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Carter gets cancer drug tested in San Antonio; Disease spreads to his brain
August 20, 2015

Former President Jimmy Carter talks about his cancer diagnosis during a news conference at The Carter Center in Atlanta on Thursday, Aug. 20, 2015. (AP Photo/Phil Skinner)

By Todd Ackerman, Houston Chronicle

For additional coverage, click here to see KENS-TV video.

Former President Jimmy Carter, who announced Thursday that his cancer had spread to his brain, will be treated with infusions of a new drug that unleashes the immune system to attack tumors, a promising approach pioneered by a Houston scientist and tested in San Antonio.

Carter said Thursday that he had already had his first infusion of Keytruda, an immunotherapy drug, and also would undergo radiation treatments.

Jim Allison, a scientist at M.D. Anderson Cancer Center, did groundbreaking research on immunotherapy, fast becoming the fourth pillar of cancer care.

"While a diagnosis of Stage 4 melanoma is an unfortunate turn of events, we are more optimistic than ever before about treating the disease," said Dr. Sapna Patel, a professor of melanoma medical oncology at M.D. Anderson. "Immunotherapy provides long-term tumor control and minimal toxicity in a portion of patients."

Keytruda has an established history here in San Antonio, where researchers with South Texas Accelerated Research Therapeutics were the first to show the medication can be an effective treatment for both lung cancer and melanoma.

"We were the first people to work with this drug globally," Dr. Amita Patnaik, START's associate director of clinical research and a medical oncologist, told the San Antonio Express-News in April. "No one had had prior experience in the administration of this drug to human beings.

"We were really the first to get exposure to this molecule and to be able to describe its safety - and also to be able to describe its activity in both melanoma and lung cancer."

At that time, 59 patients had undergone one of several clinical trials with the medication at START's offices in San Antonio, according to figures provided by Patnaik.

Carter, 90, acknowledged initially feeling that he "had just a few weeks left" when he learned the cancer had spread to his brain, but added that he is "surprisingly at ease with whatever comes." He said he feels that "this is in the hands of God."

Carter had surgery Aug. 3 to remove cancer from his liver, where the disease first was detected. He said he had initially thought it was confined there - doctors successfully removed the cancer and about a tenth of his liver - but a test that same afternoon showed four small spots on his brain. The brain is one of the most common sites where melanoma spreads.

Carter said he expects future tests likely will show the cancer is in other parts of his body.

Protein acts as ‘brake'

He becomes the nation's most high-profile patient on immunotherapy, a dream that had tantalized cancer researchers for decades before Allison's breakthrough.

Allison found a protein that acts as a "brake," part of a network that keeps the immune system in check but is exploited by cancer cells. The drug Allison developed to take off the brake, Yervoy, was approved by the Food and Drug Administration for metastatic melanoma in 2011.

Keytruda targets another brake, known as PD-1. It was given FDA "fast-track" approval last year, following even more impressive clinical trial results than Yervoy in metastatic melanoma patients.

Both drugs, and a third in the same class, are being applied to other cancers. But so far they've achieved the greatest success in melanoma, a form of skin cancer that historically killed 95 percent of patients within two years.

The drugs have generated great excitement because, even though they do not yet work on most patients, they provide long-term benefits when they do. That's usually not the case with surgery, radiation and chemotherapy, cancer's other primary treatment methods.

About 35 percent of patients with metastatic melanoma who received Keytruda still were alive after three years, according to the study that led to the drug's approval.

That study didn't include patients whose melanoma had spread to the brain, but Dr. Antoni Ribas, a UCLA oncologist who's led Keytruda research, said a very small trial of the drug in patients whose melanoma spread to the brain found similar results.

Ribas said that if the drug is effective in patients, it usually works against cancer cells wherever they circulate in the body.

Keytruda and Yervoy together have provided even greater benefits against advanced melanoma - significantly extending survival in as many as 75 percent of patients - but the combination's side effects - typically diarrhea - are so severe that many patients dropped out of the clinical trial.

Patel and Ribas speculated that's probably why Carter is just being given Keytruda. Side effects from just one of the drugs usually are easily managed.

Neither Patel nor Ribas is involved in Carter's care, which is being provided at Emory University Hospital in Atlanta. Carter said he sought advice from M.D. Anderson, but center officials declined to share information about the advice, citing privacy concerns.


The use of radiation at the same time also may enhance immunotherapy's benefits against cancer, experts said. Although there's no clinical data yet, early research suggests radiation makes cancer cells more recognizable to the immune system. Trials have recently been launched testing the combination in numerous cancer sites.

 

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