"This was a very happy day for the Yaghoobi family. Mark (left) was thankful to be able to walk his daughter down the aisle on her wedding day. We all felt very blessed." Kaye Yaghoobi
Mark Yaghoobi has always been an active man. He gets up in the morning,
rain or shine -- and there is plenty of both in Sugarland, Texas --dons
his running shoes and religiously puts in his four miles. He has never
smoked or drank. His body has always been his proverbial "temple."
Shortness of Breath Caused by Pleural Effusion
In approximately August of 1998, Mark Yaghoobi, at the age of 56, began
to experience a shortness of breath and a 'fullness' in his neck
after his morning runs. At first he chalked it up to the heavy, sometimes
foul Houston, Texas air. But when the symptoms became consistent, he went
to see his family physician. A chest film was taken which revealed a left
sided pleural effusion. A CT scan was also taken which confirmed the effusion
as well as some pleural thickening and atelectasis (partially collapsed lung).
From that point onward, Mark would encounter specialist after specialist,
take test after test, drug after drug, and his life would never be the same.
Thoracentesis Suggests Cancer
Mark was referred to a pulmonologist who performed a thoracentesis on August
5, 1998 at Memorial Hermann Hospital in Houston, Texas. The cytology showed
a poorly-differentiated malignant neoplasm, with a differential diagnosis
of metastatic adenocarcinoma versus mesothelioma. The cytology was sent
to M.D. Anderson Hospital for confirmation and was interpreted as poorly
differentiated malignant neoplasm, metastatic adenocarcinoma versus mesothelioma
and immunohistochemistry staining was recommended.
MD Anderson Prescribes Taxol and Carboplatin
Mark was next evaluated by radiologist at M.D. Anderson for a presumed
diagnosis of non-small cell lung cancer. That doctor referred Mark to
an oncologist at M.D. Anderson. The oncologist felt Mr. Yaghoobi was suffering
from stage III-B non-small cell carcinoma and prescribed a chemotherapy
treatment consisting of Taxol and Carboplatin. Mark completed two unpleasant cycles.
Unfortunately, the fluid returned in Mark's left lung. He also suffered
a collapse of the left lower lobe. On October 9, 1998, Mark underwent
a bronchoscopy and thoracentesis where 1200 ccs of bloody fluid was removed.
The pathology did not identify any tumors, but the cytopathology showed a
malignant mesothelioma. Mark was then referred to Dr. Dong Shin at MD Anderson for further evaluation
and recommendations for therapy for his mesothelioma. Dr. Shin is a thoracic
surgeon with experience in treating mesothelioma, although he does not
usually recommend the extra pleural pneumonectomy or pleurectomy (at least
for patients at MD Anderson).
Dr. Shin's Treatment Options
Dr. Shin offered the Yaghoobi's following treatment options:
- The L-NDDP protocol;
- the Onconase Phase III trial versus doxorubicin;
- No surgical intervention was offered.
The Yaghoobis favored surgery but Dr. Shin advised that M.D. Anderson would
be unable to assist them in that area. MD Anderson had encountered difficulties
with the tri modal therapy approach in the past and had aborted the procedure.
The Yaghoobis did their own research and discovered the Dana-Farber Brigham
& Women's hospital in Boston, Massachusetts.
Yaghoobis Travel to Boston's Brigham & Women's Hospital
In November of 1998, the Yaghoobis met with Dr. Vasconcelles at Brigham
& Woman's. In order to be sure of the diagnosis, Dr. Vasconcelles
felt that a thoracoscopy with biopsy should be performed. In mid November,
Mr. Yaghoobi underwent a tissue biopsy at Brigham & Women's. The
pathology confirmed the diagnosis of epithelial malignant mesothelioma.
Left Sided EPP
On December 7, 1998, Dr. Raphael Bueno of Brigham & Women's performed
a flexible bronchoscopy and extrapleural pneumonectomy with resection
of the diaphragm, pericardium and radical lymphadenectomy. Dr. Bueno removed
left lung. Mark was discharged on December 15 and returned to Houston for follow-up
treatments, including chemotherapy and adjuvant therapy.
Upon returning to Houston, Mr. Yaghoobi met with Dr. Roy Herbst at M.D.
Anderson who was hesitant to prescribe a chemotherapy regimen due to his
previous chemotherapy treatment. However, given the lack of any better
options, he did agree to radiation therapy. Mr. Yaghoobi was scheduled
for six weeks of radiation therapy delivered with weekly low-dose Taxol,
beginning the second week of January, 1999.
During the treatments, Mark complained of soreness in his throat, which
his doctors diagnosed as radiation esophagitis. After six weeks, Mark
completed his treatments.
Condition Stable Until Tumor Invades Left Cavity Again
For the next year his symptoms were remarkably stable. In January, 2000,
however, Mark noticed a large mass on the surgical scar of where Dr. Bueno
had removed his left lung. He met with his doctor who felt the mass was
benign nodularity. When the mass began to increase in size, a soft tissue
excision was performed on April 21. After reviewing the pathology, the
doctors delivered the bad news to the Yaghoobis: the mesothelioma had
returned to his
left thoracic cavity which once housed his left lung.
Tumor Metastasizes to Right Pleura
A chest film, CT scan and CAT scan of the abdomen was then done with findings of a new
right pleural effusion. A right-sided thoracentesis was performed on April 27.
The cytology returned metastatic malignant mesothelioma. Imagine the dismay.
Mark does not have a left lung and now he has tumor invading his right
lung -- and surgical EPP is
absolutely not an option. he On May 11, the Yaghoobis then met with Dr. Roy Herbst. Dr.
Herbst could only recommend systemic therapy due to the bilateral disease.
He offered to them the Adriamycin trial versus Adriamycian plus
"We refused to give up."
The Yaghoobis continued to be optimistic about finding a successful treatment
plan. According to Kaye Yaghoobi: "We were a very disappointed that
M.D. Anderson was unable to offer a more aggressive treatment plan. We
are still devastated by the cancer and can't believe it is happening
but at the same time, we refuse to give up."
The Yaghoobis wanted to do additional research and learned of the ALIMTA
(R) (pemetrexed disodium)
study at the San Antonio Cancer Research Center in San Antonio, Texas. Because
of his previous chemotherapy treatments, Mr. Yaghoobi was told that he
did not qualify for the ALIMTA program at M.D. Anderson.
Enrolled in ALIMTA Phase I trial
On May 24, they traveled to San Antonio and met with Dr. Lisa Hammond,
who spearheads the (Eli Lilly) ALIMTA Phase I protocol in San Antonio.
After several tests, the Yaghoobis returned home to Houston. A few days
later they learned that Mr. Yaghoobi
did actually qualify for the ALIMTA program. The Yaghoobis are excited to begin the ALIMTA
trial in late June.
Yaghoobi is the president of his own company, which buys and sells restaurant
equipment. Since his diagnosis, he has not been able to continue working
like he normally would. On top of all his mental and physical distress,
and the enormous medical, hospital and travel costs, his company's
bottom line has been floundering. Despite his illness, Mark's work
ethic remains strong, and he is determined to bring his company back into
the black. According to his wife Kaye, "It's good that Mark continues
to try to work. Although it is hard for him, he still serves his customers
and works to make more sales."
Mark Yaghoobi is an extraordinary man who has been tested by extraordinary
hardship. He lives on one lung, and now that lung cavity has been trespassed
by the tumor. In the face of all this darkness, Mark and Kaye keeping
moving towards the light. It would be easy to say that they "have
no choice." But they do. They could have given up or, put more benignly,
they could have "let nature take its course" (if you can attribute
something so evil as mesothelioma to the handiwork of our Creator). But
chosen to fight. Each day is a struggle -- each night affords barely a moment
of peace. The Yaghoobis have been tested, and no matter the outcome, they
have acquitted themselves with honor, courage and reverence.
*** POSTED JULY 5, 2000 ***
Mr. Mark Yaghoobi passed away on November 3, 2000