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Peer-reviewedCC BYCancers

Intratumoral Immunotherapy-The Future of Treating Merkel Cell Carcinoma?

  • Nayonika Pande1
  • Justin C Moser2,3,4
  • Sanjay Chandrasekaran5
  • Andrew S Brohl6
  • Rajan P Kulkarni7
  • Vincent T Ma8,9,10
10 affiliations
  1. 1University of Texas at Austin, Austin, TX 78712, USA.
  2. 2HonorHealth Research Institute, Scottsdale, AZ 85258, USA.
  3. 3Arizona State John Shufeldt School of Medicine and Medical Engineering, Phoenix, AZ 85004, USA.
  4. 4Department of Internal Medicine, University of Arizona College of Medicine, Phoenix, AZ 85004, USA.
  5. 5Department of Internal Medicine, University of Texas Southwestern, Dallas, TX 75390, USA.
  6. 6Moffitt Cancer Center, Tampa, FL 33612, USA.
  7. 7Department of Dermatology, Oregon Health and Sciences University, Portland, OR 97239, USA.
  8. 8Department of Medicine, Division of Hematology, Medical Oncology, and Palliative Care, University of Wisconsin-Madison, Madison, WI 53792, USA.
  9. 9Department of Dermatology, University of Wisconsin-Madison, Madison, WI 53792, USA.
  10. 10University of Wisconsin Carbone Cancer Center, 600 Highland Ave, K4/550, Madison, WI 53792, USA.
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Abstract

Merkel cell carcinoma (MCC) represents a rare but highly aggressive neuroendocrine skin cancer with limited systemic therapy options for patients who fail or are ineligible for immune checkpoint inhibitors (ICIs). Intratumoral (IT) immunotherapy has emerged as a promising strategy, leveraging the accessibility of tumor lesions and their inherent capacity to trigger immune responses, known as abscopal effects. This review synthesizes the current evidence on IT approaches in MCC, including Toll-like receptor agonists, cytokines, and oncolytic viruses, and highlights their distinct mechanisms of action, while emphasizing the critical need for standardized radiographic response assessment of injected and non-injected lesions. Inconsistent documentation of abscopal responses has hindered quantification of IT therapy's systemic potential, particularly in a disease where one-third of patients present with metastases and distant relapse is common. We outline MCC-specific rationale for routine lesion-level tracking, and recommendations for IT trial designs and objectives. Rigorous assessments of abscopal data will clarify IT's role as both rescue therapy and an ICI partner, potentially transforming outcomes in this refractory MCC.

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Cite

BibTeXRIS
BibTeX
@article{pande2026intratumoral,
  title = {{Intratumoral Immunotherapy-The Future of Treating Merkel Cell Carcinoma?}},
  author = {Nayonika Pande and Justin C Moser and Sanjay Chandrasekaran and Andrew S Brohl and Rajan P Kulkarni and Vincent T Ma},
  journal = {Cancers},
  year = {2026},
  month = oct,
  doi = {10.3390/cancers18193226},
  url = {https://europepmc.org/article/MED/42882919},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Intratumoral Immunotherapy-The Future of Treating Merkel Cell Carcinoma?
AU  - Nayonika Pande
AU  - Justin C Moser
AU  - Sanjay Chandrasekaran
AU  - Andrew S Brohl
AU  - Rajan P Kulkarni
AU  - Vincent T Ma
PY  - 2026
DA  - 2026/10/07
JO  - Cancers
DO  - 10.3390/cancers18193226
UR  - https://europepmc.org/article/MED/42882919
AB  - Merkel cell carcinoma (MCC) represents a rare but highly aggressive neuroendocrine skin cancer with limited systemic therapy options for patients who fail or are ineligible for immune checkpoint inhibitors (ICIs). Intratumoral (IT) immunotherapy has emerged as a promising strategy, leveraging the accessibility of tumor lesions and their inherent capacity to trigger immune responses, known as abscopal effects. This review synthesizes the current evidence on IT approaches in MCC, including Toll-like receptor agonists, cytokines, and oncolytic viruses, and highlights their distinct mechanisms of action, while emphasizing the critical need for standardized radiographic response assessment of injected and non-injected lesions. Inconsistent documentation of abscopal responses has hindered quantification of IT therapy's systemic potential, particularly in a disease where one-third of patients present with metastases and distant relapse is common. We outline MCC-specific rationale for routine lesion-level tracking, and recommendations for IT trial designs and objectives. Rigorous assessments of abscopal data will clarify IT's role as both rescue therapy and an ICI partner, potentially transforming outcomes in this refractory MCC.
SN  - 2072-6694
ER  -