06/01/2026
Proactive immunotherapy treatment can slash the risk of recurrence for patients with stage 3 Merkel cell carcinoma. In an analysis to be presented at , a randomized, placebo-controlled clinical trial of 100 MCC patients initiated by Fred Hutch Cancer Center scientists showed that checkpoint inhibitor treatment reduced the rate of recurrence from 40% to less than 13% after one year.
“Historically, risk of dying from stage 3 Merkel cell cancer was somewhere between 25 and 50%, depending on whether a patient had stage 3A or 3B,” Fred Hutch and UW MCC expert and lead author Dr. Shailender Bhatia. “One of the key takeaways from the study is that immunotherapy is effective in both the adjuvant and the relapse settings.”
He and his team pitted avelumab, a PD-L1-targeting drug already approved for use against stage 4 MCC, against placebo. Patients whose MCC had spread to nearby lymph nodes and who had been treated with either chemotherapy or radiation were eligible to participate in the trial, dubbed ADAM (for Adjuvant Avelumab in Merkel cell cancer).
The team focused on relapse-free survival and found that avelumab halved recurrence at the two-year mark (21.3% instead of 42.3%). At three, four and five years, only 28.3% of patients who received avelumab relapsed, a rate nearly 16% lower than the 44.5% rate seen in the placebo group.
“Previously, we could discuss this concept with patients, but we did not have the data,” Bhatia said. “One way to think about it is, one in six people may not have their cancer come back if we treat it proactively.”
Patients in the placebo arm who relapsed became eligible for immunotherapy treatment and patients in both arms had high rates of MCC-specific survival.
The data from the ADAM trial can guide clinical decision-making, Bhatia said. Patients may choose to receive avelumab proactively or to wait until their cancer returns.
“Either one of those approaches is reasonable, but it needs to be discussed with the patient,” Bhatia said.
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