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Most cases of metastatic MCC are managed with systemic chemotherapy or immunotherapy, though 5-year survival for these patients remains a dismal 17%. Here, we present the case of a 79-year-old man with MCC of the right ear with metastases to regional lymph nodes, ipsilateral parotid gland and thoracic spine. He was treated with a combination of first-line radiotherapy and concurrent immune checkpoint inhibition (avelumab), which led to complete clinical regression of disease with minimal adverse effects. This observation suggests that combined radio-immunotherapy warrants larger-scale investigation for use in patients with unresectable MCC.<\/jats:p>","DOI":"10.1136\/bcr-2019-230518","type":"journal-article","created":{"date-parts":[[2019,8,22]],"date-time":"2019-08-22T05:17:59Z","timestamp":1566451079000},"page":"e230518","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Combined radio-immunotherapy leads to complete clinical regression of stage IV Merkel cell carcinoma"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4355-6597","authenticated-orcid":false,"given":"Daniel R","family":"Principe","sequence":"first","affiliation":[{"name":"Medical Scientist Training Program, University of Illinois College of Medicine, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph I","family":"Clark","sequence":"additional","affiliation":[{"name":"Division of Hematology-Oncology, Department of Medicine, Cardinal Bernardin Cancer Center, Loyola University Medical Center, Hines, Illinois, USA"},{"name":"Medical Service, Edward Hines, Jr. Hines VA Hospital, Hines, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bahman","family":"Emami","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Loyola University Medical Center, Hines, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanley","family":"Borowicz","sequence":"additional","affiliation":[{"name":"Division of Hematology-Oncology, Department of Medicine, Cardinal Bernardin Cancer Center, Loyola University Medical Center, Hines, Illinois, USA"},{"name":"Medical Service, Edward Hines, Jr. Hines VA Hospital, Hines, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,8,21]]},"reference":[{"key":"2025082711275413000_12.8.e230518.1","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1007\/s13671-014-0068-z","article-title":"Merkel cell carcinoma: epidemiology, target, and therapy","volume":"3","author":"Hughes","year":"2014","journal-title":"Curr Dermatol Rep"},{"key":"2025082711275413000_12.8.e230518.2","unstructured":"Brady M , Spiker AM . 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