When I meet new patients diagnosed with Stage IV metastatic melanoma, I often mention the name Jimmy Carter. It’s a name most people recognize, and his survival story is nothing short of remarkable—especially considering he will soon celebrate his 100th birthday.
Like many of my patients, Carter was diagnosed with Stage IV melanoma, with metastatic disease that had spread to both his liver and brain. At the time of his diagnosis, no one truly knew whether immunotherapy would work so well, or for so long. Immunotherapy has revolutionized the way we treat melanoma, as well as many other cancers. The idea that our immune system can be trained to recognize and permanently destroy cancer cells was unheard of a decade ago. Now, it’s a reality. Today, I often tell patients that immunotherapy potentially—and I want to stress the word potentially—has the ability to completely clear the disease. I’ve personally had patients who are more than 10 years free of melanoma after undergoing treatment.
From Palliative to Curative Intent
This shift is one of the most exciting aspects of modern cancer care. In the past, when treating metastatic melanoma, we approached therapy with palliative intentions, focusing on controlling the disease, prolonging life, or “kicking the can down the road,” so to speak. Now, with immunotherapy, we are increasingly treating with curative intent. This is a fundamental change in mindset. Instead of merely aiming to buy time, we now have realistic hope of completely eliminating the disease in some patients.
Immunotherapy in Older Patients
Another important lesson we’ve learned is that immunotherapy can be well tolerated in older, even geriatric, patients. Historically, we’ve been cautious about giving chemotherapy to older adults due to concerns about their ability to withstand the treatment’s harsh side effects. However, immunotherapy has proven to be much more manageable in this population.
That said, there are still concerns. The immune system can sometimes be overstimulated by these treatments, leading to what we call immune-related adverse events. These may require steroids to manage, or, in some cases, cause endocrine dysfunction that necessitates lifelong hormone replacement therapy. But overall, the ability of older patients to tolerate immunotherapy has been a game-changer.
A Growing Toolbox for Immunotherapy
One of the most exciting aspects of immunotherapy is that we now have more tools than ever to enhance the immune system’s ability to fight cancer. In addition to the original checkpoint inhibitors like pembrolizumab and ipilimumab, we now have options such as mRNA vaccines, intratumoral therapies, dual checkpoint inhibitors, and cellular therapies.
This growing arsenal means that if option A doesn’t work, we often have a Plan B, C, and beyond. The ability to personalize treatment and adjust based on the patient’s response has transformed how we manage melanoma and other cancers.
Not Always a Lifelong Treatment
Another key point is that immunotherapy does not always need to be lifelong. Once the immune system is “trained” to recognize and attack the cancer, it has the potential to provide long-term immunity. Some institutions recommend two years of treatment, but I personally tend to stop after one year, especially if the patient has had a complete response.
In some cases, treatment can be stopped even sooner—if there are significant adverse effects, or if the patient prefers to discontinue therapy and the circumstances are right. For instance, a negative PET scan and undetectable circulating tumor DNA are strong indicators that it may be safe to stop therapy.
Moving Forward with Optimism
The story of Jimmy Carter serves as a powerful reminder of how far we’ve come in the treatment of melanoma. His survival is a testament to the transformative power of immunotherapy and the new possibilities it offers. For patients and caregivers facing a diagnosis of Stage IV melanoma, there is now more hope than ever before.
As oncologists, we continue to learn and adapt, offering our patients not just time, but the real possibility of long-term survival—even in cases that were once considered untreatable. It’s a privilege to be a part of this rapidly evolving field, and I remain hopeful for the future as we continue to explore new ways to harness the power of the immune system.
A Life Well Lived
This October, Jimmy Carter celebrates his 100th birthday—an extraordinary milestone that few ever reach, let alone someone who was diagnosed with metastatic cancer nearly a decade ago. While he is now in home hospice care, his life and legacy continue to inspire. His longevity after such a serious diagnosis is a testament not only to the advances in cancer treatment but also to his resilience and determination.
For many of us in the medical field, his journey represents what’s possible when science, hope, and humanity come together. As we celebrate his remarkable life, we also look forward with optimism to a future where more and more patients can share in such stories of long-term survival and meaningful quality of life.
About the Author
Dr. Thomas is a distinguished medical professional and a compassionate guide in the field of oncology. With over a decade of dedicated experience as a board-certified medical oncologist/internal medicine specialist, Dr. Thomas has become a trusted expert in the treatment of melanoma, sarcoma, and gastrointestinal conditions. With his many years of experience, he brings a wealth of expertise to the complex and challenging world of oncology. About Dr Thomas – MedOncMD