HJNO May/Jun 2019

Healthcare Journal of New Orleans I  MAY / JUN 2019 29 For weekly eNews updates and to read the journal online, visit HealthcareJournalNO.com specialists nationwide who are all dedicated to providing care specific to their individual needs. Immunotherapy Drug Used as First-Line Therapy for Merkel Cell Carcinoma Improved Survival Amulti-center phase II clinical trial investigating pembrolizumab as a first-line and programmed cell death-1 therapy in patients with advanced Merkel cell carcinoma reports lasting tumor control, generally manageable side effects, and improved overall survival. The results are pub- lished online in the Journal of Clinical Oncology.  LSU Health New Orleans’ Adam Riker, MD, FACS, professor and chief of surgical oncology, led the study at its School of Medicine and Stan- ley S. Scott Cancer Center. “This study shows the amazing ability of our immune system to fight off and destroy an aggressive form of skin cancer called Merkel cell carcinoma,” said Riker. “The study drug, pem- brolizumab, which is a new form of immuno- therapy, blocks a specific receptor in our bodies, resulting in a super charging of our immune sys- tem to both recognize and destroy cancer cells. The overall impressive results show that this form of immunotherapy is quite effective, giving us an important treatment option for patients with Merkel Cell Carcinoma that has spread within the body.” Fifty patients, aged 46 - 91 years, were enrolled in the open-label, nonrandomized study. Patients were given pembrolizumab intravenously every three weeks for up to two years. Fifty-six percent of participants responded to the drug – 24 per- cent had a complete response, and 32 percent, a partial response. The average length of pro- gression-free survival was 26.8 months, with a 24-month rate of 48.3 percent. The overall sur- vival rate at 24 months was 68.7 percent. Nearly all of the participants (96 percent) experienced some type of treatment-related side effect, and seven patients discontinued the trial because of them. The authors note that one death occurred in a 73-year-old patient with widely metastatic Merkel cell carcinoma and pre-existing atrial fibrillation who withdrew from the trial and died 10 days after a single infusion of pembrolizumab. According to the National Cancer Institute, Merkel cell carcinoma is a disease in whichmalig- nant (cancer) cells form in the skin. Sun exposure and a weak immune system can affect the risk of Merkel cell carcinoma. Though rare, the inci- dence of Merkel cell carcinoma increased by 95 percent between 2000 and 2013. The five-year overall survival rate ranges between 14 and 27 percent for advanced disease. The first drug approved to treat metastatic Merkel cell carcinoma, avelumab, did not gain FDA approval until 2017. The authors add that in 2016, guidelines listed chemotherapy as the sole treatment option for advanced Merkel cell carcinoma. In 2017, pembrolizumab was recom- mended after chemotherapy; and in 2018, ave- lumab, nivolumab, and pembrolizumab were all recommended as preferred first-line therapies, ahead of chemotherapy. The fact that the incidence is highest in peo- ple who are immunosuppressed provides some support for the idea that Merkel cell carcinoma is an immunogenic cancer, one that is related to immune function, and a good candidate for immunotherapy. The National Cancer Institute defines immunotherapy as “a type of therapy that uses substances to stimulate or suppress the immune system to help the body fight can- cer, infection, and other diseases. Some types of immunotherapy only target certain cells of the immune system. Others affect the immune system in a general way.  Types of immunother- apy include cytokines, vaccines, bacillus Cal- mette-Guerin (BCG), and some monoclonal antibodies.” Pembrolizumab is a monoclonal antibody. Other centers participating in the trial are: Uni- versity of Washington/Fred Hutchinson Cancer Research Center,Johns Hopkins Kimmel Cancer Center, Bloomberg–Kimmel Institute for Cancer Immunotherapy, Emory University, Moffitt Can- cer Center, Mount Sinai Medical Center, Univer- sity of California San Francisco, Yale University, Stanford University, University of Pittsburgh, Duke University Medical Center, Ohio State Uni- versity Comprehensive Cancer Center, City of Hope, Fred Hutchinson Cancer Research Center/ Cancer Immunotherapy Trials Network, Univer- sity of Washington, and Axio Research. The research was supported by grants from the National Cancer Institute, the Merkel cell carci- noma (MCC) patient gift fund at University of Washington, the Kelsey Dickson MCC Challenge Grant from the Prostate Cancer Foundation, the Al Copeland Foundation, and Merck, which pro- vided pembrolizumab and partial funding for this study. La. Dept. of Health Urges Doctors toWatch for Measles An upswing inmeasles cases across the coun- try has the Louisiana Department of Health urg- ing doctors to be on the lookout for the disease. Louisiana has yet to report a case of measles this year. The federal Centers for Disease Control and Prevention (CDC) has identified an increase in measles cases in the United States. From Jan. 1 to Feb. 7, the CDC has documented 101 individ- ual cases in 10 states: California, Colorado, Con- necticut, Georgia, Illinois, New Jersey, New York, Oregon, Texas, andWashington.  “With Texas and Georgia in such close prox- imity, there is a possibility for measles to move across borders into Louisiana. Healthcare pro- fessionals need to be on the alert for signs and symptoms of this highly contagious disease among their patients so that we can prevent similar outbreaks from occurring here,” said Dr. Alex Billioux, assistant secretary for the Office of Public Health. Measles is a highly contagious infection spread through the air when an infected person coughs, sneezes, or speaks. It takes approximately 11 to 12 days from time of exposure to the exhibition of symptoms. All healthcare providers throughout Louisi- ana should consider measles when diagnosing patients who present with high fevers and a rash. Any suspected cases should be reported to the Office of Public Health Infectious Disease Epi- demiology Hotline at (800) 256-2748 to coor- dinate laboratory testing. Also, doctors should educate patients on the importance of washing their hands, avoiding touching infected surfaces or objects, and covering their nose and mouth when coughing or sneezing. Healthcare providers should encourage all chil- dren and unimmunized individuals to be vacci- nated against measles to protect their health