Targeted Therapy and Avelumab in Merkel Cell Carcinoma

Inclusion Criteria: * Patient is 18 years of age or older and who has provided written informed consent. * Patient has histologically confirmed metastatic MCC. * Eastern Cooperative Oncology Group (ECOG) performance status of ≤2 . * Willing and able to comply with all study protocol requirements for the duration of the study. * Patient must have measurable disease by CT or MRI per RECIST version 1.1 criteria. * Patient is treatment naïve (no prior systemic therapy for unresectable or metastatic MCC). Note that prior chemotherapy is permitted in the adjuvant setting for loco-regional disease. Prior radiation is permitted for treatment of the primary or loco-regional disease. * At least 2 weeks since the completion of prior therapy, including surgery or radiotherapy. * Screening laboratory values, obtained within 14 days prior to registration/randomisation must meet the criteria specified in the protocol. * Women of childbearing potential (WOCBP) must use appropriate method(s) of contraception * WOCBP must have a negative serum or urine pregnancy test within within 7 days prior to the start of avelumab treatment and should be performed every 4 weeks in line with other safety bloods or clinical reviews. * Male patients who are sexually active with a WOCBP must use any contraceptive method with a failure rate of less than 1% per year. * Patient must be agreeable to have archival tumour material collected Exclusion Criteria: * Patient is excluded if they have ever had any brain…