Nine years ago, Jimmy Carter held a press conference at Atlanta’s Carter Center to talk about his cancer diagnosis and treatment.
Carter, who was 91 years old at the time, explained that he had come down with a bad cold the previous May, underwent further tests, and by early August 2015 was diagnosed with melanoma, a very dangerous form of skin cancer. He underwent liver surgery earlier that month, and doctors identified four locations where the cancer had spread to his brain.
If he had been diagnosed a few years earlier, he would have been given about six months to live.
Instead, the former president will celebrate his 100th birthday on Tuesday.
Of course, luck also played a role. But experts say there is no question that he is still alive because of the immunotherapy he received.
“It’s a cliché, but in many ways he is the poster child for immunotherapy,” says Dr. Stephen Hody, director of the Melanoma Center and the Immuno-Oncology Center at Dana-Farber-Brigham Cancer Center. In the heart of Boston. “There were a lot of issues that he exemplified as a patient.”
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At the time, this treatment was a new addition to the cancer arsenal.
Just four years ago, the Food and Drug Administration approved the first so-called checkpoint inhibitor, commonly called ipilimumab. Mr. Carter received the second such drug, pembrolizumab. The drug was only approved the year before he was given it.
These and other cancer immunotherapies are now a mainstay of cancer treatment, along with surgery, chemotherapy, and radiation therapy, extending beyond melanoma, where this approach was first established, to other cancer treatments. The same is true for dozens of types of tumors.
just like any other patient
Dr. David Lawson said he treated former President Carter with pembrolizumab because he was still incredibly healthy and resilient at age 91.
At a press conference on Aug. 20, Carter said his only regret about his cancer treatment was that it would interfere with a planned trip to Nepal on behalf of the charity Habitat for Humanity. He said that this could lead to.
Lawson, who works at Emory University’s Winship Cancer Institute, said she believes she treats Carter the same way she would treat anyone else.
“The best favor you can do for famous patients is to forget that they are famous. Cancer doesn’t care,” he said. “I hope it doesn’t change[the treatment of President Carter]. We certainly tried not to, but you never know.”
Lawson said Carter’s pembrolizumab is typically given for two years, but was stopped after six months. The former president’s response seemed to be good, and because he had been in contact with so many people, Lawson didn’t want his immunity to weaken.
Hody, who conducted the drug’s first clinical trials, said Carter’s treatment came “right before” doctors first began to realize how effective the treatment was.
When Carter underwent treatment in 2015, it was still unclear whether it would be effective for patients whose cancer had spread to the brain, Hody said. The fear was that the drug would cause inflammation in the brain and worsen the patient’s condition, while having no effect on the tumor.
A subsequent study by Hody and colleagues showed that, like Carter, many patients with melanoma brain metastases could benefit from checkpoint therapy. But today, Hody said most patients will receive both pembrolizumab and a previously approved drug called ipilimumab.
Lawson said he wants to be aggressive in Carter’s treatment, but not too aggressive.
“That’s why we stopped (pembrolizumab),” Lawson said. “We never stop worrying, but we got to the point where we thought, ‘He’s probably getting better.'”
never too old
Age is not a barrier to treatment with immunotherapy.
Dr. Antoni Rivas, a melanoma expert who directs the tumor immunology program at the Johnson Comprehensive Cancer Center at the University of California, Los Angeles, has given checkpoint inhibitors to patients who were 96 or 97 years old. he said.
He said older people have weakened immune systems, but the fact that drugs can be effective at this late age shows that the immune system remains active throughout life. Ta.
“The fact that people in their 80s and 90s can get rid of metastatic melanoma shows that their immune systems are very good,” Rivas said. “I don’t want to underestimate the immunity of a 90-year-old.”
Still, he said, doctors tend to be quick to give older patients a “drug break” when they experience side effects. This is a term used to refer to patients taking a break from medication, which can be introduced to assess how well a treatment is working or to reduce side effects.
Overall, only about 1 in 20 patients experience serious side effects from immunotherapy, with the most common relatively minor factors being skin rashes and flu-like fatigue.
The “C” word: cure
In addition to immunotherapy and liver surgery, Carter also underwent radiation therapy for four small tumors found in her brain. But Lawson, Hody and Rivas agree that without pembrolizumab, he would not have survived more than six months.
“People with liver or brain metastases may only have a few months to live, even if they receive radiation therapy and surgery,” Rivas said. “If you free up your immune system, you can live a normal life.”
Pembrolizumab and ipilimumab (nicknamed “Pembro” and “Ipi”) are checkpoint inhibitors because they remove the brakes, or checkpoints, that cancer places on the immune system, allowing the immune “soldiers” to fight cancer. It is called.
Other forms of immunotherapy, many still in development, work on the immune system in other ways. Some initially attract immune soldiers to the tumor site, while others target different immune tools.
About half of patients with this extremely dangerous type of skin cancer respond well to immunotherapy, according to a study published earlier this month in the New England Journal of Medicine. The study showed that among patients whose cancer survived for three years without progression, 96% were still alive after seven years if they received both ipilimumab and a drug similar to pembrolizumab called nivolumab. It was done. 97% of patients who received nivolumab alone survived, and 88% of patients who received ipilimumab alone survived.
Before these immunotherapy drugs were used, perhaps one in 20 patients could survive for about six months or more, Rivas said.
Still, like other oncologists, Dr. Rivas doesn’t like to set unrealistic expectations for patients, saying, “I think we need to start using the word ‘cure.'”
For now, Rivas and his colleagues predict that whatever Carter ultimately dies from, it won’t be melanoma.
Looking to the future
Researchers are still working to make immunotherapy effective for more patients with melanoma and other types of cancer.
Research is underway to manipulate different aspects of the immune system, combine different treatments at different times, and improve ways to target individual tumors.
What does Carter’s longevity mean to doctors who have dedicated their careers to treating patients like Carter?
“It makes us reflect on the advances in this cancer and how it benefits patients and changes their lives,” Rivas said.
Hody added: “It’s wonderful, it’s very celebratory. It’s wonderful.”
Lawson reflected on his most famous patient.
“He’s just a great guy and a great human being,” Lawson said. “We wish him a happy birthday and wish him many more things to come.”
Karen Weintraub can be reached at kweintraub@usatoday.com.