Diagnosed with advanced abdominal cancer in early 2023, Linda Kiel was given months to live. Today, she is riding high, living her life to the fullest.
Photos by Kimberly Pham.
In just two years, Linda Kiel went from being a vibrant, on-the-go retiree to a life of crippling pain. In 2022, she developed kidney problems and needed a ureteral stent. Then in January 2023, the former middle school teacher, real estate professional and avid cyclist was suddenly overcome with intolerable stomach pain.
Rushed to the emergency department at UCI Medical Center in Orange, Kiel was diagnosed with a bowel obstruction. Colorectal surgeon Dr. Joseph C. Carmichael found more than a blockage.
“We were surprised to find small cancer deposits all over her abdomen, just everywhere, obstructing multiple areas of the bowel," the surgeon says. "While they were numerous, they weren’t the kind that show up on imaging.”
He performed a colostomy to reduce the pressure on Kiel’s intestines and took tumor biopsies to diagnose her cancer. When Kiel awoke, Carmichael had to break the news: She had a colostomy bag bypassing her colon and inoperable stage IV abdominal cancer, a disease whose typical prognosis was six months at most.
Immunotherapy's promise
Soon after that surgery, Kiel began receiving care from Dr. Arash Rezazadeh Kalebasty, a medical oncologist at the UCI Health Chao Family Comprehensive Cancer Center. He specializes in cancers of the genitourinary tract. She was diagnosed with metastatic urothelial carcinoma — cancer cells from the urinary tract lining — that had spread throughout her abdomen.
Before starting treatment, Rezazadeh studied the results of molecular genetic testing Kiel had had done. It showed that she might respond to a particular immunotherapy drug called pembrolizumab, which was first approved in 2014 to treat advanced melanoma. Subsequent clinical trials have resulted in its approval to treat a range of advanced cancers, including some types of lung, breast, prostate and cervical cancer — as well as metastatic urothelial carcinoma in some patients.
“Immunotherapy enables the immune system to see cancer and destroy it,” explains Rezazadeh. “Normally, cancer cells signal the immune system to ignore them. These drugs prevent the cancer cells from sending signals, allowing the immune system to recognize and attack them. Linda’s genetic markers indicated she might respond to this approach.”
Immediate response
Kiel began pembrolizumab infusions in April 2023. At the time, she weighed 90 pounds and suffered from constant stomach pain and nausea. Two weeks later, she woke up without symptoms.
“On April 9, cancer was killing Linda," says her husband, Stephen Kiel. "On April 10, Linda was killing the cancer.”
Before long, she began exercising. Eventually she grew strong enough to resume bike rides and mountain hikes, determined to regain her life. “I just thought, I’m going to live my life until it’s over.”
Kiel has continued the infusions very three weeks. In her case, Rezazadeh did not prescribe chemotherapy, although he uses both therapies in tandem for some patients. She was also fortunate not to experience any side effects from the drug.
“Immunotherapy can cause serious side effects in certain patients, and while we can’t know which ones ahead of time, most patients can tolerate it,” says Rezazadeh. “Linda did exceptionally well.”
In fact, Kiel felt so much better by late summer of 2023, she asked Carmichael to remove her colostomy bag, telling him that it would be hugely inconvenient for the Tour de Palm Springs, a 102-mile bike race she planned to enter in February 2024.
Stunning results
Carmichael told her that he'd first need to assess whether the bowel obstruction was sufficiently resolved. In a surgical procedure in September 2023, he was amazed to discover that the tumors he'd seen wrapped around her abdominal organs — including her kidney, colon and urinary tract — had completely disappeared.
"We went into the OR that day with reasonable optimism, but we didn’t know how great the results would be,” the surgeon recalls. “The targeted therapy had been so effective, it was stunning.”
When Carmichael removed the colostomy bag, it was a pivotal moment for Kiel. “Dr. Carmichael was with me on the saddest day of my life and the happiest day of my life: The saddest day was the diagnosis and the colostomy bag, the happiest was getting the bag removed!”
Today, Kiel's regular imaging scans and blood tests show no evidence of cancer cells in her body. She is still getting infusions and plans to do so for the foreseeable future.
Her doctors don’t know her long-term prognosis, but Rezazadeh says he’s had immunotherapy patients who have remained in remission for years.
Making the most of life
Kiel, meanwhile, wasted no time. She began intensive training for the race, including a 12-day bike ride in January 2024. When she reached the finish line at the Tour de Palm Springs last Feb. 10, she held up a sign thanking UCI Health and the three doctors she credits with saving her life.
The first two were Carmichael and Rezazadeh.
The third was for urologist Dr. Pengbo Jiang, who inserted the stent from Kiel’s kidney to her bladder in 2022. She had been experiencing a block in urine flow that was causing her one functioning kidney to fail. The stent allowed urine to pass and her remaining kidney to resume functioning normally.
The comprehensive cancer center difference
While not every cancer patient can expect results like Kiel’s, her case reflects the caliber and depth of care provided by UCI Health. The Chao Family Comprehensive Cancer Center, the only Orange County-based center designated by the National Cancer Institute, has multidisciplinary teams that treat every type of cancer.
Kiel was treated by its specialized genitourinary cancer team, which includes urologists, radiation oncologists and medical oncologists. Even the team’s pathologists and radiologists also specialize in that type of cancer. Rezazadeh says team members typically see the patient on the same visit to streamline assessment and care.
Similar teams exist for brain, breast, gastrointestinal, gynecological, lung, liver, pancreatic and prostate cancers. Each specialized group follows the latest data, science and technologies in their field of cancer. They also conduct clinical trials and work with basic scientists at UC Irvine to bring breakthrough discoveries to patients.
This leading-edge care is also accessible at the new Chao Family Comprehensive Cancer Center in Irvine, which was specifically designed to foster “one-stop” team visits, allowing patients to meet the specialists simultaneously in a working space that promotes collaboration, communication and improved patient care.
The clinical trial edge
Access to clinical trials is also important, Rezazadeh says, because they are designed to test treatments that may improve on the standard of care generally available to patients.
“Even if a patient is not on a clinical trial here, they’re coming to a place where their care is informed by the latest clinical evidence and benefit from what the system is used to doing,” says Carmichael, who also serves as chief medical officer and senior vice president for UCI Health.
“We are used to treating the worst-prognosis cancers, the most severe recurrent tumors. And even patients without those types of cancer benefit from that knowledge and expertise," he adds. "Linda is an example of this. She was not on a clinical trial per se, but she had a doctor who was forward-thinking enough to identify an immunotherapy that worked incredibly well.”
For now, Kiel keeps pedaling and preparing for the 2025 Tour de Palm Springs.
“I’m 75 years old and I was supposed to die in July 2023, six months after my stage IV cancer diagnosis,” she says. “I’m still here a year later, thanks to UCI Health. The battle was hard and the temptation to give up was enormous.
“I don’t know how long I have, but I’m healthy. And I not only have more time, but very high-quality time. I’m living for the moment and I’m very grateful.”
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