Seeing former President Jimmy Carter doing so well is the most gratifying moment of the Presidential inauguration

I cannot talk about the Presidential inauguration without mentioning science/medicine.  After talking about the most gracious moment of the day, seeing former President Jimmy Carter doing so well is the most gratifying moment.

In August 2015, 90 years old then, Carter announced he had metastatic melanoma that spread to the liver and brain.  It must have been detected (as far as the size of brain metastasis is concerned) as it said “four extremely small spots, about two millimeters in size.”

From my readings I never found out where was the primary melanoma, which can be tricky or even disappeared before the metastasis was detected.

Carter underwent surgery to remove the liver tumor in August 2015, followed by stereotactic radiation therapy, which delivers a strong beam of radiation with precision to the four tiny spots in his brain, thus avoiding the “collateral” damage to the nearby healthy brain.

One has to presume Carter might have other “micro-metastasis” in the brain or liver or other organs of the body that cannot be picked up by any image studies.  According to Dr. Keith Flaherty, Director of Termeer Center for Targeted Therapy at Massachusetts General Hospital (MGH), Carter received Pembrolizumab (or Keytrude marked by Merck).

Keytruda (Pembrolizumab) embodies the ingenious immunotherapy, expanding the powerful arsenal against cancer.

Keytruda is an anti-PD-1 monoclonal antibody (the concept of programmed death or PD-1 is beyond the scope of this writing).  Cancer activates brakes to the immune system; thus suppresses our immune system to attack cancer.  Keytrude inhibits the action of those brakes, reverses immune T-cell suppression and induce anti-tumor responses; this is the basic concept of cancer immunotherapy.

Normally activation of PD-1 receptor/pathway leads to programmed death, so it is negative regulation.  Keytrude binds to PD-1 receptor (thus PD-1 ligand cannot bind to it) on immune T cells, thus inhibits programmed cell death-1 (PD-1) activity.  Removing this suppression sets immune T cells free to do its job of attacking the cancer.

PD-1 (or PD-L1, PD-ligand 1) also has synergy with radiation therapy.

Keytrude (approved in Sept 2014) is the 6^th new anti-melanoma agent FDA approved since 2011.  A Wall Street Journal reported (5/19/16) 40% of 655 patients still alive 3 years after taking Keytrude; it used to be 10-20%.

The most famous Sunday School teacher (Carter never retired from this job) announced in his Bible lesson class at Maranatha Baptist Church in his hometown of Plains, Georgia on 12/7/15 that his latest scan showed no sign of cancer, he said, “When I went this week, they didn’t find any cancer at all, so I have good news.”  Glory to God!