AUTHOR=Buonerba Luciana , Di Trolio Rossella , Grimaldi Antonio , Tucci Aniello , Leo Emilio , Ingenito Concetta , Costabile Ferdinando , Ragone Gianluca , Savastano Beatrice , Uzzauto Maria Teresa , Belsito Petrizzi Valeria , Di Lorenzo Giuseppe 

TITLE=Hematological Toxicity During Concomitant Treatment With Ruxolitinib and Avelumab for Merkel Cell Carcinoma

JOURNAL=Frontiers in Oncology

VOLUME=Volume 10 - 2020

YEAR=2020

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2020.579914

DOI=10.3389/fonc.2020.579914

ISSN=2234-943X

ABSTRACT=Background
Merkel Cell Carcinoma (MCC) is a rare neuroendocrine skin cancer.  It frequently emerges in presence of immunosuppression state  as myeloprofiliferative syndromes (MS). MS are treated with Ruxolitinib, a selective JAK1 and JAK2 inhibitor.
Avelumab, an Anti PDL-1 inhibitor is MCC standard treatment. At to date is unknown if avelumab and ruxolitinib have a sinergistic or antagonistic effect when used together.
Methods
We have identified all patients diagnosed with MCC, treated with avelumab, concomitant ruxolitinib, belonging to Tortora Hospital, Pagani and “Santa Maria La Pietà” Hospital, Nola, Italy between 1 June 2019  and 1 April 2020. 
Results
Among 6 MCC we have found 2 patients in treatment with concomitant drugs.  Both  patients were in treatment with Ruxolitinib for MS at standard  regimen  without  hematological side effects. Starting Avelumab dose we found thrombocytopenia, leukopenia and anemia  after cycle 1 and cycle 4 respectively, deciding to suspend  both treatments. Following the suspension the hematological values improved allowing the recovery of avelumab without resuming ruxolitinib.
Conclusions 
The combined treatment of ruxolitinib and avelumab demonstrated severe toxicity. Modify the schedule or reduce the dose of both drugs needs to be studied in order to be able to treat both pathologies.