The predominant therapy for merkel cell cancer is surgical resection. Adjunctive chemoradiation and adjuvant immunotherapy may also be required in more advanced disease.

• Merkel cell cancer that has metastasized may respond, at least partially, to treatment with chemotherapy and/or radiation.

• Merkel cell cancer is radiosensitive carcinoma.

• Radiation is an alternative treatment and used can be alone in patients with merkel cell cancer who are not suitable for surgery.^[1]
• Radiotherapy has a curative rate of 75 to 85 percent.^[2]
• Systemic relapse after radiotherapy is one f the cause of death in patients with merkel cell cancer.^[3]

• Adjuvant radiotherapy is effective in reducing the rate of recurrence and increasing the 5-year survival of patients with merkel cell cancer.
  • Preferred dosage: 60 to 66 Gy

• Patients with merkel cell cancer who are having a metastatic disease may get beneficial results with chemotherapy.^[4]

• Chemotherapy usually does not cure the disease, but it can be effective in shrinking the tumor size if the tumor is either too large to be resectable or is located within in critical or difficult regions.
• Contraindications in using chemotherapy is immunosuppression which are of a great concern.
  • Preferred regimen (1): Carboplatin a weekly regimen IV: Target AUC 4.5 on day 1 of weeks 1, 4, 7, and 10.
  • Preferred regimen (2): Etoposide IV concentrations >0.4 mg/mL.

• Using new medications like monoclonal antibodies in patients with merkel cell cancer shows promising results especially if the patients have metastasis.^{[5][6][7][8][9][10][11]}
  • Preferred regimen (1):Avelumab(PD-L1 inhibition ), IV: 800 mg once every 2 weeks until disease progression or unacceptable toxicity.
  • Preferred regimen (2):Nivolumab, IV 240 mg on Day 1 and Day 15.
  • Preferred regimen (3):Pembrolizumab, IV: 200 mg once every 3 weeks until disease progression, unacceptable toxicity.

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