Two patients: One makes it, the other doesn't. Why?

Jimmy Carter and his battle with melanoma has been the headline story of melanoma this fall.  His treatment – brain radiation followed by the anti-PD-1 inhibitor Keytruda – has showcased the new class of cancer immunotherapy drugs being pioneered in melanoma. President Carter surprised his local congregation, and subsequently the media, by announcing he was cancer-free at Sunday mass.

In parallel, Cara Combs has been the talk of the melanoma community this week.  Her name might not ring a bell to the average person, at least not before Tuesday, but her story made the go-round in our Facebook group.  Diagnosed with Stage IV melanoma at just 38, she had 5 weeks to go before she would be able to give birth to her baby girl.  Treatment could not start while she was pregnant.  She postponed immunotherapy treatment (presumably for its unknown effects on unborn children) to give her daughter a chance of survival.

Baby Shaylin was born on Saturday.  Cara Combs died three days later.

Why the disparate paths?  Why does this person live, and that person doesn't?  The survival guilt, for lack of a better word, isn't uncommon.  Our melanoma group has that question thrown out monthly via a "Just learned that fellow patient 'X' has passed away.  How come they didn't get a response to immunotherapy??" proxy.  I even wrote of dealing with mortality two years ago next week. Tonight, I get to coach my little girl's soccer team, while a friend's daughter grows up fatherless.  Why?

We'll never know if Cara's health and life would have turned out differently had she started the treatments immediately.  Melanoma at that stage is tough; that it took her from little Shay so quickly shows how far along it was, and/or how difficult it would have been to stop.  As a patient, her courage is remarkable; as a parent, it's both indescribable and understandable at the same time.  Faced with the decision, I'd like to think all of us would choose the same path, but staring death in the face is not easy.  Her courage is beyond admirable, and the Combs family loss is equally incomprehensible.

Two different people, two similar flavors of the same diagnosis.  One makes it, one doesn't.  One has sacrificed for his country; the other, her family.  One whose age doesn't fit the stereotypical melanoma survivor; the other, the conventional melanoma victim.  One whose treatment gives hope to thousands of others across all cancers; the other's potential miracle heartbreakingly dashed.

"They couldn't find any cancer at all" – President Carter

"I wanted to let everyone know that we lost Cara Walters Combs this morning." – Cara's husband Roy

One story gives tears of happiness; the other, disbelief.

There is a GoFundMe page setup for the Combs family.

T.J. Sharpe shares his fight against Stage 4 Melanoma in the Patient #1 blog. Read more »