Questions and answers about Jimmy Carter’s condition.
A look at Jimmy Carter’s situation:
Q. Isn’t melanoma a skin cancer?
A. “Most melanomas occur on the skin, about 95 percent of them,” and Carter’s cancer probably originated there even though no skin tumor may be apparent now, said Dr. Anna Pavlick, co-director of the melanoma program at NYU’s Perlmutter Cancer Center.
Sometimes the origin of melanoma cannot be determined. On rare occasions, melanoma can start in mucus membranes or the eye. But spreading to the liver and the brain is not uncommon after a tumor that starts in skin, several cancer specialists said.
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A skin cancer is not unlikely considering that Carter lives in the South, is fair-skinned and freckled, and through Habitat for Humanity and travel, has spent a lot of time outdoors, all known risks for melanoma.
Q. What can be done?
A. Carter said he will get two types of treatment: focused radiation to the tumors in his brain and a drug aimed at boosting his immune system. He received the first dose Wednesday of pembrolizumab, or Keytruda, a Merck drug recently approved for treating melanoma. It removes a sort of cloaking mechanism that cancer cells use to evade attack by the immune system. Three additional doses are planned at three-week intervals.
Carter also received a stereotactic radiation treatment Thursday afternoon. It focuses beams precisely on tumors and avoids other areas of the brain and causes far fewer side effects than the whole-brain radiation. He was fitted with a customized mask to hold his head still to help make sure the radiation goes only where it is intended. More radiation treatment could be scheduled if needed.
Q. Could more tumors show up?
A. Carter said doctors said the cancer is “likely to show up other places in my body.”
Q. Is his cancer curable?
A. Hard to say. “There is a chance of cure,” even with tumors in the brain, said Dr. Mario Sznol, a melanoma specialist at Yale Cancer Center. Up to half of patients respond well to the immune-system drug, and many have remissions that can last years, he said.
One of Carter’s physicians, Dr. Walter Curran Jr., of Emory University, said: “We’re not looking for a cure in patients who have a disease like melanoma that has spread. I’ll emphasize … high blood pressure is not cured, and yet some of our friends live for decades with it. The goal is control and to have a good quality of life.”