Challenges with Treating Merkel Cell Carcinoma and Other Rare Diseases

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In an interview with Rare Disease Report®, Nicholas J. Robert, MD, of McKesson Specialty Health, discussed the challenges and advances involving treating with treating Merkel cell carcinoma.

Merkel cell carcinoma (MCC) is a rare disease as there are only approximately 1500 new cases annually in the United States, according the American Cancer Society.

Nicholas J. Robert, MD, medical director of Health Economic and Research Outcomes/Health Informatics for McKesson Specialty Health, recently discussed the challenges and advances involving treating MCC with Rare Disease Report® at the American Society of Clinical Oncology 2018 annual meeting in Chicago.

Robert explained that with the increasing role of immunotherapy for treating diseases, a unique approach must be taken when treating rare diseases.


“Consequently, a strategy that’s being used now more and more for rare tumors is to treat the patients one way, see what their outcomes are, and then compare this to the data you can find from patients that have been treated; that experience is captured by electronic medical records,” Dr. Robert stated.

Cancers, including MCC, often provide such a challenge because the window of opportunity to cure patients is often early on. With the use of immunotherapies, there has been some benefit, however, not all long-term, according to Robert. He noted how doctors are learning that immunotherapies may be beneficial when used in combination with one another or through combinations with other agents.

“By using a combination of their trial and real-world evidence, there was enough evidence to be convincing to lead to approval,” Robert said. “The expectation is there will be more immunotherapy agents addressing this issue, addressing this kind of cancer.”

Along with the advancements with immunotherapies, Robert discussed the innovation surrounding personalized healthcare precision medicine. Additionally, he mentioned how electronic medical health records have changed, including the addition of an electronic medical record designed for oncology outpatient care. This technology can help physicians make decisions and determine the appropriate treatment, and therefore hopefully improving the outcome, Robert explained.

Additionally, he discussed how patient-reported outcomes are being incorporated into apps, and therefore can help form a connection between patients and their physicians. This connection will help educate patients through better communication but also educate the physicians on their patients outside of the office.

“I think there has been an emphasis [on] educating patients in terms of cancer care and an emphasis on the health team in terms of different treatments,” Robert said in the interview. “However, I think the back-and-forth, the communications with our patients, the education [of providers] is critical, and I think we’re now developing some tools where we have a better opportunity to do that. There’s data to support that it translates to better care.”

See the full interview at Rare Disease Report®'s website.