Cancer Treatment That Helped Jimmy Carter With Brain Cancer
In August 2015, former President Jimmy Carter had surgery to remove a mass from his liver. Tests that were done after surgery showed the mass turned out to be melanoma, the most serious type of skin cancer because it tends to metastasize or spread to other parts of the body. Doctors also ordered an imaging scan and discovered that the cancer had spread to four different parts of his brain.
The former president, then 91, held a news conference announcing his cancer diagnosis and his plan to undergo radiation therapy to treat the “spots” on his brain, followed by at least four rounds of cancer immunotherapy with the drug pembrolizumab (Keytruda).
One year before Carter’s cancer diagnosis, the U.S. Food and Drug Administration (FDA) granted accelerated approval to pembrolizumab for certain patients whose metastatic melanoma had not responded to other treatments.
In December 2015, the former president made another announcement: He was cancer-free.
“My most recent MRI brain scan did not reveal any signs of the original cancer spots nor any new ones,” Carter said in a statement. “I will continue to receive regular 3-week immunotherapy treatments of pembrolizumab.”
Immunotherapy drugs help cancer patients survive
Medical experts say Carter and other cancer patients like him have a better chance of survival because of the advances in cancer immunotherapy, most notably with newer “checkpoint inhibitor” drugs like pembrolizumab and ipilimumab (Yervoy), approved by the FDA in 2011. These drugs are called checkpoint inhibitors because they release the “natural” brake or “checkpoint” on the immune system and allow the immune cells to recognize and fight cancer cells.
Dr. Ramsay Farah, division chief for dermatology at the SUNY Upstate Medical University in Syracuse, NY, described pembrolizumab as an antibody that targets a receptor on a cell of the immune system called a “T cell.”
“Normally, T cells have some natural breaks on them so that they don‘t attack every cell in your body,” Dr. Farah explained in an article for Upstate Medical University. “When the T cells are sleeping, they‘re not going to attack the melanoma. This medicine basically awakens the T cell, so it can awaken its brothers and sisters, and they all attack the melanoma.”
Doctors and researchers believe Carter survived because of the immune therapy he received, which is still being used today, along with surgery, chemotherapy, and radiation to treat cancer.
A study published in The New England Journal of Medicine in September found that patients respond well to immunotherapy. The trial results showed patients treated with both ipilimumab and a drug similar to pembrolizumab called nivolumab were cancer-free for 10 years or longer.
At the time of Carter’s treatment, doctors were on the verge of realizing that the drugs were effective in treating melanoma, Dr. Stephen Hodi, who directs the Melanoma Center and the Center for Immuno-Oncology at the Dana-Farber Brigham Cancer Center in Boston, told USA Today. However, Dr. Hodi said it was not clear if patients whose cancer had metastasized to the brain could benefit from these medications. The concern was whether the drugs would cause brain inflammation and not treat the tumors, making the patients’ conditions worse.
Since then, studies by Dr. Hodi and others have found that patients whose melanoma has spread to the brain can benefit from immunotherapy. Dr. Hodi said now he would give most patients both pembrolizumab and ipilimumab. Dr. Hodi conducted one of the first clinical trials with ipilimumab, which blocks a protein that prevents the immune system from attacking cancer cells.
Seniors benefit from Immunotherapies, too
Doctors have also discovered that immunotherapies are effective in older adults whose immune systems weaken during aging.
Dr. Antoni Ribas, a melanoma specialist who directs the Tumor Immunology Program at the Jonsson Comprehensive Cancer Center at the University of California, Los Angeles, told USA Today that he has used checkpoint inhibitors to treat patients as old as 96 or 97.
“The fact that people in their 80s and 90s can get rid of metastatic melanoma tells us that the immune system is pretty remarkable,” Ribas said. “I would not underestimate the immune system of a 90-year-old.”
Carter’s physician, Dr. David Lawson, told USA Today that he treated the former president with pembrolizumab because he was “still incredibly healthy and resilient.” Since his patient seemed to be responding well to the medication and was exposed to a lot of people, Dr. Lawson said he stopped Carter’s pembrolizumab after six months. He would have typically given the medication for two years, but Dr. Lawson said he did not want his patient to have a weakened immune system.
While he wanted to be aggressive with Carter’s cancer treatment, Dr. Lawson said he did not want to be too aggressive. “That’s why we stopped (the pembrolizumab),” Dr. Lawson told USA Today. “You never stop worrying, but we got to a point thinking, ‘He’s probably cured of this.’”
At this point, Dr. Ribas and others expect that whatever Carter eventually dies from, it won’t be melanoma.
Warning Signs of Melanoma
Dr. Farah recommends staying vigilant against skin cancer by getting screened so that any melanomas can be caught early before they spread. One way of doing that is to watch for any new moles, freckles, spots, or lesions on your skin that begin changing over time.
One way to remember the common signs of melanoma is to remember the ABCDEs:
A—Asymmetry.
The mole or lesion is not symmetrical. One half does not match the other.
B—Border.
The edges of the mole are jagged or irregular in shape. Non-cancerous moles typically have smooth, well-defined borders.
C—Color.
Normal moles are usually tan or brown. Cancerous moles have colors that vary from one area to the next, such as shades of tan, brown, or black or areas that are white, red, or blue.
D—Diameter.
Moles usually measure 1/4 inch. Any moles larger than that should be checked for melanoma.
E—Evolution.
Any change in a mole’s size, shape, or color mole over time or any new symptom in it, such as bleeding, itching, or crusting, may be a warning sign of melanoma.
If you find spots or moles on your skin with these characteristics, doctors strongly advise seeing your healthcare provider or a dermatologist.
This site offers information designed for educational purposes only. You should not rely on any information on this site as a substitute for professional medical advice, diagnosis, treatment, or as a substitute for, professional counseling care, advice, diagnosis, or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other healthcare professional.
