Merkel Cell Carcinoma (MCC) is a rare, highly aggressive
neuroendocrine skin cancer. Risk factors for MCC include age
>65 years, immunosuppression, sun exposure and infection by
polyomavirus. This neuroendocrine skin cancer is characterized
by a high rate of recurrence and metastases, including regional
nodal metastases. The use of checkpoint inhibitors (CPIs) has
shown promising results in the treatment of metastatic MCC and,
consequently, CPIs are emerging immunotherapeutic options for
these patients. However, CPI treatment has not been recommended
for patients with organ transplant due to increased risk for acute
allograft rejection/failure possibly caused by such treatment.
Limited data exist on safety and efficacy on use of CPIs among
organ transplant recipients, since such recipients are routinely
excluded from CPI cancer trials. In this case, we describe a 76
year old man, now deceased, who received a kidney transplant
when he was 67 years old and started lifelong immunosuppressive
therapy. After approximately five years, he presented with MCC and
underwent complete surgery for his skin cancer. He progressed with
metastases 16 months later and received initially radiotherapy and
thereafter CPI treatment, with an anti-PD-L1 monoclonal antibody
(avelumab).