Avelumab for Advanced Merkel Cell Carcinoma: Global Real-World Data on Patient Response and Survival

December 22, 2023


Pragmatic and Observational Research

Publication Date

December 22, 2023


Lohray R, Verma KK, Wang LL, Haynes D, Lewis DJ

Merkelcell.org Summary

Avelumab is an immunotherapy used to boost the immune system to fight MCC. Researchers summarized studies of MCC patients on avelumab done across the globe, including data from countries in North and South America, Europe, and Asia. Most of the patients across these studies were over 70 years old or male. The average time before the MCC got worse ranged from 8-24 months and the overall survival time ranged from 20-31 months. Different studies showed different percentages of patients that had a good response to avelumab, from 29% (from a study done in Italy) to 72% (from a study done at the Fred Hutch Cancer Center). The most common side effects from avelumab across these studies included fatigue, reactions from the infusions, and shortness of breath. The researchers also found by comparing many studies that patients on pembrolizumab or nivolumab (two other types of immunotherapies) generally seemed to have better survival than patients on avelumab, though more research needs to be done on this.

It is important to note that responses to immunotherapy are also dependent on the individual patient’s MCC stage, whether they have a healthy immune system, and many other factors. However, this paper summarizes many global studies so that doctors and patients worldwide can get a better understanding of how avelumab works in different “real-world” settings.



Avelumab is a programmed cell death-ligand 1 (PD-L1) inhibitor approved by the Food and Drug Administration for advanced Merkel cell carcinoma (MCC). Studies conducted in real-world settings have shed light on its effectiveness and safety in clinical settings.

Areas Covered

Real-world studies on avelumab for MCC from North and South America, Europe, and Asia have been presented in this review. Most studies are on patients over age 70 and have a male-predominant sex ratio. Overall response rates range from 29.1% to 72.1%, (disease control rate: 60.0–72.7%; complete response rate: 15.8%–37.2%; partial rate: 18.2–42.1%; stable disease: 7.1–30.9%; progressive disease: 7.1–40.0%) and median progression free survival ranges from 8.1 to 24.1 months depending on the population studied. Immunosuppressed patients appear to benefit from avelumab as well, with response rates equivalent to the general population. Patients receiving avelumab as a first-line agent tend to have better outcomes than those using it as a second-line therapy. Fatigue, infusion-related reactions, and dyspnea were some of the most common adverse events identified in real-world studies. Autoimmune hepatitis and thyroiditis were also observed.


The use of avelumab as a safe and effective treatment option for advanced MCC is supported by real-world data, although additional study is required to assess long-term efficacy and safety outcomes.

View the clinical publication