Avelumab for the treatment of locally advanced or metastatic Merkel cell carcinoma—A multicenter real-world experience in Israel

Itamar Averbuch, Ronen Stoff, Mor Miodovnik, Shlomit Fennig, Gil Bar-Sela, Alexander Yakobson, Jonathan Daliot, Nethanel Asher, Eyal Fenig*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Merkel cell carcinoma (MCC) is a rare and aggressive malignancy of the skin, affecting predominantly the fair-skinned older population exposed to high levels of ultraviolet light. Immune suppression is considered a significant risk factor. With the recent advances in the field of immunotherapy, the treatment paradigm for advanced MCC, traditionally based on chemotherapy, has largely shifted to anti-PD-L1 and PD-1 agents such as avelumab and pembrolizumab, respectively. However, real-world data remain sparse. The aim of this study was to assess real-world evidence of the effectiveness of avelumab in a diverse group of patients with MCC in Israel. Methods: The electronic databases of five university hospitals in Israel were searched for all consecutive patients with MCC treated with at least one dose of avelumab in 2018–2022. Data on baseline, disease-related, treatment-related, and outcome parameters were collected and analyzed. Results: The cohort included 62 patients of whom 22% were immune-suppressed. The overall response rate to avelumab was 59%. The median progression-free survival was 8.1 months, and the median overall survival, 23.5 months, with no differences between immune-competent and immune-suppressed patients. Treatment was well tolerated; any-grade toxicity developed in 34% of patients, and grade 3–4 toxicity, in 14%. Conclusions: Avelumab was found to be effective and safe for the treatment of advanced MCC in a diverse group of patients, including some with immune suppression. Further studies are warranted to evaluate the optimal sequence and duration of treatment and to assess the potential role of avelumab for earlier stages of MCC.

Original languageEnglish
Pages (from-to)12065-12070
Number of pages6
JournalCancer Medicine
Issue number11
StatePublished - Jun 2023


  • Merkel cell carcinoma
  • avelumab
  • immunotherapy
  • real-world experience


Dive into the research topics of 'Avelumab for the treatment of locally advanced or metastatic Merkel cell carcinoma—A multicenter real-world experience in Israel'. Together they form a unique fingerprint.

Cite this