How Immunotherapy and Genetic Sequencing Created New Hope for Stage IV Patients

Meleah F. marked her 70th birthday filled with gratitude, despite a life-altering diagnosis of plasmacytoid bladder cancer in August 2019. Initially, recurring urinary tract infections signaled that something was wrong. Having recently lost both parents—her mother passing only five weeks after a stage IV cancer diagnosis—Meleah felt an urgent need for expert care. She turned to MD Anderson, a decision she credits for the sense of safety and trust she describes as “a pleasant journey.”

Before cancer, Meleah spent over a decade teaching elementary school, but the uncertainty of her condition led to early retirement. In September 2019, she began treatment under Dr. Sangeeta Goswami. With the disease still at a resectable stage, she received six cycles of chemotherapy to shrink the tumor, followed by a cystectomy in January 2020. During this four-hour surgery, her bladder and pelvic lymph nodes were removed, and a new urinary tract route was constructed. Two weeks of hospitalization and about two months of recovery later, Meleah felt optimistic the cancer had been eliminated.

However, in October 2020, a suspicious bump on her scalp confirmed cancer’s return. It had spread to her scalp, pelvis, ribs, and femur, elevating her diagnosis to stage IV. Dr. Goswami swiftly ordered next-generation sequencing, identifying an ARID1a mutation. Research suggested that tumors with this specific mutation could respond favorably to immunotherapy. Meleah then started receiving pembrolizumab, experiencing manageable side effects like rashes, muscle aches, and joint pain.

Today, her scans show no evidence of disease, a result that fills her with hope for the future. Meleah remains deeply thankful for the comprehensive care at MD Anderson, acknowledging Dr. Goswami’s dual role as both physician and scientist. Her retirement may look different than initially planned, but with continued immunotherapy, she feels ready to reach new milestones, including seeing her granddaughter graduate from college.