Crossing borders: on the treatment of stage III melanoma and Merkel cell carcinoma

Abstract

With the arrival of effective systemic therapies, the treatment of metastasized melanoma and Merkel cell carcinoma has evolved rapidly in recent years. In this thesis we have studied the role of surgery in the era of immunotherapy, as well as two new combination therapies for stage III melanoma. We found that lymph node dissections for stage III melanoma can be performed safely after treatment with neoadjuvant systemic therapy. Furthermore, we present the results of the phase II NIVEC trial, investigating the combination of nivolumab with T-VEC treatment for stage III melanoma. In addition, the phase I of the Nivo-ILP trial is presented here, testing the safety of combining nivolumab with an isolated limb perfusion for stage III melanoma.

The second part of this thesis studies the more rare but aggressive skin cancer called Merkel cell carcinoma. We have investigated the use of different types of imaging for optimal staging of this cancer type, as well as two histopathological parameters as prognostic value for survival. In the last chapter of this thesis, we show that the duration of immunotherapy treatment for metastasized Merkel cell carcinoma can safely be reduced.