Due to their side effects, however, National Comprehensive Cancer Network guidelines recommend PD-1 inhibitors for people with disseminated rather than early-stage MCC.PD1/PDL1 pathway inhibitors approved or in clinical trials for use in MCC treatment include:

In March 2017, the U.S. Food and Drug Administration granted accelerated approval to avelumab, a PDL1 inhibitor, to treat adults and children above 12 years with metastatic MCC. In December 2018, the U.S. Food and Drug Administration granted accelerated approval to pembrolizumab (KEYTRUDA, Merck & Co. Inc.) for all ages (adults and pediatrics) with recurrent locally advanced or metastatic Merkel cell carcinoma
Nivolumab (brand name Opdivo, Bristol-Myers Squibb) is in phase III/IV clinical trials
Ipilimumab (brand name Yervoy, Bristol-Myers Squibb) is in phase II clinical trials for use in adults with metastatic MCC.Studies to date have shown a clinical response rate between 50 and 65% for MCC treated with PD-1 pathway inhibitors. Suggestions for further immunotherapy research areas have included therapeutic vaccines or epigenetic modification of HLA-receptors. Prognosis
According to the American Joint Committee on Cancer (AJCC), the natural course of MCC is "variable and depends heavily on the stage at diagnosis". Staging of MCC is classified according to the TNM staging system, a notation system that describes the stage of cancer according to the size of the primary tumor (T), the degree of spread to regional lymph nodes (N), and the presence of distant metastasis (M). A combination of T, N, and M stages dictate the final clinical stage group (0, I, IIA, IIB, IIIA, IIIB, IV). Advanced stage (i.e.
A meta-analysis of seven clinical trials of critically ill COVID-19 participants, each treated with one of three different corticosteroids found a statistically significant reduction in death. The largest reduction was obtained with dexamethasone (36% compared to placebo).In September 2020, the European Medicines Agency (EMA) endorsed the use of dexamethasone in adults and adolescents, from twelve years of age and weighing at least 40 kilograms (88 lb), who require supplemental oxygen therapy. Dexamethasone can be taken by mouth or given as an injection or infusion (drip) into a vein.In November 2020, the Public Health Agency of Canadas Clinical Pharmacology Task Group recommended dexamethasone for hospitalized patients requiring mechanical ventilation. Although dexamethasone, and other glucocorticoids, reduce mortality in COVID-19 they have also been associated with an increased risk of secondary infections, secondary infections being a significant issue in critically ill COVID-19 patients.The mechanism of action of dexamethasone involves suppression of late-stage interferon type I programs in severe COVID-19 patients. Endocrine
Dexamethasone is the treatment for the very rare disorder of glucocorticoid resistance.In adrenal insufficiency and Addisons disease, dexamethasone is prescribed when the patient does not respond well to prednisone or methylprednisolone.It can be used in congenital adrenal hyperplasia in older adolescents and adults to suppress Adrenocorticotropic hormone (ACTH) production. It is typically given at night. Pregnancy
Dexamethasone may be given to women at risk of delivering prematurely to promote maturation of the fetus lungs.