Cancer Talk

Cancer Talk M a r o o n e C a n c e r C e n t e r | S u m m e r / Fa l l 2 0 2 1

Inside This Issue:

Director’s Message...1 Service Spotlight: Survive and Thrive...1 Cancer Care: A Multidisciplinary Approach to Melanoma...2 Cancer Innovations: Advances in Melanoma Treatment...3 Caregiver Corner...4 Cancer Resources and Clinical Trials...5

D i r e c tor ’s Mes s age

Dear Friends: It has been a difficult year. But hope has and will continue to be our guiding force as physicians and healthcare professionals serving patients with cancer.

Our focus will continue to be on making the most meaningful impact on our patients and community and help them through these tough times. We continue to provide cutting edge acute specialty care as well as holistic care to enhance our patient’s experience.

Our ongoing partnership with patients and their families is based on wellness and a lifelong commitment for cuttingedge advanced treatment that is personalized, safe, and convenient.

In this edition, you will hear about our multidisciplinary skin cancer team and the great advances and technologies practiced by our dedicated team.

We are so fortunate to be with an organization that is a leader in patient experience and that has pioneered the practice of safety measures during the pandemic to keep our patients and staff safe.

As such, we take this and every opportunity to advocate for people in our community not to put off routine care or ignore symptoms of a health issue. In addition, we are striving to meet the evolving needs of our patients by developing digitally enabled processes, but with a consistent human touch at all encounters.

We anticipate continued growth ahead full of hope and possibilities. We are excited to continue this partnership with all of you.

Zeina Nahleh, MD Regional Institute Chair for Cancer Director, Maroone Cancer Center Chair, Department of Hematology-Oncology Cleveland Clinic Florida

S er v i c e Sp otligh t

Survive and Thrive Maroone Cancer Center team affords patients the opportunity to ‘be human together.’

Education, support and camaraderie are vital for anyone at any point in their cancer journey.

In the Survive and Thrive support group at Maroone Cancer Center, patients share helpful coping tips and discuss their common experiences, whether they’re newly diagnosed with cancer, undergoing active treatment or are long-term survivors.

As the group’s organizer, Selin Santos, PsyD, a staff psychooncologist at Maroone Cancer Center, leads instructional presentations about cancer treatments, coping skills and other topics of interest. However, “Most of the time, I’m just facilitating, and they’re the ones giving each other tools and tricks to make it through the different seasons of survivorship,” he explains.

One of the participants notes that the group has helped her to quell negative thoughts and develop a more positive outlook.

“When I first started with this group, I thought my life was over,” she writes. “But I’ve met people who are coping, surviving, thriving and doing well. It has given me the opportunity to view my diagnosis from a completely different perspective.”

Survive and Thrive meets online at noon on the second and fourth Thursdays of each month (in-person sessions may resume as pandemic conditions allow).

The group is free and open to Maroone Cancer Center patients and their loved ones and caregivers. Participants can join and leave at any time. To join, call 954.659.5840 and provide your email address.

Survive and Thrive support group is open to patients and their loved ones and caregivers. In-person sessions may resume as pandemic conditions allow.

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“Patients might feel emotionally isolated,” Dr. Santos says.

“But, if they join a group like this, they might feel better understood, gain a sense of support and maybe even have a laugh or two about the things that happen in their lives. It’s about being human together.”

C a n c er C a re

A Multidisciplinary Approach to Melanoma Maroone Cancer Center’s experts specialize in early identification and comprehensive treatment of the most aggressive form of skin cancer.

There’s rarely a shortage of sunshine in South Florida, nor is there a lack of sun exposure.

With that sun exposure comes an increased risk of skin cancer, including melanoma. Although melanoma is less common than some other forms of skin cancer, it is the most lethal. So, it’s of paramount importance to detect it and treat it early on, before it becomes life-threatening.

Maroone Cancer Center’s experts take a multidisciplinary approach—from early detection and removal of localized lesions to treatment of more advanced disease—to provide the most cutting-edge, comprehensive and compassionate care for people with melanoma.

“There has to be a multidisciplinary approach to melanoma,” explains Maroone Cancer Center dermatologist Paul X. Benedetto, MD. “We strive to deliver world-class care on a patient-by-patient basis. Our entire focus is to provide the best outcomes for our patients. We have the resources, the desire, the willpower and the multidisciplinary approach to provide for all cancers, including melanoma.”

Our multidisciplinary team of experts in plastic surgery, otolaryngology, pathology, radiation oncology and other disciplines collaborate daily and meet periodically as a tumor board to determine the best treatment course for more complex melanoma cases.

Broad-Based Melanoma Management Early detection remains the key to optimizing melanoma outcomes. As such, Maroone Cancer Center experts perform detailed skin checks to find melanoma in its more curable stages.

“We take the time that patients need,” Dr. Benedetto says.

“We’re going to examine their skin thoroughly, offer the appropriate follow-up recommendations, identify lesions of concern early on and treat them effectively.”

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Advanced immunochemical staining is used to pinpoint melanoma cells.

Our specialists use advanced immunochemical staining to pinpoint melanoma cells for surgical removal, as well as detailed molecular testing of specific genetic characteristics to determine a patient’s candidacy for targeted therapies. For certain patients, our experts employ state-of-the-art genomic testing to determine the risk that melanoma will recur or metastasize.

Maroone Cancer Center’s dermatologic surgeons remove localized melanomas with precision, using sophisticated Mohs micrographic procedures. Our medical oncologists offer the latest in targeted therapies and immunotherapies that have revolutionized the treatment of more aggressive melanomas.

These specialists, along with our multidisciplinary team of experts in plastic surgery, otolaryngology, pathology, radiation oncology and other disciplines, collaborate daily and meet periodically as a tumor board to determine the best treatment course for more complex melanoma cases. Our expert physicians are backed by a team of skilled nurses, geneticists, nutritionists and support staff who provide the highest-quality, well-rounded individualized care for patients with melanoma.

“Melanoma management frequently requires oncology and dermatology,” explains Maroone Cancer Center medical oncologist David Grossman, MD. “Sometimes it requires plastic surgery, and at times it can require a surgeon with experience in biopsying or removing lymph nodes in certain areas of the body. We can call on every specialist we need when we need them.”

Patient-Centered Care Most importantly, Maroone Cancer Center offers broadbased, compassionate, multidisciplinary melanoma care in one convenient location—always focusing on each patient’s individual needs.

“Your access to care is excellent, you get in quickly and you’re well cared for,” Dr. Grossman emphasizes. “We have highly trained, fantastic doctors who take the whole person into account. In addition to the scientific expertise, we have many supportive care services that really take care of everything.

I bring my family here, and I would recommend Maroone Cancer Center to anybody.”

C a n c er Innova tions

Advances in Melanoma Treatment Innovative surgical approaches and immunotherapies at Maroone Cancer Center effectively treat melanoma, with less of an effect on quality of life.

Maroone Cancer Center is on the melanoma treatment vanguard, offering a range of cutting-edge therapies that can cure this aggressive type of skin cancer and prolong survival in advanced cases—all while minimizing treatment-related side effects.

For certain early-stage melanomas, our dermatologic surgeons perform detailed Mohs micrographic surgery to excise the cancer precisely in a more cosmetically appealing way.

And, for people with more advanced melanomas, our medical oncologists offer newer immunotherapies, as well as targeted therapies based on an individual person’s genetic makeup, that have reshaped the melanoma treatment landscape for the better.

Surgical Solutions A longstanding treatment for basal cell or squamous cell skin cancers, Mohs surgery is now used at Maroone Cancer Center to treat early-stage melanomas such as melanoma in situ and lentigo maligna, especially in sun-damaged areas of the head and neck.

In Mohs, the surgeon removes a thin slice of tissue and examines it under a microscope. The specialist repeats this process until no cancer cells remain along the edges or the underside of the tissue samples. As part of the surgery, our experts use specialized immunochemical staining to identify melanoma cells more effectively and limit the treatment area, thus minimizing the effects on adjacent noncancerous tissue.

“Melanoma in situ can be a challenge because there’s a lot of subclinical spread of these lesions, and they can often be difficult to identify,” explains Maroone Cancer Center dermatologist Paul X. Benedetto, MD. “These specific types of immunochemical stains allow us to identify cancer cells more easily under a microscope and be more accurate in removing these lesions during Mohs surgery.

immune system recognize and target melanoma cells. Our experts also perform special molecular testing on melanomas to determine if they carry certain genetic alterations that make them amenable to targeted therapies, which include drugs such as BRAF inhibitors and MEK inhibitors, among others.

These immunotherapies and targeted therapies treat melanomas that can’t be removed completely by surgery or have metastasized. In some instances, they may be used to prevent a recurrence of melanoma after surgery. With the rise in the use of immunotherapies and targeted therapies, use of chemotherapy to treat advanced melanoma has declined greatly, according to Maroone Cancer Center medical oncologist David Grossman, MD. “For localized disease, immunotherapies—or even the targeted therapies if you have the right mutation in your melanoma— can halve the recurrence rate or even more, which is amazing, and they’re much better tolerated than chemotherapy,” Dr. Grossman explains. “Immunotherapy has changed the world of melanoma. It has been life-changing for patients and the doctors who take care of them.”

“There are so many new cutting-edge medications that are immunotherapies for treating invasive or metastatic melanoma,” Dr. Benedetto adds. “Hopefully the future is always brighter for people with melanoma.”

Prevention Remains Key Despite the advanced treatments available at Maroone Cancer Center, both Dr. Grossman and Dr. Benedetto emphasize that the mainstay of melanoma management is prevention—using sunscreen and sun-protective clothing, avoiding the use of tanning beds and undergoing routine skin exams by a dermatologist.

“If you find a thin melanoma and remove it, it’s curative, but if it progresses and metastasizes, it can be quite aggressive,” Dr. Benedetto cautions. “We’re making great strides in surgery and immunotherapy, but I would love to help patients avoid the need for those treatments through early identification and removal of the melanoma.”

“Performing Mohs surgery for melanoma in situ, and potentially certain invasive ones, is a relatively new front,” he continues.

“The benefit is that it allows for higher accuracy and smaller scars as a curative treatment for noninvasive melanomas.”

Immunotherapy Innovations In 2015, former President Jimmy Carter revealed that he had melanoma with liver and brain metastases. By the end of that year, he announced he was cancer-free, thanks to a combination of treatments that included immunotherapy.

For people with advanced melanomas, Maroone Cancer Center specialists offer the latest immunotherapies, which help the 3 | ClevelandClinicFlorida.org /CancerTalk

In Mohs surgery, the surgeon removes a thin slice of tissue and examines it under a microscope. The specialist repeats this process until no cancer cells remain along the edges or the underside of the tissue samples.

C a r egiver C orn er

Introducing New Staff We are pleased to welcome the newest members of our growing cancer care team.

Diana Saravia, MD Medical Onocology Diana Saravia, MD, joined the Maroone Cancer Center team in July 2020 as a medical oncologist, specializing in thoracic cancers and breast cancer.

“It’s been a great experience and very gratifying,” she says. “There are so many patients of all ages who can be affected by cancer, and being able to help them through it is a great part of my job.”

Dr. Saravia earned a bachelor’s degree from the University of Miami and a master’s degree from Barry University. She completed her medical training at the University of Miami/Jackson Memorial Hospital.

Dr, Saravia is a native of Peru and a longtime south Florida resident. In her spare time, she enjoys staying physically active with Pilates and other forms of exercise.

Trisha Plastini, DO Hematology/Oncology Trisha Plastini, DO, joined the Maroone Cancer Center team in July 2021 as a general hematologist/oncologist at the Tomsich Health and Medical Center of West Palm Beach.

Dr. Plastini completed her residency in internal medicine at Pennsylvania Hospital, part of the Penn Medicine Health System, and then a fellowship in hematology/oncology at the University of Miami/Jackson Memorial Hospital.

A native of Fort Lauderdale, Dr. Plastini says she chose Maroone Cancer Center because it “checked all the boxes.

I wanted to have access to good support and resources ... all the things that are important to oncology patients.”

CONTACT OUR EXPERTS To contact our experts, call 877.463.2010.

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Tiffany George, MD Medical Onocology Tiffany George, MD, joined the Maroone Cancer Center team in 2020.

She specializes in genitourinary and gastrointestinal cancers.

Dr. George completed her undergraduate education at the University of Central Florida and her medical training at Meharry Medical College School of Medicine, in Nashville, in 2014. Later, she trained in internal medicine at Case Western Reserve University/University Hospitals Case Medical Center, in Cleveland, and then completed a fellowship at the Ohio State University Medical Center, in Columbus.

Chebli Mrad, MD Hematology/Oncology Chebli Mrad, MD joined the Maroone Cancer Center team in July 2021. He specializes in brain cancers, sarcoma, head and neck, melanoma and rare tumors.

Dr. Mrad attended medical school at the Lebanese University Faculty of Medical Sciences, in Lebanon. He completed an internal medicine residency at Mount Sinai West and Mount Sinai St. Luke’s, in New York City, and a fellowship at Roswell Park Comprehensive Cancer Center, in Buffalo, NY.

Anatoly (Tony) Nikolaev, MD PhD Radiation Oncology Anatoly (Tony) Nikolaev, MD PhD joined the Maroone Cancer Center team in July 2021. He specializes in head and neck cancer and central nervous system (CNS) disease sites.

He has a research lab at the Florida Research and Innovation Center (FRIC), focusing on the molecular mechanisms of resistance to radiation, chemotherapy and immunotherapy in the high-risk HPV-negative head and neck cancers and pediatric brainstem gliomas (DIPG).

Dr. Tony Nikolaev attended Charles E. Schmidt College of Medicine at Florida Atlantic University (FAU) in Boca Raton and did his sub-internships and medical school research projects at Cleveland Clinic Florida in Weston. He completed an internal medicine internship at Boca Raton Regional Hospital and radiation oncology residency program at University of Alabama, in Birmingham (UAB), as well as PhD thesis in Cancer Biology at Columbia University, in New York City.

C a n c er Res ources and Clinical Tr ials

Cancer Resources

Support and Counseling Services

DrConnect® (for physicians) Our practice-tested DrConnect® service elevates the team approach to a new level by giving you and your staff an instantaneous, comprehensive and secure online view of your patients’ treatment progress while at Cleveland Clinic. With DrConnect®, our specialty care becomes a seamless part of your practice, providing you with added confidence when making decisions regarding the next step in your patients’ care.

To get more information or to sign up online, please visit clevelandclinic.org/drconnect or call our DrConnect® help desk at 877.224.7367.

Request for Medical Records To request medical records, please contact Health Information Management at 954.659.5000.

Patient Appointment Center To schedule an appointment with one of our specialists, patients may call 877.463.2010.

To speak with one of our Maroone Cancer Center staff and to schedule an appointment for support services, call 954.659.5840.

• Art Therapy Services • Caring Touch Services - Gentle - Craniosacral - Beauty/Body Therapeutic Therapy Image Services Massages - Gentle Yoga - Chair Yoga - Reflexology - Reiki • Social Work Services • Dietary Services and Nutritional Counseling • Support Groups • Genetic Counseling • Survivorship Services • Music Therapy Services • Wig Boutique and Wellness Store • Patient Navigation Services • Psychological Services Additional information is available in our Patient Resource and Education Center located on the 1st floor of the Egil and Pauline Braathen Center or online at ClevelandClinicFlorida.org/ SupportServices.

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Clinical Trials Maroone Cancer Center is participating in a clinical trial to evaluate the impact of the DecisionDx®-Melanoma gene expression profile on sentinel lymph node biopsy decisions and clinical outcomes.

Until recently, physicians have relied on traditional clinical and pathological factors to determine whether melanoma is likely to spread to the lymph nodes and elsewhere in the body. DecisionDx-Melanoma analyzes the genetic profile of an individual patient’s melanoma tissue to gauge the risk of metastasis or recurrence more accurately and determine the need for an invasive sentinel lymph node biopsy. Patients with a positive sentinel lymph node biopsy are at higher risk for recurrence and are considered eligible for immunotherapy to decrease the risk of melanoma recurrence.

“It’s difficult to predict whether early-stage melanoma will spread to the lymph nodes,” explains Maroone Cancer Center oncologist Timmy Nguyen, MD. “You can’t do a biopsy for everyone because the majority of cases will not have

melanoma involved in the lymph nodes, and those procedures can cause complications. So, this test is used along with the tissue specimen viewed under a microscope to be a better and more personalized predictor of risk.”

The test results also may guide the intensity of follow-up surveillance after initial surgical removal of the melanoma, Dr. Nguyen adds.

The trial will evaluate the association between use of DecisionDx-Melanoma and sentinel lymph node biopsy decisions, and will track five-year clinical outcomes of patients who undergo the genetic testing. Study participants must be at least 18 years old with newly diagnosed invasive melanoma being considered for sentinel lymph node biopsy.

Anyone interested in participating in the trial should contact Sharon Lew, MHA, CCRP, Cancer Clinical Research Program Supervisor at Maroone Cancer Center, at lews2@ccf. org. For more information, visit ClevelandClinicFlorida.org/ CancerResearch.

CME Activity

2022 MULTIDISCIPLINARY HEAD AND NECK CANCER UPDATE

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Friday and Saturday March 18-19 2022 Register Now!