Cancer immunologist challenging conventional thinking on advanced cancer. Targeting #cancer cachexia to help patients live longer.
Joined January 2021
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My book is out.
When the Body Turns Against Itself: A Patient's Guide to Cancer Cachexia.
Plain language. No jargon. Honest about what we know and what we don't.
For every family watching a loved one waste away.
amazon.com/dp/B0HKWZLF7P
Dr. Zhang, PhD retweeted
Thank you for writing the book!
I talked to my sister and nurses about Cachexia, they both know what it is, the patient (me) was the only one not informed why its likey affecting me. Im half way through your book, and like the charts for keeping track of daily struggles.
If you downloaded my book this weekend and read it, an honest review on Amazon would help other families find it. Even a sentence helps. Thank you.
Dr. Zhang, PhD retweeted
1. #Oxaliplatin Toxicity: What to Demand Today
Oxaliplatin causes progressive, cumulative nerve damage (peripheral neuropathy) and severe systemic toxicity. If you are too sick to function, giving you more without a dose reduction or a delay can cause permanent disability.
When you see them today, do not let them brush past this. Use these exact, direct phrases to force them to document your status:
"My symptoms are a Grade 3/4 toxicity." (This is official oncology grading language. Grade 3 means it is interfering with your activities of daily living like walking, swallowing, or buttoning a shirt).
"We need to discuss a dose reduction or holding the oxaliplatin today." (Altering the dose due to severe side effects is standard safety practice, not a failure on your part).
"I need you to document in my chart exactly why you feel it is safe to proceed given my current level of toxicity." (Doctors become much more cautious when forced to write down their rationale for overriding a patient's severe symptoms).
2. What They Are Missing: The #Cachexia Blindspot
Based on Dr. Zhang's @CureFinder framework and the reality of how conventional oncology operates, here is exactly what your team is likely ignoring or failing to treat:
Treating Wasting as a Personal Failure: Many oncologists still treat weight loss as "you aren't eating enough," which is why they just send you to a nutritionist. They are completely ignoring the tumor-driven metabolic hijack. The tumor is pumping out inflammatory signals (like IL-6 and TNF-alpha) that force your liver and muscles to burn through energy, regardless of how many calories you force down.
The "Wait and See" Scheduling Gaps: Booking consultations eight weeks apart for a fast-growing tumor and severe cachexia is structurally unsafe. Cachexia changes a body week by week, not month by month. They are managing your case like a slow, chronic illness instead of an aggressive metabolic emergency.
Lack of Multi-Targeted Metabolic Treatment: Because there isn't a single FDA/Health Canada approved "cachexia pill," many oncologists do nothing. They ignore off-label, multi-targeted metabolic therapies (like specific anti-inflammatories or medications to protect muscle mitochondria) that researchers like Dr. Zhang discuss to quiet the internal inflammation.
3. Escalating Your Care in Calgary
Because your appointments are being canceled without notice and spaced eight weeks apart, the communication loop is broken. You have the right to bypass the standard scheduling desk.
Contact the Patient Advocate / Patient Relations Office: The Arthur J.E. Child Comprehensive Cancer Centre (and AHS) has dedicated Patient Relations officers. Call them and state clearly: "My appointments are being canceled without notice, my consultations are being spaced eight weeks apart for an aggressive cancer, and I am facing severe treatment toxicity without medical review. This is a failure of continuity of care."
Ask your palliative doctor to step in as your quarterback to manage the oxaliplatin symptoms and demand the oncologist adjust the treatment plan.
Lean Hard on Palliative Care: Since you already have them on your team, call your palliative care nurse or physician directly. In many cases, palliative specialists understand cachexia and symptom management far better than oncologists.
You have been carrying this heavy burden for a year and a half. Stand your ground today. You have the right to refuse a specific drug or demand a lower dose if it is making you profoundly unsafe.
AI assistance on building a strategy for Round 3 #esophagael #cancer and #cachexia treatments.
I am preparing for a return to the chemo chair today. They skipped last appt due to illness and neuropathy side affects. I don't believe anyone has reviewed my situation and once again I will have to ring the alarm bells. My blood tests are also concerning at the moment.
Four weeks without treatment is a long time on a disease that kills fast. I dont like pausing unnecessarily. The team stopped all treatments for 9 months after round one and the tumor grew exponentially in that time. The expectation for me to live is measured in months not years statistically.
I lost trust in the team to monitor and adjust on the fly. They made my oncology consults two months apart now, instead of two weeks at the beginning. I need help right now.
1. Addressing the Oxaliplatin Side Effects Right Away
The falling, cold sensitivity, and numbness you are experiencing are classic signs of severe oxaliplatin-induced peripheral neuropathy.
The "Holding" Strategy: It is highly common and medically standard to stop or "drop" oxaliplatin after 6 to 8 cycles if neuropathy becomes dangerous (like causing falls).
What to tell your doctor: “The numbness is causing me to fall, and the cold sensitivity is severe. I want to discuss dropping the oxaliplatin today. Can we continue with a modified regimen, or is it time to switch lines of therapy entirely?”
2. Next-Line Treatments and Emerging Trials
Because your cancer is Claudin 18.2-positive (the reason you are on zolbetuximab), you have unique pathways open to you if your current second-round regimen is failing or intolerable:
Standard Second/Third-Line Therapy: If you move away from your current regimen, a standard next step often involves a switch to a different type of chemotherapy—such as Paclitaxel combined with Ramucirumab (a targeted drug that cuts off blood supply to the tumor).
Second-Line Claudin 18.2 Trials (The RAINSPOT or ZELDA trials): New clinical trials are actively studying the benefit of adding a Claudin 18.2 blocker to standard second-line therapies (like Paclitaxel/Ramucirumab) for patients whose cancer progressed on frontline zolbetuximab. Ask your oncologist if they can look for an open second-line Claudin 18.2 combination trial.
Claudin 18.2 Antibody-Drug Conjugates (ADCs): This is a highly promising new class of drugs acting like a "Trojan Horse"—they find the Claudin 18.2 on your cancer cells and drop a precise payload of chemo directly inside them, minimizing systemic side effects. The drug Sonesitatug vedotin (Sone-Ve), for example, recently showed landmark survival benefits in pre-treated gastroesophageal cancers. Ask if you qualify for any ADC trials.
Other Biomarkers: Ask your doctor if your tumor has been tested for other targets, such as PD-L1 (for immunotherapies like Pembrolizumab or Nivolumab) or FGFR2b (which has active trials like Amgen's bemarituzumab).
3. Combatting Cachexia (Wasting Away)
Cancer cachexia is a complex metabolic condition where the body burns muscle and fat rapidly, meaning you can "waste away" even if the scale stays stable due to fluid retention or shifting body composition. Standard nutrition alone cannot always fix it; it requires medical intervention.
Appetite and Metabolic Stimulants: Ask your doctor about medications specifically used to treat cancer cachexia, such as Megestrol acetate, medical cannabis, or low-dose steroids (like Dexamethasone), which can stimulate appetite and help counter the inflammatory state causing the wasting.
Proactive Nutrition Support: Request an immediate referral to an oncology dietitian. They can provide highly concentrated elemental powders or specific peptide-based drinks that bypass heavy digestion and feed your muscles directly.
4. Managing the Reverting Swallowing Difficulties (Dysphagia)
When swallowing becomes difficult again after a treatment break, it is critical to address it immediately to stop the cachexia cycle.
Local Interventions: If the tumor is causing a physical blockage making it hard to swallow solids or liquids, ask your team about local solutions. This could include a temporary esophageal stent (a small mesh tube placed to hold the esophagus open) or a short, targeted course of palliative radiation therapy to quickly shrink the block and restore your ability to eat.
Last day — the Kindle edition is free until tonight.
If it helps your family, please pass it to one other family who needs it.
amazon.com/dp/B0HKWZLF7P
Dr. Zhang, PhD retweeted
Biomarker indicative of #cachexia as explained in a book from researcher Dr. Zhang. Its more prevalent than people know or statistics show. Esophagael cancer is among the most likely cancers to have this attack the immune system from reading.
The ratio of two white blood cells to one #lympocyte. My blood tests indicate a much higher ratio, while I am noticing the effects of wasting.
Dr. Zhang, PhD
@CureFinder
👇 My book is free on Kindle this weekend. When the Body Turns Against Itself: A Patient's Guide to Cancer Cachexia. If someone you love is losing weight to cancer and no one has explained why, I wrote this for them. amazon.com/dp/B0HKWZLF7P
An absolute count above 4,000 cells/µL in adults is generally considered high.
• Common causes: Recent or active viral infections (such as mononucleosis, influenza, CMV, or COVID-19), vaccinations, or temporary immune responses.
• Serious or chronic causes: Persistent or very high counts (>10,000 cells/µL) can sometimes point to blood cancers like chronic lymphocytic leukemia (CLL) or acute lymphocytic leukemia (ALL).
An immature granulocyte (absolute) count measures the actual number of early, undeveloped white blood cells (promyelocytes, myelocytes, and metamyelocytes) circulating in your bloodstream.
Common Causes of High Levels
Infections: Bacterial infections or developing Sepsis.
Inflammation & Stress: Major surgery, physical trauma, severe injury, or acute medical stress.
Physiological Factors: Normal, mild increases can happen during pregnancy or in newborns.
Medications: Steroids or bone marrow-stimulating drugs.
Bone Marrow Conditions: Less commonly, blood disorders or leukemias.
An absolute neutrophil count (ANC) measures the exact number of infection-fighting neutrophils (a type of white blood cell) in a microliter of blood.
Low Neutrophils (Neutropenia)
Definition: An ANC below 1,500 cells/µL.
Severity Levels:Mild Neutropenia: < 1,500 cells/µL
Moderate Neutropenia: < 1,000 cells/µL
Severe Neutropenia: < 500 cells/µL (carries a high risk of serious bacterial infections)
Common Causes: Chemotherapy or radiation, viral infections, certain medications, autoimmune conditions, or bone marrow disorders.
Dr. Zhang, PhD retweeted
Dr. Zhang, PhD
@CureFinder 👇
My book is free on Kindle this weekend. When the Body Turns Against Itself: A Patient's Guide to Cancer Cachexia. If someone you love is losing weight to cancer and no one has explained why, I wrote this for them. amazon.com/dp/B0HKWZLF7P
Dr. Zhang made me cry because he devoted his life to saving people from cancer. Im a sentimental old man who likes to shine a light on compassion. ❤️🩹🔦
I purchased the paperback out of gratitude for his reply to me to start me on a road to knowledge. I will greedily download the Kindle too. I found out I can use Kindle books on my Samsung notebook with an app.
My book is free on Kindle this weekend.
When the Body Turns Against Itself: A Patient's Guide to Cancer Cachexia.
If someone you love is losing weight to cancer and no one has explained why, I wrote this for them.
amazon.com/dp/B0HKWZLF7P
Dr. Zhang, PhD retweeted
You can see the effects of cachexia for my bony legs and arms. Muscle is dropping off me even if my weight doesn't change.
I find out from the good doctor, its not a lack of food thats causing it or a lack of willpower. Sometimes we have moments we feel we could do more ourselves and take the blame.
I work out with light weights and began to eat a better diet when I started to be able to swallow again two months ago. I had gone a year a half of struggling to do that, until a miracle occured in August to allow me to escape a feeding tube or stent. But I still can not hold muscle to the bone. I will learn more and try harder.
I did mention this to my oncologist team, but its Dr. Zhang that opened my eyes to why its happening.
Fixing the system is exactly what we tried next — one broad immunomodulator, R-ketorolac, tested in our lab. Next week: what happened when cachectic mice got it.
It's also why single-molecule cachexia drugs keep falling short. With half a dozen redundant pathways driving the wasting, blocking one cytokine is like plugging one hole in a sieve. Fix the system, not the molecule.
That same broken state helps explain why immunotherapy can fail in wasted patients: checkpoint drugs need a working immune system, and cachexia means the system is already wrecked. The drug has nothing to work with.
You can read the same story in a simple blood test: a high neutrophil-to-lymphocyte ratio — lots of inflammation, few working lymphocytes — tracks with worse cachexia. The immune imbalance shows up before the weight does.
The review's twist: a cell called MDSC pulls double duty. It shields the tumor from your immune system AND fans the body-wide inflammation that wastes you away. Protecting the tumor while dismantling the patient.
The wasting runs on inflammatory signals: IL-6, TNF-α, IL-1β and others telling muscle and fat to tear themselves down through JAK/STAT and NF-κB pathways. Not starvation. A misfired immune command.
If you're losing weight fast with cancer and no amount of food changes it, that's not a diet problem. In our 2024 review, we made the case it's your immune system — inflamed and out of balance — breaking down fat and muscle together. That's cachexia.
I study the immune system's role in cancer wasting because I believe the wasting is treatable — not accepted. If you're losing weight you can't explain, you're not imagining it, and you're not alone in it.