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Business Owner Now Optimistic About ALIMTA

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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:

  1. The L-NDDP protocol;
  2. The Onconase Phase III trial versus doxorubicin;
  3. 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 Mark's 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 Onconase.

"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 they have 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