How One Patient Took on Cervical Cancer, Childbirth, and a Pandemic All at Once

In 2019, Hamida Patrick had just finished up a months of post-wedding travel. She and her husband spent most of 2018 everywhere from California, via a 50-day road trip, to Israel and Southeast Asia. Upon her return, she had begun her own concierge business when she got the good news: she was pregnant.

It was the perfect time to start a family, something she, who'd grown up with three brothers, had always wanted. But juxtaposed with that joy was the news that soon followed. After getting her early pregnancy pap smear, the doctors found that she had precancerous cells. 

After some thought, Hamida, her husband, and her OB-GYN decided to wait until after the birth to get a LEEP (loop electrosurgical excision procedure) to keep the baby safe. This procedure tests and treats abnormal cervical cancer growth. Cervical cancer growth is typically very slow, so they thought that they had time.

Later on, however, at 36 weeks, Hamida began bleeding excessively. In only a few short months, she'd gone from precancerous cells to a cervical cancer tumor the size of a walnut. Because of the tumor's location at the base of her cervix, it was necessary to have a C-section three weeks ahead of schedule.

"They needed to take the baby before I started dilating because we didn't want the tumor to start hemorrhaging," Hamida says. "And your cervix isn't just something you can put a Band-Aid on and it stops bleeding."

It was the right decision. On Dec. 17, 2019, she and her husband welcomed Charles—a healthy eight-pound, one-ounces—into the world. He was just the distraction the new parents needed for the months to come. "Having a newborn, you kind of just can't focus on anything else," she says.

 

In the days after Charles's birth, further scans revealed that the cancer had spread to Hamida's lymph nodes. She decided to get a second opinion with MUSC Women's Health and MUSC Health Hollings Cancer Center. There she met Dr. Matthew Kohler, gynecologic oncologist, and Dr. Samuel Cooper, radiation oncologist. Cooper recommended brachytherapy, a radiation therapy most often used to treat cervical cancer.

While all of this is happening—switching providers, therapy planning, becoming a mother—Hamida had something else weighing heavily on her: the question of having more children.

"I've always known I wanted to have a really big family," she says. "I come from a big family so learning all of this information at the time that I was having a baby, that I wasn't going to be able to have any more babies, the whole situation was disturbing...I was planning to have a natural birth prior to this. I was taking classes and then in one hour we learned that 'No, you're having a c-section, you have cancer and you can't have any more babies.'"

That's why in just over a week after giving birth, Hamida turned to Coastal Fertility in search of a solution before beginning chemotherapy. She wound up finding a friend in her doctor, who is a cancer survivor. "He said, 'I'll be honest, most people don't come in here eight days after having a baby trying to harvest some eggs, but we will do everything we can for you,'" she remembers.

That they did, finding a program to cover the cost of the drugs for patients with cancer and enabling Hamida to harvest 22 eggs, which is a lot more than they normally see produced. She says, "I got the feeling it was divine intervention."

Soon after, the new mother began an intense chemotherapy routine (once a week) and radiation (every day). Luckily, she had plenty of support, like a mother with a background in early childhood education and a mother-in-law who was a neonatologist.

But then, 2020 arrived. On top of encountering a pandemic while undergoing several months of treatment, in the summer new cancerous nodules were discovered on Hamida's neck and lung: her cancer was in stage four. They learned that Hamida is platinum-resistant, and so while radiation showed reduction, her platinum-based chemotherapy drugs had been ineffective.

"It was really disheartening," Hamida says. "It was not the news we were looking for. It was a really hard day for my husband and I, but we were still really optimistic.

Hamida decided to briefly explore other options, like a potential clinical trial in Houston with an immunotherapy that would extract lymphocytes from the tumor, multiply them, put them back in, "and they do the fighting for you," she says. "The trial is amazing in itself and is a curative approach, so I was really jazzed up, hoping this works.”

Unfortunately, they ultimately told Hamida that she was ineligible for this particular trial because she hadn't received any kind of immunotherapy before. Disheartened again, she and her husband returned to Charleston. They placed their hopes in a new treatment plan with Dr. Brian Orr, a gynecologic oncologist at the MUSC Health Gynecologic Cancer Program. He was aware and in contact with a similar trial in Pittsburgh that did not have the same eligibility restrictions as the one in Houston. This type of treatment required CT scans, travel to Pittsburgh, and a surgery.

However, after the CT scans, they received some bad news that now precluded her from this trial as well. "Unfortunately, the tumor was like an iceberg, so everything we could see was just the tip of it, and it had actually gone below my collar bone and was touching an artery," Hamida says. "My whole collar bone would have to be removed to operate on it, an all-or-nothing situation. So, again, my cancer just wasn't that bad yet." Fortunately, radiation was able to shrink the tumor in the neck while the team regrouped to come up with the plan for the next steps.

Back to the drawing board, Hamida was to receive second-line chemotherapy in Charleston. However, within a few weeks she finally received some good news. Dr. Orr informed her that her Caris Report indicated that she was a good candidate for IV immunotherapy, specifically using a combination of Ipilimumab and Nivolumab. There would be no chemotherapy: "I was so excited I was in tears," she says.

“Here at MUSC Hollings Cancer Center, we will offer the most up to date research and clinical trial options to our patients,” Orr says. “Some of these options for promising agents or treatments do have barriers to overcome in the form of trial eligibility, travel, and/or insurance approval. After the trials in Houston and Pittsburgh were not going to be an option, we opted to proceed with a combination of intravenous immunotherapy approach (Ipilimumab and Nivolumab) based on recent presented evidence at an international meeting showing much higher response rates than using a single immunotherapy agent.”

Insurance denied the combination and only approved the single drug regimen. Orr says it's not uncommon for insurance approval to take months or years after the research is available, but MUSC had the option to appeal and argue the case on her behalf.

“The landscape of novel targeted and immunologic therapies is changing rapidly,” he says. “For convincing clinical trial data, we will work hard to get the promising therapies to our patients in the clinic that don’t have the luxury to wait the months or years for it to become the standard of care. She has been so strong through all of this, with a new baby, so many set-backs, she would do anything to beat this cancer. She deserves a victory. After appeal phone calls and letters, we were able to get approval for the combination immunotherapy. I was so happy for them when we got the call that it was approved.”

Hamida received her second immunotherapy infusion on Dec. 29 and entered into 2021 on a good note. "I'm really hopeful, and I'm all about speaking things into existence and manifesting things," she says. "And I really believe this is going to be it for me."

These days, Hamida is feeling good. Her spirits are up, and she's still confident in her care. She does battle a little fatigue, and a tumor in her groin is painful, leaving her unable to walk for long periods. But she's looking forward to seeing the improvements that come with time and more treatment.

As for the pandemic, it hasn't affected their family that much—beginning treatment in January of 2020 meant that Hamida had already formed a protective bubble before lockdowns ever began. They just had to continue to be as safe as possible; her care team at MUSC Health made that easy for her.

"They are the best," she says. "When I had to do brachytherapy, which involves an overnight stay, I was terrified. Because of COVID, I had to do it all by myself, on top of having to leave my newborn for the first time. But Dr. Cooper's nurses Jen [Longstreet] and Danielle [Martin] were amazing and it made a world of difference."

When Hamida isn't catching up with her new nurse friends at MUSC, she's happily soaking in quarantine time with her new family. Food is a big part of their lives, so she and her husband love to cook, trying out new recipes in one of their many cookbooks. They miss entertaining friends, but in the meantime, they daydream of better days with their people, and with their suitcases.

"We keep sending each other things on Instagram, forming a future to-do list," she says. We call it the Travel-Planning Committee." The first destination? London. "My mom is from Sierra Leone but most of her family lives in London...and they've been dying for us to come so they can see the baby."

Until then, Hamida expects to continue two years of immunotherapy. For now, she gets treatment every three weeks. "As we get more scans and see if it's working well, it'll be longer gaps in between, when I need it," she says. "I'll take it."