Understanding Jimmy Carter’s Surprise Cancer Turnaround: A Conversation with Jedd Wolchok

By Matthew Tontonoz,

Wednesday, December 9, 2015

Former US President Jimmy Carter

Jimmy Carter announced this week he is free of melanoma. In addition to surgery and radiation, Mr. Carter was treated with a new immunotherapy drug called pembrolizumab. Combining immunotherapies with other treatments may improve outcomes for some patients.

  • Melanoma is a type of skin cancer that can spread to other organs, including the brain.
  • Immunotherapy drugs like the one Mr. Carter received are offering new hope to patients with metastatic melanoma. 
  • Combination treatments may improve outcomes for some patients.

Update: The immunotherapy drug that helped President Carter beat back cancer is yielding even more encouraging results. Data released on May 18, 2016 in advance of the annual meeting of the American Society of Clinical Oncology indicate that 40% of patients who received pembrolizumab (Keytruda®) as part of a large clinical trial are still alive three years later — a huge improvement over just a few years ago when average survival time for patients with metastatic melanoma was measured in months.

This week, former President Jimmy Carter announced that he is “cancer free” after receiving treatment for metastatic melanoma — a type of skin cancer that often spreads, or metastasizes, to other parts of the body. Mr. Carter’s cancer was discovered in his liver and spread to his brain.

In addition to surgery and radiation, Mr. Carter received a new immunotherapy drug called pembrolizumab (Keytruda®), which releases a brake on the immune system, empowering it to mount a stronger attack against cancer. The particular braking molecule targeted by this drug is called PD-1.

To get a better sense of what Mr. Carter’s surprise announcement means — especially for patients in a similar situation — we spoke with Jedd Wolchok, Chief of the Melanoma and Immunotherapeutics Service at Memorial Sloan Kettering.

Mr. Carter received three types of cancer treatment: surgery, radiation, and immunotherapy. At this point, can we say which was most responsible for his cancer-free outcome?

That’s a great question. My colleagues and I were just discussing this. I think it’s probably a contribution from all of the above. I don’t think it’s possible to ascribe the very favorable result to just one intervention. As time goes on, if he continues to have durable control of his disease, then I think we can be confident that immunotherapy played an important role.

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Can the combination of radiation and immunotherapy work together in a synergistic way to provide added benefit to patients?

There is that possibility. The hope is that when you kill a tumor with a tool like radiation therapy, you release cell debris that can trigger an immune response — similar to a kind of vaccination. Then, by blocking an immune checkpoint — in this case PD-1 — you allow that immune response to really take off.

Mr. Carter's case is a great example of how far the field has come in a relatively short period.
Jedd D. Wolchok
Jedd D. Wolchok immunologist and melanoma expert

We’ve certainly seen isolated examples of this phenomenon, called the abscopal response, with other immunotherapy drugs. I wrote a paper about this a couple of years ago with my MSK colleague Michael Postow. We’re now about to open a study using a combination of two immunotherapy drugs, ipilimumab and nivolumab, along with radiation for patients with melanoma. A lot of folks are really interested in this, and you can build a strong rationale for why it makes sense to use them together. But it has to be tested. 

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Are there times when it’s not possible to receive immunotherapy because of brain metastases?

We have a lot of issues yet to settle here. We know that the same medicines that can have a favorable effect on disease outside of the brain can have a favorable effect in the brain. There was a clinical trial that I participated in and published in Lancet Oncology about two years ago that looked at ipilimumab treatment in melanoma patients with brain metastases.

Learn more about melanoma screening and diagnosis.

The challenge with brain metastases is that sometimes patients require corticosteroid treatments [which can suppress the immune system] to control swelling and symptoms. In the trial I referred to, the benefit of ipilimumab was seen only in the patients who were able to come off corticosteroids. So that’s an important consideration.

That’s why it’s good to do exactly what Mr. Carter’s physicians did, which was to control the brain metastases to the best of their ability — in this case with stereotactic radiosurgery — get him off the steroids as quickly as possible, and then initiate the immunotherapy.

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Is Mr. Carter’s experience representative of patients with metastatic melanoma and brain metastases?

It’s becoming more and more common. Mr. Carter’s case is a great example of how far the field has come in a relatively short period. If you turn back the clock ten years or so, people with melanoma and brain metastases had life expectancies that were measured in weeks and months. Now, there are patients in my practice who have had brain metastases and have been alive for years. And of course we hope the same is true for Mr. Carter.

I find it very inspiring that he’s been able to continue the important work that he’s engaged in without any side effects from treatment.

It’s also inspirational to patients, who can see that a devastating diagnosis doesn’t necessarily mean that you’re going to die immediately, or that the treatment is going to incapacitate you. Here’s a 90-year-old person not just living but fully active and engaged in activities that are making the world better for the rest of us. 

Pembrolizumab is one of two PD-1-blocking drugs approved by the FDA for the treatment of advanced melanoma, the other being nivolumab (Opdivo®). The five-year survival rate for patients treated with nivolumab is 34%, as reported last month at the annual meeting of the American Association for Cancer Research. Check back here on the MSK blog for more updates on progress in immunotherapy.

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12 years ago Dr. Jedd Wolchok saved my life. My husband and I and our two year old daughter are eternally greatful.God bless Dr. Wolchok and his good work.

Kristen, we are so glad to hear you're doing well! We've forwarded your message to Dr. Wolchok. Happy holidays to you and your family!

Has immunotherapy been tested on Mesothelomia?

Is it known were President Carter's primary melanoma was? Was it cutaneous, mucosal, or ocular? Those of us in the melanoma community really appreciate knowing what kind of melanoma someone has. I'm glad he has responded so well to treatment.

Elizabeth, thank you for your comment. It is not clear what type of primary melanoma President Carter had. He did not reveal it when he made his announcement and presumably chose not to divulge that information.

This is miraculous! Is there any research about immunotherapies with other types of cancers? Does this work across the board?

Rima, thank you for your question. Immunotherapy is a very active field in cancer research and it is being tested against a wide range of cancers. Here is some further information on cancer immunotherapy and current research:





I want to thank Dr Wolchok for his efforts to helping me fight Stage IV melanoma four years ago. Without his knowledge and research of immunotherapy I would not be celebrating another Christmas. Happy holiday to my "second life director".

Gary, thank you for your kind words--we will pass them on to Dr. Wolchok. We are pleased to hear that you are doing well.

does immunotherapy help prevent recurrence of colon cancer following colorectal re-section, followed by re-section of liver metastasis.

Kamdar, thank you for your question. The latest generation of immune modulating medicines has not yet be tested in this situation, so it is too early to tell whether the approach would be effective.

Can this treatment method treat pancreatic cancer?

Has immunotheraphy been successfully tested on leyomyosarcoma?

Eduardo, thank you for your question. Immunotherapy is currently being studied for leyomyosarcoma, but there is no definitive data yet.

Is their any research with these immunotherapy drugs on mestatic rectal cancer.

Brenda, thank you for reaching out. Yes, a specific subset colorectal cancers which have a high number of mutations seems to respond to PD-1 blockade. This work was published by a group from Johns Hopkins in NEJM over the summer. We have a trial at Memorial Sloan Kettering testing PDL-1 blockade in the subset of colorectal patients with high mutations, called MSI-H. You can find more information at this link:


We also have trials of PD-1 blockade plus another therapy, such as radiation or ablation in conventional colorectal cancer:


Can the treatment that President Carter had be used on Grade IV Glioblastoma in an adult?

Hi Lynne, just to clarify, Mr. Carter was treated for melanoma (skin cancer) that had spread to the brain, rather than for primary brain cancer (glioblastoma). That said, MSK and other institutions are currently studying the use of immune therapies like the one Mr. Carter received in a number of clinical trials for brain cancer. You can find a list of our trials here: https://www.mskcc.org/cancer-care/types/brain-tumors-primary/clinical-t… Please note that none of these treatments are part of standard care for brain cancer at this time.

If you or a loved one would like to make an appointment for a consultation at MSK, you can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information on making an appointment. Thank you for your comment.

Hi there! Can immunotherapy be used to treat Multiple Myeloma & is this treatment method standardized I.e.,across the world as I am writing from India. Thanks in advance.

Hi there! Can immunotherapy be used to treat Multiple Myeloma & is this treatment method standardized I.e.,across the world as I am writing from India. Thanks in advance.

Afefa, the drug that President Carter received, called Keytruda, is currently being studied for multiple myeloma, but its use in treating that condition is not part of standard treatment at this time. If you'd like to find out whether the drug may be available in India as part of a clinical trial, we recommend that you speak to an oncologist where you are located. Thank you for your comment.

Please advise us what could new therapy is available for this Case from my relative in Canada .Female age 44.
Metastatic Breat cancer that is now in the Liver , Lungs , Bone and Right eye .
Her cancer is estrogen /progesterone positive , herceptin negative .
She had 6 Cycles of Taxatere Chemo then Xyloda and Halaven which did not respond to.
Ophorectomy was done two months ago and now on Oral Femara as Antiestrogen .
THAT COULD BE AVAIABLE since Canada gave up on her case , any reversal to Rosewell park , in Buffalo closer to her in Canada .

Hi Wassief, if your relative in Canada wants to know what treatment options are available, she should discuss this with her healthcare team. If she's interested in trials, she may want to go to www.clinicaltrials.gov, a database of clinical trials all over the world. If she'd like to come to MSK for a consultation, she can contact our Bobst International Center at international@mskcc.org or go to https://www.mskcc.org/experience/become-patient/international-patients for more information. Thank you for your comment.

02.08.16 - Dear Dr. Wolchok, My nephew, age 58, underwent surgery, chemo-therapy and radiation one year ago for lung cancer. Now, after a year, the lung cancer has spread - metastasized) to the brain (Meningioma). He has been diagnosed "terminal" - weeks to live. He is not a candidate for the Gamma Knife Therapy, as the brain cancer is all over. His doctors would like to try an immunotherapy drug. I did read that you mentioned that immunotherapy is not part of a standard care for brain cancer. Is there been any other treatment available to extend my nephew's life - if only for months. Any information is greatly appreciated. He is being treated in Long Island. Most graciously and thank you.

Marie, we're sorry to hear about your nephew. MSK has several clinical trials for brain cancer, including some that involve immunotherapy. If your nephew would like to make an appointment, he can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information on making an appointment. Thank you for your comment.

I read with interest the internet article by Matthew Tontonoz regarding Jimmy Carter’s remarkable recovery. My wife suffers from lymphoma of the central nervous system. She has been treated with Methatrixate at UCSF hospital. The treatment was able to shrink the original tumor, but a mass has returned and she underwent the Methatrixate therapy again.

Have any of the experimental drugs been used on lymphoma of the brain? I am willing to make an appointment, if experiments have been conducted with this condition.

Dear Milton, we are sorry to hear about your wife's tumor returning. We are conducting clinical trials for which your wife may be eligible. It's best if you contact our Physician Referral Service at 800-225-2225. The staff there can answer your questions about our open trials for people with the type of lymphoma that your wife has (two can be found here, though there may be others: https://www.mskcc.org/cancer-care/types/brain-tumors-primary/clinical-t…). Thank you for reaching out to us.

Where can I find immunotherapy trials or treatments for multiple myeloma of the bones and bone marrow? Thanks in advance

Eric, MSK has a number of current trials for multiple myeloma, including several that involve immunotherapy. You can see the complete list at https://www.mskcc.org/cancer-care/types/multiple-myeloma/clinical-trials. If you're interested in making an appointment, you can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information. If you're not able to come to New York City for treatment, you can go to www.clinicaltrials.gov to find myeloma trials being conducted near where you live. Thank you for your comment.

Hi tomorrow I get my second scan ( almost 8 months ago after surgery for esophageal cancer) I had chemo/rad ivor lewis surgery that's been going on for decades. I know in the us it's rare so funding and protocols seem stagnant. Are any great strides being done for esophageal cancer.

Is there any trial immunotherapy for carcinoid tumor?; I have lung carcinoid s/p lung surgery; mets to liver And bones: on XELODA and Temodar with limited response; thank you

Dear Solrac, pulmonary carcinoid tumors are a type of neuroendocrine cancer. To learn more about how people with advanced forms of this disease are treated, please visit https://www.mskcc.org/cancer-care/types/pulmonary-neuroendocrine-tumors…. Some of our clinic trials for people with this type of cancer can be found here: https://www.mskcc.org/cancer-care/types/pulmonary-neuroendocrine-tumors…. If you would like to make an appointment with one of our specialists about your treatment options, please call our Physician Referral Service at 800-525-2225. The staff there can also answer your questions regarding your eligibility for our clinical trials. Thank you for reaching out to us.

Are there any current immunotherapy trials for those with stage four lung adenoCARCINOMA already treated with (and failed at low phase 1 clinical trials doses) of ipilimumab and nivolumab?

Myra, we sent your question to Matthew Hellmann, a medical oncologist who is an expert in immunotherapy for lung cancer, and he said, "There are some clinical trials that are enrolling patients treated with prior immunotherapies, particularly phase 1 trials of new immunotherapy molecules. It's best to talk with your doctor about available trials and centers participating in early phase clinical trials to determine what might be the best treatment for you." If you'd like to make an appointment for a consultation at MSK, you can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information on making an appointment. Thank you for your comment.

When do you expect definitive data to be available on the trial(s) involving immunotherapy and Leiomyosarcoma (Lyomyosarcoma)?

Dear Susan, unfortunately there are no updates to share just yet. We continue to investigate new treatments - including immunotherapy - for people with leiomyosarcoma. Thanks for reaching out to us.

Have had two operations on left arm now stage 4 or 3c maybe no signs of return 2 yrs out and Pet scans every 6 months Told it is Nras mutation do these drugs work on nras as well? Pretty sure after reading for months that melenomia will return and probably in brain Looking for future hope Thanks

Dear Tim, there is some evidence suggesting that patients with NRAS mutations respond well to immunotherapies such as those described in this article. We encourage you to discuss with your doctor whether immunotherapy would be right for you. If you would like to make an appointment with one of our specialists, please contact our Physician Referral Service at 800-525-2225. Thank you for reaching out to us.

My father was diagnosed with stage 4 small cell lung cancer. Went through chemo. 3 months later cancer started to grow back. Has had 3 treatments of opdivo. Cat scan today showed excellent results! Cancer is shrinking again and has not grown at all!!

Dear Marilynne, we are sorry to hear about your father, but glad to know that his disease is responding to immunotherapy. Thank you for sharing your good news!

Can this drug be used against Neuroblastoma? There is a five year old in Texas that needs help. He was just deemed terminal. Any ideas?

Dear Susan, researchers at MSK are making great strides in the treatment of children with neuroblastoma. Immunotherapy is one of several treatment options being evaluated in clinical trials at MSK. To learn more about our work in this area, please visit https://www.mskcc.org/pediatrics/cancer-care/types/neuroblastoma/treatm…. If this child's parents would like to make an appointment with one of our pediatric oncologists to discuss possible next steps in their son or daughter's care, please ask them to call 212-639-5954. Thank you for reaching out to us.

Was president carters mutation nras I have had 2 surgerys and am now 2 yrs free but am afraid that these new trails are not for nras mutations Melonima

Dear Tim, we are investigating immunotherapy and other novel treatments for people with melanoma and an NRAS mutation. You may be interested in learning more about these clinical trials here: https://www.mskcc.org/cancer-care/clinical-trials/search?keys=NRAS&dise…. If you have any questions about these studies or would like to make an appointment, please call our Physician Referral Service at 800-525-2225. Thank you for reaching out to us.

Is immunotherapy an option for treating adult Leukemia (ALL B cell Philadelphia+)?
If so, which cancer centers provide this treatment?

Dear Sue, to learn more about how this type of leukemia is treated, please visit https://www.mskcc.org/cancer-care/types/leukemias/treatment/acute-lymph….

In addition, immunotherapy has produced very encouraging results in patients with B cell acute lymphoblastic leukemia that has come back after or been resistant to standard therapy. Our researchers are pioneers in this field, working to engineer T cells, a form of white blood cell, that can recognize and attack a patient’s cancer cells. Learn more about how this approach, called CAR T cell therapy, works by going to https://www.mskcc.org/blog/car-t-cell-therapy-growing-area-research.

To browse through clinical trials studying novel treatments, including immunotherapy, for people with ALL, please visit https://www.mskcc.org/cancer-care/types/leukemias/clinical-trials?keys=….

If you have any questions about these studies or would like to make an appointment, please call our Physician Referral Service at 800-525-2225. Thank you for reaching out to us.

I had my prostate removed 20 years ago. Recently PSA went to 9.4. Am now on LUPRON, applied every 4 months. PSA is now 1.1. This is not a cure. Is Proton therapy a viable cure/treatment. I am 92 yrs. old & still active.

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