We were all thrilled to learn of the complete remission from malignant melanoma and brain metastases that former president Jimmy Carter has achieved. It is indeed a miracle, but a miracle of modern medical science that is available to our patients here in Queens. In addition to targeted radiotherapy he received a drug called pembrolizumab, one of a new class of agents called immunotherapy. This particular drug attacks a shield that cancer cells build so the immune system can’t get at them. Take away this protection and T-cells, one key part of our immune system, can attack and kill the cancer cells.
A similar drug, Nivolumab has been in use in our office for over a year, first as part of a research protocol and then for treatment of some lung cancers, kidney cancer and melanoma. The FDA has approved pembrolizumab so we can use that drug as well and we are now testing tumors to find patients for whom the treatment is likely to work. Unfortunately, these medications are not “magic bullets” and only work in a minority of most diseases.
I have been a hematologist since 1967 and an oncologist since 1974 and I have been thrilled with all the new weapons I have at my disposal. Three new medications were approved for treatment of myeloma just in the past three weeks and the number of new agents is just exploding. There are two major problems: first – not everyone responds and so we still have plenty of work to do; second, these new treatments are fiendishly expensive and I do not know what the health care system can afford. Pembrolizumab costs over $10,000/month/patient and while some insurance will cover the cost, the system eventually cannot.
Bless President Carter and all patients and those who love and care for them. We will bring the best available treatments to our patients and fight for them as hard as we can.
Written by: Dr. Barry H. Kaplan, M.D., Ph.D.
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