Navigating the unpredictable waves of cancer treatment with our patients is not just a professional journey but a deeply personal experience that binds us together in shared hope and resilience. This week, I found myself reflecting on the incredible journey of a young 40 year old patient I’ve been caring for over the past six years—a testament to the enduring spirit of those we serve and the profound dedication of our medical team.
A Long Battle with Melanoma
When I first met her, she was diagnosed with stage III melanoma, a stark reality that came with its own set of challenges and fears. After a year of adjuvant immunotherapy, we hoped she would be one of the fortunate ones to avoid recurrence. However, cancer, as it often does, charted its own course, recurring in her lung and gallbladder. Each recurrence was met with a robust response—radiation and surgical resection, respectively, followed by dual checkpoint inhibitors. Despite these aggressive interventions, the shadows of her disease lingered, evidenced by detectable and rising ctDNA.
The Turning Point
With BRAF MEK inhibitors, she achieved a year of undetectable ctDNA levels, along with periodic scans confirming complete remission—a brief but significant victory. However, the cancer’s persistence became apparent when her ctDNA levels became detectable again and began to rise. This led us to initiate preparations for TIL therapy as her next best option. The initial PET scan revealed only a small tumor—a 1-2 cm right chest subcutaneous lesion, biopsy-confirmed as metastatic melanoma. At this point, I was very optimistic that TIL therapy would give us our best chance for long-term disease control, given the low burden of disease. She had always been asymptomatic.
Facing Rapid Progression
The speed at which her condition deteriorated was heartbreaking. Within weeks after the surgical harvest, she went from being an outpatient managing her condition to being hospitalized for severe systemic decline. She suffered from profound fatigue, failure to thrive, severe bone pain, and was barely able to communicate or move or get of a bed—a stark contrast to the vibrant person I had known ambulating into my clinic for over six years. Her CT scan painted a grim picture: widespread disease affecting nearly all her organs.
A Glimmer of Hope
In the face of overwhelming odds and given her young age, we initiated last-resort chemotherapy with carboplatin and taxol, fully preparing for the possibility of transitioning to hospice care. As an oncologist, we hope for the best but we also prepare for the worst by being directly honest with the patient and family. Her prognosis was very poor at this point and I was not so sure if she would even see the next sunrise. The following day brought an unforeseen glimmer of hope. Reports from my team, initially dismissed by me as overly optimistic, turned into a tangible reality. Remarkably, she began to improve—talking more, regaining her appetite, and interacting with her family. By the afternoon, she sat up in a chair, smiling and eating full meals, surrounded by her loved ones, a stark contrast to the person who had been confined to her bed just the entire week before.
Reflections on the Journey and the Road Ahead
This dramatic turnaround has been a profound lesson in humility and hope. It reminded me that even in the bleakest moments, the fight is worth continuing. Her resilience has inspired not just her family and friends but all of us who have stood by her side in this fight. As we proceed with her treatment, each step is now guided not just by clinical protocols but by a renewed spirit of hope and cautious optimism. After maximal response to chemotherapy, it is my greatest hope she will get a chance for cellular therapy on or off protocol as her next best option or perhaps participate in other forms of novel immunotherapy clinical trials.
The journey through cancer is fraught with unknowns, making the victories all the sweeter and the setbacks deeply painful. This story is a testament to the courage of one woman, the dedication of a healthcare team, and the unpredictable nature of life itself. For those walking this path, let her story remind you to hold onto hope, to fight fiercely, and to cherish every moment of strength regained. In oncology, our promise is simple yet profound: to never give up, to never give in, and to always believe in the possibility of a new sunrise.
Dr. Sajeve 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. Currently practicing at the renowned Orlando Health Cancer Institute, he brings a wealth of expertise to the complex and challenging world of oncology.