Rational treatment selection for Merkel cell carcinoma

Merkel cell carcinoma is rare enough that almost every treatment decision in it rests on retrospective series. This trial asked the one question that matters most at diagnosis, whether radical surgery or radical radiotherapy gives better loco-regional control as first definitive treatment, and it is the only randomised attempt at it. The registry entry gives a target of 400, recruitment from 31 March 2016 to 30 December 2018 and an overall end date of 30 September 2020, and lists no publication.

It belongs on a UK page because the failure it represents is a UK service problem as much as a scientific one: a cancer that is out of scope for the genomic test directory, has no patient charity of its own, is counted inside a generic Skin heading in three of the four nations' waiting-time statistics, and whose one randomised trial has left no public answer. What the NHS does fund for it is avelumab, which is on the national list for both the untreated and the previously treated metastatic settings.