1.1 Avelumab is recommended as an option for treating metastatic Merkel cell carcinoma in adults who have had 1 or more lines of chemotherapy for metastatic disease. It is recommended only if the company provides avelumab according to the commercial arrangement.
1.2 This recommendation has been updated and replaced by avelumab for untreated metastatic Merkel cell carcinoma (NICE technology appraisal 691).
Why the committee made these recommendations
Treatment options for metastatic Merkel cell carcinoma are limited. People are usually offered chemotherapy or best supportive care. Avelumab could potentially be used as a first-line treatment or after chemotherapy.
Clinical trial evidence suggests that avelumab may improve overall survival compared with chemotherapy. But chemotherapy has not been compared directly with avelumab so the results are highly uncertain. The evidence on avelumab is promising, but at the time these recommendations were published the trial included only a small number of people and data were still being collected.
Avelumab as a first-line or second-line treatment meets NICE's criteria to be considered a life-extending end-of-life treatment.
Avelumab is recommended as a second-line treatment after chemotherapy because it is within the range NICE normally considers acceptable for end-of-life treatments. In April 2021 the company submitted updated data from the Cancer Drugs Fund on the use of avelumab as first-line treatment. NICE has therefore published new recommendations on avelumab for untreated Merkel cell carcinoma (see NICE technology appraisal 691) and recommendation 1.2 was removed.