Dec. 12, 2015
By Virginia Anderson
Indeed, the prognosis for Carter may have been much more grim if he had been diagnosed with late-stage melanoma just two years earlier, cancer specialists say. But the former president’s announcement last Sunday in Plains that he is cancer free comes after decades of trial and error by researchers.
That work finally paid off in September of 2014, when the Food and Drug Administration (FDA) granted special approval for a drug, pembrolizumab, to treat late-state melanoma for patients who are no longer responding to other drugs.
“There have been decades of research, where you build the knowledge one step at a time,” said Dr. Len Lichtenfeld, deputy medical officer for the American Cancer Society. “What we lose sight of is that the knowledge base took an incredibly long time to develop, and a substantial amount of investment.”
It’s important to note that not all patients with stage IV melanoma will have similar results to Carter’s, medical experts said in interviews with The Atlanta Journal-Constitution. In clinical trials, about 24 percent of those who received the drug experienced tumor shrinkage, the FDA has reported.
Cancer claims more than half a million lives a year. And, doctors say, prevention is still key for many cancers, such as melanoma, where sun exposure and tanning beds dramatically raise a person’s risk.
Yet those who work in laboratories and clinics all their lives to overcome the nation’s number two killer said that Carter’s cancer and his response to it are reasons for great hope in the fight against the disease. They also praised the way the former president has shared his diagnosis and treatment openly.
“This is extremely important because it allows our patients to feel hope and to allow him to continue to do his very important work,” said Dr. Jedd Wolchok, chief of the melanoma and immunotherapeutics program at Memorial Sloan Kettering Cancer Center in New York. “He’s doing something now — showing such enormous grace, courage and transparency — that may be just as important as anything he’s done.”
Wolchok said he feels great personal satisfaction in the President’s response to treatment because Wolchok was a principal investigator on one of the many worldwide Phase I clinical trials to test the safety of the drug.
While the story might sound like an overnight success, it is not. It is the result of years of painstaking and expensive research, clinical trials with successes and failures — with millions of lives lost along the way, despite researchers’ best efforts.
The war on cancer
The fight against cancer began in earnest with then-President Richard Nixon’s proclamation of the War on Cancer in 1971.
“There was the thinking that ‘if we can put a man on the moon, we can cure cancer,’” Lichtenfeld said.
But that goal has been harder to reach than many people anticipated.
First, there are many types of cancer — it is not all one disease. Even within certain types of cancer that are designated by organ site, such as lung cancer or breast cancer, there are many genetic subtypes.
Researchers also have been confounded because of how “smart” cancer cells are.
“If you treat them with a targeted therapy, they may or may not respond, but then they figure that out, and they change,” Lichtenfeld said.
For those who began practicing medicine about the time the war on cancer was proclaimed, there was a lot of disappointment.
“You start to scratch your head, and you want to have something to offer your patients,” Lichtenfeld said.
Patients, their families, researchers and doctors across the country — and around the world — felt the same way. Work continued. And while today there are more than 14 million cancer survivors across the country, millions of others died as cancer fought back in the war against it.
Success in melanoma fight
One of the ways cancer fights back is by mutating, said Dr. Amod Sarnaik, an associate professor at Moffitt Cancer Center in Tampa, who specializes in melanoma.
“Melanoma is one of the most heavily mutated cancers there is,” Sarnaik said. Melanoma cells have mutated in thousands of ways, outfoxing many of the drugs that were developed to destroy it.
For more than a decade, not a single new drug to treat melanoma was approved, Sarnaik said. Then in 2011 came the immunotherapeutic drug Yervoy, and at least five other drugs to fight melanoma have gained approval since then.
These drugs differ from traditional chemotherapy drugs in that they help the body’s own immune system to fight the cancer; they do not destroy the cancer cells themselves.
The immune system typically recognizes cells that are bad for the body, such as bacteria that cause infections.
“But the immune system has a tough time with cancer cells because they look very much like a normal cell,” Wolchok said. The immunotherapeutic drugs turn off certain “brakes” within the immune system that tell it to leave the cancer cells alone.
“We’ve waited many decades for the scientific understanding of the immune system,” Wolchok said.
Those years of trial and error are producing significant advances in a disease that once had a life expectancy of just a few months, he said. “Many, many patients have given of themselves to participate in clinical trials, and none of this would be happening without them.”
Healthwise
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Carter says he first started feeling ill in May, on a trip to Guyana.
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'I have had a wonderful life. I'm looking forward to new adventure. It’s in God’s hands’: Humble Carter reveals he has melanoma of the brain
- The 39th president addressed the media Thursday morning about his recent cancer diagnosis
- After doctors removed a small mass from his liver, they found the cancer had spread and there were four spots of melanoma on his brain
- While melanoma is typically associated with skin cancer, a small percentage of melanomas are found internally
- Carter says he will undergo his first radiation treatment later today
- The former president was in surprisingly high spirits, and joked throughout the press conference
- 'I'm perfectly at ease with whatever comes,' he said
Former President Jimmy Carter says cancer that was first discovered as a tumor on his liver has spread throughout his body and is now growing in his brain.
At a press conference at the Carter Center in Atlanta on Thursday, the 39th president said that so far the pain was been 'very slight' and he hasn't felt any weakness or debility.
Still, he will cut back on his work with the Carter Center and will give the treatment regimen his 'top priority.' His first radiation treatment was set for Thursday afternoon.
Fighter: Former President Jimmy Carter addressed the media on Thursday to discuss his recent cancer diagnosis
Treatment plan: During the press conference, Carter announced that he would be starting his radiation treatment later that same day. Pictured above walking into the conference win front of his wife Rosalynn
Supporters: Rosalynn Carter, right, and her grandson Jason Carter, left, listen as former US President Jimmy Carter (background) gives the media an update on his recent cancer diagnosis at the Carter Center in Atlanta
Carter says he first started feeling ill in May, on a trip to Guyana.
He cut the trip short and came home to Atlanta early where he underwent tests at Emory University Hospital.
It was then that doctors first found a small mass on his liver. Carter underwent surgery to remove the mass on August 3, and that's when doctors discovered that the cancer had metastasized and spread to his brain where a scan turned up four spots of melanoma about two millimeters long.
Leaving the hospital that day, Carter said he was afraid he only had a few weeks left.
But now he is more optimistic that the treatment plan devised by his doctors will extend his life. He has decided to undergo radiation treatment and his first session will happen later Thursday. The following three treatments will happen at three week intervals
Wishing well: Carter said he had received calls of support from all of the living presidents. 'It's the first time they've called me in a long time,' he joked. From left to right, all of the current living presidents pictured in 2009: George HW Bush, Barack Obama, George W Bush, Bill Clinton, Jimmy Carter
Meanwhile, doctors will continue to scan Carter's body for more tumors, and he was frank in saying that he expects them to find more as the process continues.
I think it's in the hands of God and I'll be prepared for anything that comes.
His father, brother and two sisters died of pancreatic cancer. His mother also had the disease. Carter said no cancer has been found on his pancreas so far.
Despite the gloomy diagnosis, the former president was in surprisingly high spirits during the press conference and said he was 'perfectly at ease with whatever comes.'
'I've had a wonderful life and thousands of friends - an exciting and adventurous and gratifying existence.
'So I was surprisingly at ease, much more than my wife was. But now I think it's in the hands of God and I'll be prepared for anything that comes.
Administration: Carter was the nation's 39th president, advancing as a virtual unknown on the national stage to defeat President Gerald Ford in 1976. But several foreign policy crises, in particular the Iran hostage crisis, crushed his bid for re-election and Ronald Reagan swept into the White House
Hopes: Carter will undergo four radiation treatments in three-week intervals, starting Thursday. One thing he hopes to do is travel to Nepal in November to build houses for Habitat for Humanity, one of his favorite charities. Pictured above building a home with the group in 2007
'I'm surprised I didn't go into an attitude of despair or anger or anything like that. I was just completely at ease,' he said.
He also joked with reporters about his presidency, saying if he had sent 'just one more helicopter' to rescue the Americans held captive in the U.S. Embassy during the Iran hostage crisis of the late 70s, he would have been elected to a second term.
Carter also spoke about receiving calls from well-wishers, including both former presidents Bush, Bill and Hillary Clinton, President Obama, Vice President Joe Biden and Secretary of State John Kerry.
Carter smiled and chuckled as he said: 'It's the first time they've called me in a long time.'
As for cutting back his work at the Carter center, the former president said it has been in the works for a long time but that he and his wife Rosalynn hadn't gotten around to it yet.
While he will not be as active in the foundation as he was before, he says he will still continue to attend some meetings and help raise funds to fuel the center's good works.
Carter also added that his grandson Jason would be taking over as chairman of the board, and that 'if he wants me to give him advice, I will be delighted.'
One thing he hopes to be strong enough to do is travel to Nepal in November to build homes for Habitat for Humanity.
However, the timing of the trip would mean that the president would have to postpone his last radiation treatment, something he hasn't discussed fully with his doctors yet.
He says if he doesn't go, the rest of his family will go in his place.
Carter was the nation's 39th president, advancing as a virtual unknown on the national stage to defeat President Gerald Ford in 1976. But several foreign policy crises, in particular the Iran hostage crisis, crushed his bid for re-election and Ronald Reagan swept into the White House.
The native of tiny Plains, Georgia, rebuilt his career as a humanitarian guiding the center focused on global issues, including health care and democracy. Carter earned a Nobel Peace Prize in 2002, helped defuse nuclear tensions in the Koreas and helped avert a U.S. invasion of Haiti.
He and his wife, Rosalynn, still make regular appearances at events in Atlanta and travel overseas. When the couple is in Plains, Carter frequently teaches a Sunday School class before services at Maranatha Baptist Church. He plans to teach this weekend as scheduled, according to the church.
'No matter where we are in the world, we're always looking forward to getting home to Plains,' Carter said.
http://www.dailymail.co.uk/news/article-3204836/Former-President-Jimmy-Carter-90-says-undergo-radiation-treatment-cancer-today-four-spots-melanomas-brain.html
http://www.dailymail.co.uk/news/article-3204836/Former-President-Jimmy-Carter-90-says-undergo-radiation-treatment-cancer-today-four-spots-melanomas-brain.html
