all it the Jimmy Carter effect.
Last week, after the 91-year-old former president announced that he was cancer-free, patient requests started to pour in for “the president’s drug.”
“I want what Jimmy Carter had,” Dr. Patrick Ott, a melanoma specialist at the Dana-Farber Cancer Institute in Boston, heard from one patient — a message that was echoed at cancer clinics nationwide.
The patients were all talking about Keytruda, a new type of cancer drug that unleashes the body’s immune system to attack tumor cells. Carter announced in August that he had an aggressive form of melanoma skin cancer, and that tumors had spread into his liver and brain. He received surgery, radiation, and multiple doses of Keytruda. And on Dec. 6, he said that all signs of cancer were gone.
The public’s response to Carter’s news has been overwhelmingly optimistic — both for the former president and for Keytruda itself. Dr. Antoni Ribas from the UCLA Medical Center, who was involved in the original clinical trials for Merck drug, said he’s been receiving a couple emails a day from patients who bring up Carter’s case, saying they want what he had.
All this free publicity for Merck comes amidst a fierce commercial battle between Keytruda and Opdivo, a similar immune-modulating agent from Bristol-Myers Squibb.
Both drugs won approval last year for treating advanced melanoma; both work the same way — by blocking a protein called PD-1; both cost about the same; both are predicted to bring in billions of dollars; and both have yielded the same kinds of dramatic responses in clinical trials.
But now, some patients on Opdivo want to switch.
Dr. Elizabeth Buchbinder had one of those patients. The Dana-Farber oncologist explained to her patient that the two drugs were basically the same — the main difference being one of dose scheduling — and that insurance companies typically wouldn’t cover such a swap.
No doctor interviewed by STAT said that patient enthusiasm about Carter would change their prescribing practices, especially since survival from serious forms of cancer has no demonstrable placebo effect. “I would hope an oncologist wouldn’t say, ‘We should really do this because it worked in Jimmy Carter,’” Ott said.
In a clinical trial, only one-quarter of patients receiving a standard dose of Keytruda saw their tumors shrink, according to the FDA. That’s typical of immunotherapy drugs: They only help a minority of patients, but those who respond often do extremely well.
Dr. Michael Atkins, deputy director of the Georgetown Lombardi Comprehensive Cancer Center in Washington, D.C., also pointed out that it’s still unclear whether Keytruda or some other aspect of Carter’s therapy deserves the credit for his remission.
“I can tell you the radiation treatment would have eliminated the brain metastases,” said Atkins, who led trials of Opdivo. It’s possible that Keytruda is preventing the growth of other tumors, but it’s also possible that “just nothing else has shown up,” he said.
Atkins is worried that the public’s fervor for Keytruda may backfire if the former president relapses. People might swing from thinking this drug cured his cancer to thinking that it is an ineffective treatment.
Such a public reaction could have far-reaching health consequences since regular consumers often follow in the footsteps of well-known public figures who undergo medical procedures.
Katie Couric publicized her colonoscopy in 2000, and colon cancer screening rates shot up in the months afterward. Angelina Jolie had a mastectomy in 2013 because she carried a genetic mutation that increased her risk for breast cancer, and researchers documented a surge in demand for this surgery.
Dr. Steve Woloshin, a Dartmouth professor who has studied the “celebrity effect” on health care decisions, said he would not be surprised if Carter’s treatment impacts uptake and sales of Keytruda.
“It seems like it has all the ingredients for a lot of traction with the public,” Woloshin said. “I would imagine that you would see something.”
Correction: An earlier version of this story misstated Carter’s age.