Jimmy Carter, with characteristic forthrightness, personally announced four small tumors have been spotted in his brain by MRI testing. He had surgery to remove a tumor from his liver a couple of weeks ago, and had been warned that cancer had likely spread to other parts of his body.
Now we know that his liver cancer was actually metastatic melanoma, which has spread to his brain.
His medical team at Emory have started infusions of Pembrolizumab, a drug that revs up the immune system to attack melanoma systemically. They will also start Stereotactic Radiation, directed at the tumors in his brain, immediately.
Pemprolizumab was recently approved for treatment of advanced melanoma, and it seems reasonable to apply that treatment straightaway, since it will help reduce tumors system-wide, even in the brain. The medical team at Emory will be watching Carter very closely for signs that his revved-up immune system is attacking healthy organs, a problem that happens in a small percent of patients.
Stereotactic Radiation is administered by “gamma knife,” a computer-guided machine that uses a 3-D map of the patient’s brain to guide precise pulses of radiation converging on the location of the tumors. This treatment is effective at shrinking and destroying tumors. Side effects include serious fatigue and problems with buildup of pressure. In some cases this fluid pressure may require surgery to relieve the pressure.
Personally, if I were Jimmy Carter, I would probably take the immune therapy and hold off on the radiation to see if the brain tumors respond without it. I’m admittedly biased toward newer immune-system treatments and against radiation, even in targeted doses. A likely counter-argument is that if Carter cannot tolerate Pemprolizumab, then it would beneficial to have administered radiation while the tumors are still small.
Jimmy Carter is 90, and a decision to forego further treatment would also be reasonable. This would be a difficult and unpopular decision, especially for Rosalynn and other family members who do not want to lose their beloved. The Emory medical team are also motivated to do all they can to help their high-profile patient.
Jimmy Carter has been such a remarkable citizen, president and example of decency and goodness. May his treatment be helpful and his soul untroubled in the days ahead.