The National Institute for Health and Care Excellence (NICE) has recommended avelumab (Bavencio) as a treatment option for metastatic Merkel cell carcinoma.
Avelumab is recommended for the treatment of adults with metastatic Merkel cell carcinoma who have received 1 or more lines of chemotherapy for metastatic disease. It is also recommended within the Cancer Drugs Fund for treatment of adults with metastatic Merkel cell carcinoma who have not been treated with chemotherapy for metastatic disease.
The recommended dose for avelumab is 10 mg/kg administered intravenously over 60 minutes every 2 weeks. Therapy is to be continued until the patient has disease progression or experiences unacceptable toxicity. However, treatment may be continued in presence of radiological disease progression which is not associated with significant clinical deterioration.
Evidence from a small clinical trial suggests improvement in OS with avelumab compared with chemotherapy, but there have been no direct comparisons of avelumab and chemotherapy. As a first- or second-line therapy, it fulfils NICE's criteria for life-extending end-of-life treatment. As a first-line therapy, it is recommended for use within the Cancer Drugs Fund until further evidence is available.
