Jimmy Carter’s cancer legacy

Posted at 11:34 AM, Dec 08, 2015
and last updated 2015-12-08 11:34:37-05

When 91-year-old former President Jimmy Carter announced he was cancer-free from a dangerous melanoma that had metastasized to his brain, the nation cheered his good news.

Cheers also went up in cancer labs and treatment centers around the country, as front-line doctors applauded the message his success sends to other melanoma patients, especially the elderly.

“A lot of patients and their doctors will say, he’s 80 years old, he’s 90 there’s no point of giving him this treatment,” said Dr. Adi Diab of the MD Anderson Melanoma Medical Oncology Department. “The case of President Carter put an answer to that. It’s not true.”

“A patient’s overall health condition is more important than their age,” adds Vanderbilt melanoma oncologist Dr. Douglas Johnson.

“So the legacy for me as a cancer physician is that I take a look at a 90 year old, and if they’re doing pretty well as Mr. Carter was, I would not hesitate to give him treatment,” agreed Cleveland Clinic melanoma oncologist Dr. Marc Ernstoff. “These new therapies can be well tolerated and can provide significant benefit.”

Former President Carter’s treatment

Carter’s treatment began with the removal of a lesion on his liver in early August.

Tests soon discovered that the cancer was melanoma, one of the deadliest of all cancers, and shortly after came even more bad news: the cancer had spread to his brain.

Carter and his doctors opted to use the current gold standard of treatment, radiation, on the four small tumors in his brain, but they also decided to add a new immunotherapy drug, pembrolizumab, just approved by the FDA last year.

“I think there’s a huge effect of President Carter on cancer patients and cancer survivors because there were several things he demonstrated that are wonderful role models,” said Dr. Leonard Lichtenfeld, deputy chief medical officer for the American Cancer Society.

“Here’s a man who’s in his 90s being active in his treatment. He demonstrated he was fully engaged and informed on the discussion about his care — he helped make the decisions.”

The use of pembrolizumab was considered off-label in Carter’s case because the FDA only approved it for patients who had already tried other therapies and failed them. But studies in mice and anecdotal reports from cancer centers around the country were showing amazing success in patients of all ages to the newer immunotherapy drugs, with fewer side effects, especially when combined with radiation.

The National Comprehensive Cancer Network, which sets guidelines for cancer treatment, has recently recommended some of the drugs, such as pembrolizumab, be used as first line treatments for advanced melanoma, just as it was for Carter.

Carter’s cancer legacy

Carter’s legacy goes beyond his active participation in his care, say experts. His fighting spirit and positive attitude are winning combinations they hope more patients will emulate.

“Hope is an important aspect of surviving cancer,” said Ernstoff. “Whether that’s faith, religion, mindfulness, any one of many different ways that one can get into that state of mind, it’s important to do so.”

“It’s so important not to give up,” agrees Lichtenfeld. “The tendency of older patients with cancer, along with their loved ones, and even the doctors taking care of them, is to just accept fate and move on. They grew up in a time when ‘fighting’ cancer was painful, debilitating and often not successful.”

“And these treatments are very different than traditional chemotherapy,” said Johnson. “They work in a very different way, they activate the immune system instead of directly targeting the cancer cells and they are in most cases very well tolerated. Even patients of relatively advanced age like President Carter often can tolerate them without too many side effects.”

Another benefit of Carter’s success: putting the spotlight on a deadly disease and a relatively new way of treating it.

“I think it will certainly raise awareness of melanoma — it’s the most deadly form of skin cancer and is responsible for about 9,000 deaths each year,” said Johnson. “And it certainly raises awareness of these new immune therapies, and may increase philanthropy and jump-start research, especially because they are beginning to work in many more tumor types than just melanoma, such as nonsmall cell lung cancer and kidney cancer.”