Developments about former President Jimmy Carter’s melanoma diagnosis and the subsequent story about his positive response to treatment has made me pause and reflect on the extraordinary progress in a remarkably short period of time, both in the treatment of what used to be considered one of the most deadly cancers and in the very rapid advancement of immunotherapy.
In August 2015, President Carter was diagnosed with Stage IV melanoma that had spread to his liver and brain. He had surgery for the tumors in the liver and focused radiation for those in his brain followed by immunotherapy with a drug – pembrolizumab – classified as an anti-PD-1 antibody. A happy update indicated that President Carter was having an excellent response to the immunotherapy: there have been no new tumors. Importantly, he was reported as feeling great and was continuing to maintain his active lifestyle at 93 years of age.
And we now know from our experience with immunotherapy and these drugs that it is not at all unrealistic to think President Carter’s amazing response could continue for months or even years. This was almost unthinkable a decade ago.
Melanoma has a predilection for spreading — to metastasize in medical terms — to challenging locations such as the brain. Metastatic disease involving the brain used to have an average survival of only a few months. As recently as 2010, treatment options for metastatic melanoma mostly included chemotherapy, which was usually ineffective, and sometimes surgery or radiation to extend the patient’s life or to transiently relieve symptoms.
Until recently the widespread use of immunotherapy in cancer treatment was unfathomable. But, the dogged persistence of the believers in immunotherapy is now making a huge difference for patients. Because of its success, immuno-oncology is now a standalone medical field and most major pharmaceutical companies are rapidly building up their immunotherapy research efforts. New immunotherapy drugs are being approved rapidly and are being used not just to treat established cancers, but also to prevent recurrences and, amazingly, even the initial development of certain cancers.
As Carter’s results demonstrate, this is a very exciting time for cancer treatment. Because of immunotherapy, the days of severe retching or hair loss, which are typical for patients who undergo traditional chemotherapies, are on the decline. We can now tell a then-91 year-old (at time of diagnosis) with conviction that there is a realistic chance of long-term survival with a good quality of life beyond a few weeks or months.
And as any immune-oncologist will excitedly tell you, this is just the beginning.