body. This approach is currently in an early clinical trial.

Precision medicine gives a reason for hope

Dr. Nghiem was asked about a cure, and he said there will not be a single cure for any cancer, as there are hundreds or thousands of different flavors of cancer, and we need unique approaches for each of them. His passion and excitement were evident as he described how quickly immunotherapy and precision medicine are developing. He said it’s impossible to envision where cancer care will be 30 years from now because it is moving incredibly rapidly.

About Dr. Nghiem

Paul Nghiem, MD, PhD is UW Professor of Medicine, Head of Dermatology, and the George F. Odland Chair in Dermatology. He is also Director of the Skin Oncology Clinical Program at Seattle Cancer Care Alliance and Affiliate Investigator at Fred Hutchinson Cancer Research Center.