Hope rises for cancer cure By Chukwuma Muanya, Assistant Editor

• New drug shrinks Carter’s brain tumour
• Costs N3.1m per patient per month
• Not yet registered in Nigeria
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A GLIMMER of light may have appeared at the
end of the tunnel in the search for cancer cure
with new immunotherapy drug, Keytruda, being
linked to former United States (U.S.) President
Jimmy Carter’s brain tumour shrinkage.
Pembrolizumab (formerly MK-3475 and
Lambrolizumab (trade name Keytruda) is a
human antibody used in cancer immunotherapy
marketed by Merck which targets the
programmed cell death 1 (PD-1) receptor. The
drug was initially used in treating metastatic
melanoma.
Merck said Keytruda (pembrolizumab), the latest
in a string of breakthrough cancer therapies
helping push the overall market for oncology
drugs to $100 billion a year, would cost $12,500
(N3.1 million) per patient per month, or $150,000
(N37.35 million) per year.
It was learnt that the drug is not one of the Merck
drugs registered by the National Agency for Food
Drug Administration and Control (NAFDAC).
However, this could not be confirmed at press
time because The Guardian was not able to reach
the Director General of NAFDAC, Dr. Paul Orhii.
It was also learnt that Merck and Co. is already
well established in Nigeria. It was also found that
most Nigerians who need it access it when they
travel abroad for medical treatment or order it
through the help of their doctors or treatment
centres.
The Guardian’s investigation also revealed that
most Nigerian doctors and pharmacists do not
know about the drug.
On September 4, 2014 the U.S. Food and Drug
Administration (FDA) approved pembrolizumab
under the FDA Fast Track Development
Programme. It is approved for use following
treatment with ipilimumab, or after treatment
with ipilimumab and a BRAF inhibitor in
advanced melanoma patients who carry a BRAF
mutation.
On October 2, 2015, the US FDA approved
pembrolizumab for the treatment of metastatic
non-small cell lung cancer in patients whose
tumors express PD-L1 and who have failed
treatment with other chemotherapeutic agents.
Indeed, Carter credits the new cancer drug
Keytruda for shrinking his brain tumors
completely. It is one more possible victory for the
newest class of cancer drugs that empower the
immune system to fight off tumors.
Carter shared the happy news on Sunday when
he told his Sunday School class that recent brain
scans showed he was clear of cancer.
“My most recent MRI brain scan did not reveal
any signs of the original cancer spots nor any
new ones,” the former president said to his class
at Maranatha Baptist Church in his hometown of
Plains, Georgia. Carter, now 91, was diagnosed
over the summer with melanoma that had spread
to his liver and brain.
Whether Carter’s cancer is gone for good, no one
knows for sure, but experts say the fact that the
metastatic melanoma is no longer detectable and
that no new tumors have appeared are good
signs, and may offer hope for others who may
benefit from new immunotherapy treatments like
the one used to fight Carter’s cancer.
“It is fantastic news. This really illustrates the
importance of multidisciplinary care,” Cleveland
Clinic cancer specialist Dr. Dale Shepard, told CBS
News.
Carter was first diagnosed in August after a mass
was removed from his liver. Then doctors
discovered that the cancer had also spread to his
brain as four small spots.
Most cases of melanoma begin as a skin cancer,
but Carter said this past summer that his doctors
had not determined where his cancer originated.
He underwent liver surgery, received radiation
therapy on his brain and then began
immunotherapy, said Shepard, a medical
oncologist.
According to Shepard, there are about 200,000
cases of metastatic melanoma in the U.S. every
year and that it is the most dangerous type of
skin cancer. Approximately 10,000 deaths occur
from it annually.
“Not uncommonly, it can spread to organs like
the liver and the brain,” said Shepard.
In a statement, Carter talked about his ongoing
medical plan, “I will continue to receive regular
three-week immunotherapy treatments of
pembrolizumab.” The drug goes by the name
Keytruda commercially.
According to Shepard, the recently-approved
drug and others like it are important.
“Prior to these immunotherapies, we didn’t have
good treatment options for melanoma that was
metastatic, that had spread to other organs,”
Shepard said.
Normally, the immune system can recognise
things that shouldn’t be there, like bacteria or
virus, Shepard explained. “But you can have a
very large tumor that the immune system
seemingly ignores, even though it’s an abnormal
collection of cells,” he said.
These tumours can express proteins on their
surfaces that essentially can hide the mass from
the immune system so that it can’t attack it and
get rid of it.
Newer immunotherapy drugs are engineered to
“unmask” the tumors by interacting with those
proteins to make them visible to the immune
system so it can fight the offending cancer.
Now, several months since beginning
immunotherapy, Carter’s treatments appear to
have worked.
“While giving this therapy, they were able to
prevent regrowth of existing tumors and growth
of new tumors,” said Shepard.
Carter’s family is no stranger to cancer; three
siblings and his father died from pancreatic
cancer.
Is it a cure? While Carter’s clean bill of health is
very good news, Shepard said it was too early to
call it ‘a cure.’
“The way we think about this is that the drug has
kept the disease under control and it has been
well-tolerated,” he said.
“For someone who is 90 years old, getting these
sorts of therapies and doing so well, it is pretty
amazing,” said Shepard.
Shepard is not involved in Carter’s treatment, but
he said his doctors would probably continue with
his treatment another two or three months and
then scan again to see if it was still controlling his
disease.
Carter, the 39th president of the United States,
served between 1977 and 1981 and is now the
nation’s second-oldest living president.
After leaving the White House, he established the
Carter Centre and has travelled the world
working on issues like health care and global
democracy. He recently finished a book tour
promoting his latest book, A Full Life: Reflections
at 90.
The medication Carter is taking is currently FDA-
approved for use in certain lung cancers. There
are ongoing trials in a number of other diseases,
too.
“This is good science — realising that the
therapies we have available are not optimal and
creatively looking for new ways to treat cancers,”
said Shepard.
According to him, Carter’s news underlies the
importance of the need for continued basic
scientific research and clinical trials.
“You can actually see that it can have benefits-
this particular case with the former president
puts a face to this- and how people can really
benefit from this,” Shepard said
Making the drugs affordable needs to be
addressed, too, he added. “This therapy costs tens
of thousands of dollars a month.”