Nine years ago, Jimmy Carter held a press conference at the Carter Center in Atlanta to discuss his cancer diagnosis and treatment. At 91 years old, Carter shared how a severe cold in May 2015 prompted a comprehensive physical examination, which ultimately led to a melanoma diagnosis by August of that year. Following liver surgery, doctors discovered that the cancer had metastasized to four spots in his brain.
Had his diagnosis occurred a few years earlier, he would likely have had a prognosis of only six months. Instead, this Tuesday, the former president will celebrate his 100th birthday.
Experts attribute his longevity not just to luck, but primarily to the immune therapy he received. Dr. Stephen Hodi, director of the Melanoma Center and the Center for Immuno-Oncology at Dana-Farber Brigham Cancer Center, referred to Carter as a “poster child for immune therapy,” highlighting his unique status as a patient.
Carter’s treatment came during a period when immune therapies were gaining traction in oncology. The FDA had just approved the first checkpoint inhibitor, ipilimumab, four years prior to his treatment. Carter received pembrolizumab, which was authorized only a year before his diagnosis.
These immunotherapy treatments are now considered essential components of cancer care alongside surgery, chemotherapy, and radiation, applicable not just to melanoma but also to many other cancer types.
Dr. David Lawson, who administered pembrolizumab to Carter, stated that despite the former president’s age, he remained remarkably healthy and strong. During the August 20 press conference, Carter expressed regret that his treatment might conflict with a planned trip to Nepal for Habitat for Humanity.
Lawson emphasized that he treated Carter like any other patient. “The cancer doesn’t care,” he noted, reminding us that fame shouldn’t influence medical care. Although he typically would prescribe pembrolizumab for two years, Lawson decided to stop Carter’s treatment after six months, believing it was unnecessary given Carter’s positive response and his exposure to many people.
At the time of Carter’s treatment, there was still uncertainty around the efficacy of immunotherapy for patients with brain metastases. Research since then has indicated that many patients with such conditions can benefit from checkpoint therapy. Today, clinicians like Hodi typically combine pembrolizumab with ipilimumab for greater effectiveness.
Age does not disqualify patients from receiving immunotherapies. Dr. Antoni Ribas, a melanoma specialist at UCLA, noted administering these drugs to patients aged 96 or 97, emphasizing that the immune system remains potent even in advanced age. However, doctors are more inclined to allow older patients breaks from treatment when side effects occur.
About one in twenty patients experience severe side effects from immunotherapies, with skin rashes and flu-like fatigue being the most common mild reactions.
In addition to immunotherapy and liver surgery, Carter underwent targeted radiation for the small tumors in his brain. Experts agree that without the pembrolizumab, his life expectancy would have been measured in months. Ribas stated that activating the immune system can lead to normal life spans.
The immunotherapies Carter received, including pembrolizumab and ipilimumab, work by removing the “brakes” on the immune system, enabling it to combat cancer more effectively. Other immunotherapy methods being researched aim to draw immune cells to tumors or utilize different immune mechanisms.
Recent studies indicate that about half of patients with advanced melanoma respond favorably to immunotherapy. The survival rates are promising, with up to 97% of those who received certain combinations alive seven years post-treatment. In contrast, without these therapies, historically, only one in twenty melanoma patients could expect to live longer than six months.
As medical professionals like Ribas acknowledge, a shift towards using the term “cure” is becoming more appropriate. Experts predict that whatever Carter ultimately succumbs to, it likely won’t be melanoma.
Researchers continue to refine immunotherapies for an increasing number of melanoma patients and various cancer types. Investigations are ongoing into manipulating the immune response, combining treatments, and improving tumor targeting.
The long survival of patients like Carter serves as a testament to the advancements in cancer treatment, offering hope and celebration for both patients and dedicated healthcare providers. Lawson called Carter a “great human being” and wished him a happy birthday with hopes for many more in the future.