It’s been quite a stretch these past few weeks as I wrap up my year of locums work and prepare for what’s next. I recently completed my hematology board recertification—maintaining my triple board certification in internal medicine, medical oncology, and hematology—which felt like a meaningful milestone as I close out this transitional locum chapter. With my final locums assignment at Florida Cancer Specialists coming to an end, I’m now in the thick of onboarding and credentialing as I prepare to officially start at AdventHealth Cancer Institute Downtown Orlando on December 1st 2025. My focus will be building our Cutaneous and Connective Tissue Oncology program, expanding access to cellular therapies both commercially and via clinical trials, and bringing more clinical trial opportunities to Central Florida patients. The next few weeks will be busy with meetings, training, and getting everything in place to hit the ground running. Reconnecting with colleagues at recent conferences (FLASCO, ESMO East) and advisory board meetings has reminded me how much I’ve missed the energy of being part of a larger team and hybrid-academic environment. I’m grateful for this opportunity and excited to get started. In the meantime, I’ll continue balancing my entrepreneurial work in real estate and consulting while keeping this platform active with oncology updates. Almost there—December 1st!
Over recent years we’ve witnessed major advances in metastatic MCC with immune checkpoint inhibitors, and now the focus has shifted upstream: can we intervene after surgery to improve outcomes? At ESMO 2025, the newly presented Phase III EA6174 / STAMP trial presented by Dr Janice Mehnert et al. evaluates adjuvant pembrolizumab in patients whose MCC has been fully resected (stage I–IIIb). Here’s my summary of the data, how I interpret it and what it means for practice.
Key Findings
In the STAMP trial (~293 patients), patients were randomized post‑resection to pembrolizumab vs observation. At 1 year, relapse‑free survival (RFS) was 83 % in the pembrolizumab arm versus ~71 % in observation; at 2 years it was 73 % vs 66 %. Although this numerical difference favoured pembrolizumab, the RFS co‑primary endpoint did not reach statistical significance (HR ~0.80; p≈0.105).
Importantly, the trial showed a statistically significant improvement in distant metastasis‑free survival (DMFS) with pembrolizumab (HR ~0.58; p≈0.03) — suggesting a meaningful reduction in the risk of systemic spread. Safety was consistent with known pembrolizumab profiles (~31 % grade 3+ TRAEs). OS data remain immature.
What I Take Away
- For high‑risk resected MCC (particularly node positive / stage III), this phase 3 trial offers the first randomized evidence that adjuvant ICI may reduce the risk of distant relapse.
- The DMFS benefit is especially compelling: in a disease where distant metastases drive poor prognosis, reducing systemic spread is clinically meaningful.
- Patient selection is key: in lower‑risk patients (stage I, sentinel node negative) where the baseline risk of relapse is lower, the absolute benefit may be modest and the toxicity/risk of ICI must be weighed.
- This trial signals a shift: moving effective systemic therapy earlier in MCC, and setting the stage for future neoadjuvant/adjuvant trials, biomarker‑driven strategies and combinatorial approaches.
Practical Considerations & My View
In my cutaneous/connective malignancies clinic, when I see a patient with resected MCC who is stage III node positive, I will likely raise the option of discussing adjuvant pembrolizumab with the multidisciplinary team. More so if the patient did not receive upfront neoadjuvant PD1 inhibitors and/or if circulating tumor DNA positive. For patients with lower‑risk disease, I would lean toward standard surveillance, clinical trials if available and adjuvant radiation (if appropriate) rather than immediate systemic therapy, unless additional high‑risk features exist (e.g., immunosuppression, large tumour burden, lymphovascular invasion, ctdna positive, MCPyV negative status).
Limitations & Future Questions
- As noted, OS data are pending — we await whether the RFS/DMFS advantages translate into survival benefit.
- Biomarker stratification (viral vs non‑viral MCC, immune infiltration, PD‑L1 status) was not yet incorporated into primary analysis — future work is needed.
- The role of neoadjuvant immunotherapy remains to be defined in MCC: could earlier immune priming improve outcomes further?
- Synergy between adjuvant RT and ICI deserves further investigation (scheduling, fractionation, toxicity).
- Real‑world uptake, cost considerations and long‑term toxicities (especially in older patients) will need to be tracked.
In summary: The STAMP trial represents an important step in adjuvant therapy for MCC — offering a signal that adjuvant pembrolizumab can meaningfully reduce distant relapse in resected high‑risk MCC. While not yet definitive for all patients, it provides a compelling rationale for discussions of adjuvant ICI in selected cases and paves the way for future advances in this challenging disease. For patients and providers dealing with MCC, this is good news — and a reminder that even rare, aggressive cancers can be meaningfully improved by thoughtfully applied systemic therapy earlier in the disease course.
About the author
Dr. Sajeve Thomas is a distinguished medical professional and a compassionate guide in the field of oncology. With over a decade of dedicated experience as a board-certified medical oncologist/internal medicine specialist, Dr. Thomas has become a trusted expert in the treatment of melanoma, sarcoma, and gastrointestinal conditions. He brings a wealth of expertise to the complex and challenging world of oncology.
Disclosures:
Dr. Thomas serves as a speaker for Bristol Myers Squibb (BMS), Merck, Ipsen, Natera, Immunocore, Pfizer, and SpringWorks. He also receives industry grants in support of numerous clinical trials.