Editor-DN
nine years ago, Jimmy Carter held a news conference at the Carter Center in Atlanta to discuss his cancer diagnosis and treatment.
Then 91, Carter explained that a bad cold last May led to a full-blown illness, leading to a diagnosis of melanoma in early August 2015. Very dangerous form of skin cancer. He underwent liver surgery earlier this month, and doctors identified four places where the cancer had spread to his brain.
Had he been diagnosed a few years earlier, he would have been given about six months to live.
Instead, on Tuesday, the former president is celebrating his 100th birthday.
Luck played a role, of course. But there’s no question, experts say, that he’s alive today because of his immune therapy.
“It’s a small term, but in many ways, it’s the poster child for immunotherapy,” said Dr. Stephen Howdy, who directs the Melanoma Center and Center for Immuno-Oncology at Dana-Farber Brigham Cancer. It’s like.” Center in Boston. “There were a lot of issues that he exemplified as a patient.”
More:Jimmy Carter, America’s longest-serving president, completes 1 year in hospice care.
At the time, this treatment was a new addition to the cancer arsenal.
Just four years ago, Food and Drug Administration previously approved a so-called checkpoint inhibitor, commonly known as ipilimumab. Carter received another such drug, pembrolizumab, which was prescribed a year before it was prescribed to him.
Now, these treatments and other cancer immunotherapies are among the mainstays of cancer care, alongside surgery, chemotherapy and radiation — not just in melanoma, where the approach first caught on, but in dozens of tumor types.
Just like any other patient
Dr. David Lawson said he treated Carter with pembrolizumab because the former president was incredibly healthy and resilient even at age 91.
At a news conference on August 20, Carter said that one of his regrets about his cancer treatment was that it might interfere with a planned trip to Nepal for charity. Habitat for Humanity.
Lawson, who works at Emory University’s Winship Cancer Institute, said he believes he treated Carter as he would have treated anyone else.
“The best favor you can do for a famous patient is to forget they’re famous. Never mind the cancer,” he said. “I hope it didn’t happen (the way we treated President Carter).
Lawson said he stopped Carter’s pembrolizumab after six months, though he would normally give it for two years. The former president seemed to be responding well and had been around a lot of people, so Lawson didn’t want his immune system to be compromised.
Carter’s treatment came at a time when doctors were first realizing how effective the treatments could be, said Howdy, who conducted the first clinical trials with the drug.
When Carter was treated in 2015, Huddy said, it was still unclear whether patients with The cancer had spread to the brain. may be beneficial. The fear was that the drugs would cause inflammation of the brain and make patients’ conditions worse while doing nothing to their tumors.
Research by Hudi et al has shown that many patients with brain metastases from melanoma, like Carter’s, may benefit from checkpoint therapy. But today, Houdi said, they would prescribe pembrolizumab and the already approved drug ipilimumab to most patients.
Lawson said he wants to be aggressive with Carter’s treatment, but not too aggressive.
“That’s why we stopped (pembrolizumab),” Lawson said. “You never stop worrying, but we got to a point where we thought, ‘He’s probably over it.’
Never gets too old
Age is not a barrier to treatment with immunotherapy.
Dr. Anthony Rabas, a melanoma specialist who directs the tumor immunology program at the Johnson Comprehensive Cancer Center at the University of California, Los Angeles, said he gave checkpoint inhibitors to patients as young as 96 or 97. are
Although older people have weaker immune systems, he said, the fact that drugs can be effective at such an old age shows that the immune system remains active throughout life.
“The fact that people in their 80s and 90s can get rid of metastatic melanoma tells us that the immune system is pretty remarkable,” Rabas said. “I wouldn’t underestimate a 90-year-old’s immune system.”
Still, doctors are quick to give older patients “medication holidays” if they experience side effects, he said. This is a term that refers to patients who are taking a break from medication, and can be used to assess how well a therapy is working, eliminating side effects. There is and much more.
Overall, only 1 in 20 patients have serious side effects from immunotherapy, with skin rash and flu-like fatigue being the most common relatively minor factors.
The ‘C’ Word: Cure
In addition to immunotherapy and liver surgery, Carter underwent radiation treatments for four small tumors in his brain. But Lawson, Houdi and Rabas agree that they would not have survived more than six months without pembrolizumab.
“The life expectancy of someone with liver and brain metastases would be months, even with radiation and surgery,” Rabas said. “Suppressing the immune system can lead to normal life.”
Pembrolizumab and ipilimumab ‒ nicknamed “pembro” and “ipi” ‒ are called checkpoint inhibitors because they remove the brakes, or checkpoints, on the cancer’s immune system, allowing immune “soldiers” to attack. There is an opportunity to work to fight cancer.
Other forms of immunotherapy, many of which are still in development, target the immune system in other ways. Some first attract immune soldiers to the tumor site, while others target different immune apparatuses.
According to one study, about half of patients with this very dangerous type of skin cancer respond well to immunotherapy. Published earlier this month in The New England Journal of Medicine.. Among patients who survived three years without their cancer progressing, the study found, 96% were alive after seven years if they had received a drug similar to pembrolizumab, called nivolumab, in addition to ipilimumab. 97% were alive if they received nivolumab alone, and 88% were alive if they received only ipilimumab.
Before these immunotherapy drugs, perhaps 1 in 20 patients had a chance of surviving more than about six months, Rabas said.
Still, like other cancer doctors, Rabas doesn’t like to set unrealistic expectations for his patients, “I think we have to start using the word ‘cure’.”
At this point, Rabas and others expect that whatever Carter eventually dies of, it won’t be melanoma.
Looking ahead.
Researchers are still trying to get immunotherapies to work for more melanoma patients and for more people. Other types of cancer.
Studies are underway to improve methods of manipulating different aspects of the immune system, combining different treatments at different times, and targeting individual tumors.
What does Carter’s longevity mean for doctors who have dedicated their careers to caring for patients like him?
“It gives us a look at the progress we’re making on this cancer and how it benefits patients and changes their lives,” Rabas said.
Hodi added: “It’s great and very celebratory. It’s fantastic.”
Lawson reflected on his most famous patient.
“He’s just a great guy, a great human being,” Lawson said. “I wish him a happy birthday and many more to come.”
Karen Weintraub can be reached at [email protected].
