Jimmy Carter's latest brain scan good news, doctors say
Carter said he'll continue to receive the drug, Keytruda, a type of immunotherapy
A recent MRI showing no cancer on Jimmy Carter's brain is "very positive" news for the former president but will not end his medical treatment, doctors said.
Carter, 91, announced Sunday that doctors found no evidence of the four lesions discovered on his brain this summer and no signs of new cancer growth. He revealed in August that he had been diagnosed with melanoma and had begun treatment, including surgery to remove part of his liver, targeted radiation therapy and doses of a recently approved drug to help his immune system seek out any new cancer cells.
"For today, the news cannot be better," said Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society. "Circumstances may change over time or he may be in a situation where it does not recur for many years or at all."
Carter said he will continue every three weeks to receive the drug, Keytruda, one type of "immunotherapy" that melanoma specialists credit for improving treatment of the disease without the side-effects of traditional chemotherapy drugs that can cause hair loss and other symptoms, said Dr. Douglas Johnson, a melanoma specialist at Vanderbilt-Ingram Cancer Center who is not involved with Carter's treatment.
The drugs also have shown promise as a "long-lasting" treatment, but doctors continue to learn more as the drugs are used outside of clinical trials, he said.
"So many cancer treatments can be effective in the short-term, causing tumours to shrink," he said. "Immune therapy, in at least a subset of patients, has truly long-lasting responses."
Carter has said he experienced no side-effects during treatment, a positive sign for his doctors, said Dr. Keith Flaherty, a melanoma specialist at Massachusetts General Hospital's Termeer Center for Targeted Therapies who is not involved in Carter's treatment.
"If [a patient] breaks the right way, the likelihood that he will do well in the short term is extremely high," Flaherty said. "There have been instances of relapse two to three years in while using immunotherapy treatment, but you'd say there is a good reason to be quite optimistic. At President Carter's age, it's very likely he's going to enjoy an excellent quality of life."
But doctors caution that they are still learning about the long-term effect of Keytruda and similar drugs, which have only received approval for wide patient use in the last five years.
"President Carter's doctors certainly will continue close surveillance as they would for any patient in this situation," Lichtenfeld said. "One hopes that by using immunotherapy the body can respond to whatever happens but cancer cells are clever and can develop workarounds for the various treatments."
Cost to society?
Keytruda or pembrolizumab is a second-generation immunotherapy that is available at a few cancer treatment centres in Canada.
Dr. David Hogg is medical oncologist and senior scientist at the Princess Margaret Cancer Centre in Toronto, where he treats metastatic melanoma.
"You only know how good you are in retrospect," Hogg said. "But if I was to make any prediction I'd say that 2015 is probably the year that we'll look back in the future and say that's when we crossed the boundary and 50 per cent of patients with metastatic melanoma surviving for a prolonged period."
On average, the immunotherapy treatment extends a recipient's life expectancy by a year and a half.
The drugs were pioneered for use in melanoma but they're starting to be used to treat other malignancies, such as lung cancer, kidney cancer and Hodgkin's disease.
"The big question is what will the cost to society be of these drugs?" Hogg said.
Doctors will continue to scan Carter's brain and the rest of his body to ensure the disease hasn't spread, Johnson said. The scans typically are done every three months, for a year or two after tests show no signs of cancer growth, he said.
Carter's unexpected comments Sunday came first at the small church where he frequently teaches Sunday school lessons in his hometown of Plains, Georgia.
"And when I went this week, they didn't find any cancer at all," Carter told the congregation, prompting gasps and applause as he smiled slightly. "So I have good news."
As word spread from Maranatha Baptist Church, Carter issued a brief statement confirming the scan showed no signs of the four lesions that doctors discovered this summer on his brain or new cancer growth.
With files from Reuters and CBC's Vik Adhopia