Jimmy Carter was a Democrat, an affiliation that created loyal constituents and political adversaries alike during his time as governor of Georgia and president of the United States. He was also a cancer survivor. And, as we know, cancer is not partisan. It will be diagnosed in nearly 40 percent of Americans during their lifetimes whether they’re Democrats or Republicans.
So, no matter what you may think of Carter’s political leanings or the successes and failures of his one-term presidency, his long-term cancer survivorship was an inspiration to many Americans.
The nation’s 39th president passed away on Dec. 29, 2024, 22 months after he entered home hospice care. After a series of hospital stays for a variety of conditions, Carter chose to forego additional medical care and spend his remaining days at home. He was 100.
Carter’s passing comes 10 years after he was diagnosed with metastatic melanoma, a difficult-to-treat cancer that in years past was considered a death sentence.
“I assumed, naturally, that I was going to die very quickly,” Carter said during a church service years later while reflecting on his diagnosis.
Carter’s successful treatment with the then-groundbreaking drug pembrolizumab (Keytruda®) help put immunotherapy into the spotlight and created hope for thousands of patients diagnosed with difficult cancers.
“He was extremely inspiring—his approach to his illness, dealing with it with resolve, yet reason,” says Maurie Markman, MD, President of Medicine and Science for City of Hope® Cancer Centers Atlanta, Chicago and Phoenix. “He can be a poster child for treatment.”
In this article we’ll explore:
- Carter’s metastatic melanoma diagnosis
- Carter’s treatment with immunotherapy for melanoma
- How does immunotherapy work?
- Carter’s choice of hospice care at home
- Immunotherapy today
If you’ve been diagnosed with melanoma and want to get a second opinion about your diagnosis or treatment options, call us or chat online with a member of our team.
Carter’s metastatic melanoma diagnosis
In August 2015, doctors removed a mass from Carter’s liver and discovered the tumor was metastatic melanoma.
“A year ago, I didn’t think I was going to live but two or three weeks because they had already removed part of my liver because I had cancer there,” Carter said in 2016. “After that, when they did an MRI, they found four cancer places in my brain so I thought I just had a few weeks to live.”
Carter underwent surgery, radiation therapy and he enrolled in a clinical trial for the drug pembrolizumab. His treatment lasted from August 2015 to February 2016. But in December 2016, Carter announced that the scans of his brain were clear.
“My most recent MRI brain scan did not reveal any signs of the original cancer spots nor any new ones. I will continue to receive regular three-week immunotherapy treatments of pembrolizumab,” Carter said in a statement.
In his years of cancer survivorship, Carter helped build Habitat for Humanity homes, conducted prayer sessions, taught Sunday school and ran The Carter Center, his foundation that addresses global health and human rights issues. None of these achievements may have happened had it not been for the emergence of a class of immunotherapy drugs called checkpoint inhibitors.
Carter’s treatment with immunotherapy for melanoma
Pembrolizumab blocks a protein called PD-1 that is used by some cancer cells to evade the immune system. The former president received 30-minute infusions of pembrolizumab every three weeks for six months.
While the concept of stimulating the immune system to fight cancer has been around for more than 100 years, it wasn’t until the early 2010s when checkpoint inhibitors emerged as a viable option for some patients with difficult-to-treat cancers, especially lung cancer and melanoma. In fact, pembrolizumab was approved by the U.S. Food and Drug Administration (FDA) to treat certain specific cases of melanoma just a year prior to Carter’s treatment.
His high-profile case and the apparent success of his treatment thrust immunotherapy into the spotlight. “I want what Jimmy Carter had,” cancer patients would say, one doctor told Stat News.
“For the public, Carter put immunotherapy on the map, period,” Drew M. Pardoll, Director of the Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins told The Washington Post. “Patients started asking for it.” It was called “the Jimmy Carter effect.”
How does immunotherapy work?
Immunotherapy is an umbrella term for a class of drugs that are designed to help the immune system better recognize and attack cancer. Unlike viruses or bacteria, cancer cells are mutated versions of the body’s own cells, so they can often slip by the immune system unnoticed. Immunotherapy drugs work by:
- Disrupting signals cancer cells use to hide from the immune system; or
- Using Re-engineered immune cells to attack specific features on cancer cells; or
- Stimulating the immune system to create antibodies that attack cancer cells.
Types of immunotherapy drugs include those listed below.
CAR T-cell therapy: Chimeric antigen receptor (CAR) T-cell therapy uses a patient’s own white blood cells that are harvested and strengthened, grown in large batches and injected back into the body to fight the cancer.
Vaccines: Most vaccines, such as those for the flu or COVID-19, are designed to prevent illness or reduce symptoms. Cancer vaccines help the body create antibodies to attack cancer cells.
Cytokines: These proteins are created by your body during natural infections that play an important role in stimulating your immune system cells.
Checkpoint inhibitors: These drugs work by blocking certain proteins called immune checkpoints on cancer cells that may prevent the immune system from recognizing and attacking them.
Immune checkpoints are part of the body's natural defense mechanisms that help to regulate the immune system and prevent it from attacking healthy cells.
Checkpoint inhibitors target two important immune checkpoint proteins:
- CTLA-4 (cytotoxic T-lymphocyte-associated protein 4)
- PD-1 (programmed cell death protein 1)
When these proteins, found on the surface of T-cells, bind to corresponding proteins on the surface of cancer cells they signal the immune cell to turn off or become less active. Checkpoint inhibitors block CTLA-4 or PD-1, allowing T-cells to better recognize and attack cancer cells.
Carter said he experienced minimal side effects from his immunotherapy treatment. But for some patients, side effects may be severe and include:
- Fatigue
- Nausea or vomiting
- Diarrhea
- High blood pressure
- Fever or chills
- Pain or weakness
- Headaches
- Rashes or itching
Carter’s choice of hospice care at home
Carter’s cancer treatment at age 90 showed that some cancer therapies may still be an option, even for those at an advanced age.
“Chronological age is not a deciding factor in whether someone should be treated for cancer or not,” Dr. Markman says. “One should not say that because he’s 90, he should not have treatment.”
Notably, the 2002 Nobel Peace Prize winner fell several times in 2019. He had hip replacement surgery after a fall in May that year and fractured his pelvis in a fall in October 2019. He later required surgery to relieve brain bleeding due to several falls.
Through it all, Carter bounced back and continue to make public appearances and teach Sunday school at his beloved Maranatha Baptist Church in Plains, Ga. But old age and health issues eventually caught up with the former president, leading to his decision to enter hospice.
At age 96, Former First Lady Rosalyn Carter was diagnosed with dementia in May 2023 and entered hospice six months later. She passed away six months later.
“Rosalynn was my equal partner in everything I ever accomplished,” former President Carter said in a statement released by The Carter Center . “She gave me wise guidance and encouragement when I needed it. As long as Rosalynn was in the world, I always knew somebody loved and supported me.”
Immunotherapy today
Immune checkpoint inhibitors and immunotherapy in general have evolved significantly in the 10 years since Carter’s diagnosis and treatment.
Today, the FDA has approved several more immunotherapy drugs that work similarly to pembrolizumab to treat a variety of cancers, including:
- Breast cancer
- Bladder cancer
- Cervical cancer
- Colorectal cancer
- Head and Neck cancer
- Hodgkin lymphoma
- Kidney cancer
- Liver cancer
- Lung cancer
- Stomach cancer
The FDA has also approved checkpoint inhibitors to treat so-called agnostic tumors, those that have specific genetic features, regardless of where in the body they originate. These treatments may be used to treat the following malignancies.
Solid tumors with microsatellite instability-high (MSI-h) or mismatch repair deficiency (dMMR): These tumors may have unstable strands of DNA or are unable to repair DNA damage.
Solid tumors with high tumor mutation burden (TMB-h): These tumors have cells with a high number of different gene mutations, which may make them more likely to respond to immunotherapy.
Scientists continue to develop new types of immunotherapy treatments, combinations of treatments and strategies to make checkpoint inhibitors work for more patients. They also are understanding ways to reduce challenging side effects that may come with these drugs.
“Many of my patients on immunotherapy continue in their jobs. They get the treatment in the morning and go to work in the afternoon,” Suresh Ramalingam, MD, Executive Director of the Winship Cancer Institute of Emory University, where Carter was treated, tells NBC News. “When we see patients like President Carter beat their cancer, that is the positive reinforcement that drives us to do even better.”
If you’ve been diagnosed with melanoma and want to get a second opinion about your diagnosis or treatment options, call us or chat online with a member of our team.