based on the following information and sources, canyon give a condensed version for the conclusion I have made?:

The real-world efficacy and toxicity outcomes of avelumab in patients with aMCC were consistent with the results from clinical trials. The study showed relatively high response rates (RRs) and durable responses in patients with aMCC. (Levy et al., 2020).

The study concludes that first-line treatment with avelumab led to responses in 40% of patients with mMCC and durable responses in 30%. The study did not identify a reliable biomarker for predicting response to avelumab treatment (D'Angelo et al., 2021).
The study demonstrated clinical benefit in patients with locally advanced MCC receiving first-line avelumab in a US real-world setting. The response rates observed in patients with metastatic MCC were consistent with results from pivotal trials. These findings suggest that avelumab may be an effective treatment option for patients with MCC  (Cowey et al., 2021).

The conclusion drawn from the study is that avelumab treatment demonstrates significant efficacy in real-world clinical practice for patients with advanced MCC. The high ORR, durable responses, and prolonged survival observed in the study align with the results from previous clinical trials and observational studies. This suggests that avelumab could be a valuable treatment option for patients with advanced MCC, reinforcing the positive findings reported in controlled clinical trials. The study provides real-world evidence supporting the use of avelumab in the treatment of MCC and contributes to the growing body of knowledge on the efficacy of immunotherapies, specifically anti-PD-L1 antibodies, in this rare and aggressive form of cancer (Bhatia et al., 2022).

Avelumab's impressive response rates, durability of the observed responses, and favorable safety profile make it attractive as an alternative to chemotherapy.

The real-world data showed a response rate of 59% to avelumab in patients with MCC, which is consistent with previous studies. There was no difference in response based on primary tumor location or immune status. Avelumab demonstrated a favorable safety profile with low rates of treatment discontinuation and grade 3-4 toxicities. The combination of avelumab with local salvage treatments like radiotherapy or surgery showed promising results. Further studies are needed to assess the long-term durability of complete responses and the potential of combining immune checkpoint inhibitors with radiotherapy for MCC treatment (Averbuch et al., 2023).

The avelumab expanded access program demonstrated efficacy and safety in a real-world setting, consistent with the results from the JAVELIN Merkel 200 trial. Avelumab provided a treatment option for patients with limited treatment options for mMCC (Walker et al., 2020).

Avelumab demonstrated efficacy and safety in a real-world population of mMCC patients in Europe and the Middle East. The results were consistent with findings from the JAVELIN Merkel 200 trial and supported the use of avelumab in patients who had limited treatment options (Ascierto et al., 2021).

The results from Italian patients enrolled in the avelumab EAP are consistent with the findings of the JAVELIN Merkel 200 trial, confirming the efficacy and safety of avelumab treatment in this population (Grignani et al., 2021).

The study concludes that avelumab demonstrated strong efficacy in the treatment of mMCC in the LATAM population. The results contribute to improving current knowledge about mMCC treatment and highlight the potential benefits of immunooncologic strategies, such as avelumab, for LATAM patients (Munhoz et al., 2021).