What is Immunotherapy for Merkel Cell Carcinoma and its Cost?

Harnessing Immunity Against MCC: Understanding Immunotherapy Options and Their Costs

Merkel cell carcinoma is a rare and aggressive form of skin cancer, and immunotherapy is a highly effective treatment option. This treatment is effective, especially for advanced stages of the disease.

Here is a breakdown of the key immunotherapies used in India:

1. Immune Checkpoint Inhibitors

These are known as PD-1 inhibitor drugs, which act as immune checkpoint inhibitors that block the PD-1 (programmed death-1) pathway of T-cells. Common checkpoint inhibitors include pembrolizumab, nivolumab, and dostarlimab.

These drugs help the immune system recognise and attack cancer cells by preventing it from suppressing the immune response. The cost of these drugs ranges from Rs. 25,000 to Rs. 1,50,000 per cycle.

2. CAR-T Cell Therapy

CAR-T cell therapy is a form of immunotherapy where a patient’s T-cells are genetically modified to recognise and attack cancer cells. It is a personalised treatment that involves collecting T-cells and modifying them to express Chimeric Antigen Receptor (CAR) and introducing them into the patient's body to fight cancer.

CAR-T cell therapy is not a standard treatment for Merkel cell carcinoma and is currently under investigation for solid tumors. It is primarily used for certain blood cancers.

3. Targeted Antibodies

Targeted antibodies, often known as monoclonal antibodies, are used in some cancers, but for Merkel cell carcinoma, immune checkpoint inhibitors like avelumab and pembrolizumab are the most effective and widely approved immunotherapies.

4. Immunomodulators

Immunomodulators are a specific type of biomolecules that modify and regulate the body’s immune response. They may support immune function but are not primary treatments for Merkel cell carcinoma. Checkpoint inhibitors remain the mainstay of immunotherapy.

Essentially, these drugs alter the immune function and trigger the immune cells to fight against the cancer cells. Immunomodulators can cost somewhere between Rs. 1,00,000 and Rs. 3,00,000 along with various combinations of therapies.  

How Effective is Immunotherapy in Treating Merkel Cell Carcinoma?

Immunotherapy has shown promise in treating advanced or metastatic Merkel cell carcinoma, with objective response rates (OPR), as reported in clinical trials. For example, Avelumab, which is a checkpoint inhibitor, has an OPR of 62% in the first-line setting.

The Drug Controller General of India has approved Pembrolizumab as another checkpoint inhibitor, for treating Merkel cell carcinoma. Nivolumab, another checkpoint inhibitor, has shown promising results in the treatment of Merkel cell carcinoma.