Stage IV Merkel cell carcinoma includes patients with distant metastases.
Chemotherapy may be considered for patients with stage IV disease who have a good performance status. Although responses have been seen with various regimens, evidence is lacking that chemotherapy results in permanent disease control or long-term survival.
The reported side effects of Cancell/Cantron/Protocel include temporary, moderate fatigue during the first few weeks of treatment and nausea. Reviewed in [1,2] One patient who exceeded the manufacturer's dose recommendations experienced diarrhea for a few hours but was reported to be fine the next day. Reviewed in 
Questionable methods of cancer management: Cancell/Entelev. CA Cancer J Clin 43 (1): 57-62, 1993 Jan-Feb.
Cancell Alternative Cancer...
In stage IV patients for whom chemotherapy is not considered an appropriate option, surgery and/or radiation therapy may be considered for local or regional palliation.
Standard treatment options:
Palliation with chemotherapy and/or surgery and/or radiation therapy as clinically appropriate.
Treatment options under clinical evaluation:
Enrollment in clinical trials is strongly encouraged.
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IV neuroendocrine carcinoma of the skin. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
WebMD Public Information from the National Cancer Institute
October 07, 2011
This information is not intended to replace the advice of a doctor.
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