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The prognosis of MCC with lymph node involvement was better in patients with an unknown than a known primary. Treatment with a uniform aggressive combined chemoradiation regimen, with or without lymphadenectomy, led to better survival rates than previously reported.

Background Merkel cell carcinoma (MCC) is a rare and aggressive malignancy of the skin, affecting predominantly the fair‐skinned older population exposed to high levels of ultraviolet light. Immune suppression is considered a significant risk factor. With the recent advances in the field of immunotherapy, the treatment paradigm for advanced MCC, traditionally based on chemotherapy, has largely shifted to anti‐PD‐L1 and PD‐1 agents such as avelumab and pembrolizumab, respectively. However, real‐world data remain sparse. The aim of this study was to assess real‐world evidence of the effectiveness of avelumab in a diverse group of patients with MCC in Israel. Methods The electronic databases of five university hospitals in Israel were searched for all consecutive patients with MCC treated with at least one dose of avelumab in 2018–2022. Data on baseline, disease‐related, treatment‐related, and outcome parameters were collected and analyzed. Results The cohort included 62 patients of whom 22% were immune‐suppressed. The overall response rate to avelumab was 59%. The median progression‐free survival was 8.1 months, and the median overall survival, 23.5 months, with no differences between immune‐competent and immune‐suppressed patients. Treatment was well tolerated; any‐grade toxicity developed in 34% of patients, and grade 3–4 toxicity, in 14%. Conclusions Avelumab was found to be effective and safe for the treatment of advanced MCC in a diverse group of patients, including some with immune suppression. Further studies are warranted to evaluate the optimal sequence and duration of treatment and to assess the potential role of avelumab for earlier stages of MCC. Assessment of the effectiveness of avelumab in a diverse group of patients with MCC in multi‐center real‐world evidence from Israel. Avelumab was found to be effective and safe in a diverse group of patients, including some with immune suppression.

Background: Adolescent obesity has markedly increased worldwide, and metabolic bariatric surgery is an effective treatment option. A major predictor of the outcomes of this procedure is adherence to post-surgery lifestyle changes and medical recommendations. While adolescents generally have more difficulty adhering to medical advice than adults, their failure to do so could adversely affect their physical and psychological health, the cost-effectiveness of medical care, and the results of clinical trials. To our knowledge, this is the first attempt to identify the characteristics associated with the adherence of adolescents and their families to medical advice after bariatric surgery. Methods: We investigated potential variables influencing adherence to medical advice in adolescents diagnosed with severe obesity enrolled in a nutritional and behavior-oriented bariatric program—a 3-month pre-surgical outpatient intervention and a 6-month post-surgical follow-up. The program monitored weight, program attendance, diet compliance, lifestyle changes, and daily activities. All participants and parents completed a standard battery of questionnaires, provided demographic information, and participated in a semi-structured interview about their lifestyle. Results: The study group consisted of 47 adolescents: 34 girls and 13 boys, aged 13–18 years. Over time, three groups emerged with different degrees of adherence—high, low, and delayed low adherence. The analyses showed that adolescents’ depression, autonomy, and independence from their family had strong, significant effects on adherence across the groups. Conclusions: Using adherence typologies, practitioners may be able to identify, predict, and tailor interventions to improve adolescent adherence to post-surgery recommendations. Parents have an important role in ensuring that adolescents undergoing metabolic bariatric surgery follow medical advice after the procedure.