Educational Advancements Made in Treatment of Merkel Cell Carcinoma

i3 Health has provided a continuing medical education/nursing continuing professional development (CME/NCPD)–approved activity, Update on Immunotherapeutic Strategies for Advanced Merkel Cell Carcinoma, that enabled the health care team to acquire significant gains in proficiency and knowledge for treating their patients with Merkel cell carcinoma (MCC).

Merkel cell carcinoma is a rare and aggressive neuroendocrine tumor of unknown origin that typically presents in older white and immunocompromised adults. The American Cancer Society estimates an average of 2,000 diagnoses are made each year. The incidence of MCC has risen rapidly during the past few decades, which has been attributed in part to people living longer with increased sun exposure and weakened immune systems, a feature that suggests an infectious origin and warrants further research. The mortality rate for MCC presently exceeds that of melanoma. The overall 5-year survival rate ranges from 23% to 76%, depending upon stage at presentation. Due to this prognosis, it is valuable for clinicians to participate in educational activities that provide updates on novel treatment strategies for their patients with MCC.

To address the knowledge gaps experienced by clinicians regarding treatment strategies for MCC, i3 Health provided the online educational activity from January 23, 2021, until January 22, 2022. Two key researchers in the field of MCC led the activity: Shailender Bhatia, MD, an Associate Professor in the Division of Medical Oncology at the University of Washington School of Medicine, and Ciara Kelly, MBBCh, BAO, a Medical Oncologist at Memorial Sloan Kettering Cancer Center.

Throughout the duration of the activity, a total of 1,099 people participated, with 170 moving on to complete the activity for credit. Most learners were registered nurses (92%), followed by nurse practitioners, physicians, physician assistants, advanced practice nurses, clinical nurse specialists, and those who chose “other” as their profession. The average number of patients seen with MCC per month was two, and the average number of years in practice was 17.

The baseline data collected revealed knowledge gaps in the following areas: assessing emerging evidence on immunotherapeutic strategies for advanced MCC and describing multidisciplinary approaches to monitor and manage immune-related adverse events in patients receiving treatment for advanced MCC.

Participants were given a matching pretest and posttest at the beginning and end of the activity, respectively. The pretest revealed that 33% of participants successfully understood that immune checkpoint inhibitor therapy is likely to be effective for a patient with MCC who is negative for Merkel cell polyomavirus (MCPyV); 67% successfully understood that first-line pembrolizumab is likely to prolong overall survival compared with first-line chemotherapy for a patient with previously untreated programmed death ligand 1 (PD-L1)–negative MCC; 45% successfully identified enrollment in a clinical trial as the best second-line treatment option for a patient with MCC that has become resistant to pembrolizumab; 65% successfully understood that avelumab should be continued for a patient with MCC who experiences grade 1 immunotherapy-related hepatitis, with close monitoring to ensure that the hepatitis resolves; and only 11% successfully identified pituitary dysfunction as the immune-related adverse event in which a grade 4 toxicity would not warrant discontinuation of immune checkpoint inhibitor therapy for a patient with MCC who is about to start first-line therapy with pembrolizumab.

The posttest assessment revealed significant knowledge gains for each learning outcome: an increase of 63% of participants (96% total) now understood immune checkpoint inhibitor efficacy in MCPyV-negative MCC; 32% more (99% total) understood pembrolizumab efficacy for PD-L1–negative MCC; 51% more (96% total) understood the appropriate setting for clinical trial enrollment for second-line MCC treatment; 32% more (97% total) understood management of grade 1 immunotherapy-related hepatitis; and 75% more (86% total) understood indications for treatment discontinuation for grade 4 immune-related toxicities.

Upon completion of the activity, 87% of participants reported that they felt more confident in treating their patients with MCC, and 88% felt that the material presented would be used to improve the outcomes of their patients.

The data revealed by the posttest assessment affirm the effectiveness of online educational content pertaining to immunotherapeutic strategies for advanced MCC. Based on these data, i3 Health has determined that the multidisciplinary team may benefit from CME/NCPD activities that provide MCC education on the efficacy of novel immunotherapeutic strategies, evaluation of prognostic markers to inform treatment selection, and management of immune-related toxicities.

For More Information

i3 Health (2022). Update on immunotherapeutic strategies for advanced Merkel cell carcinoma: activity outcomes report. Data on file.

American Cancer Society (2023). Survival rates of Merkel cell carcinoma. Available at:

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