PHILADELPHIA INTERNATIONAL MEDICINE NEWS BUREAU
Contact: Leonard N. Karp
lkarp@philadelphiamedicine.com
215-735-3989
In this month’s issue:
1. The Children's Hospital of Philadelphia announces $650 million expansion
2. MossRehab to spearhead research into more effective treatment for brain injuries
3. Fox Chase study looks at new treatment that shuts down cancer's molecular activity
Philadelphia -- Philadelphia International Medicine hospitals continue to make the investments in facilities and research that enable them to maintain their standing among the best hospitals in the world. Below are some examples. To schedule a medical appointment with a PIM physician, to arrange for a visiting physician from PIM to lecture at your facility, or for more information about Philadelphia International Medicine, please call 215-735-3575.
The Children's Hospital of Philadelphia announces $650 million expansion
The Children's Hospital of Philadelphia, a PIM member hospital, will nearly double its size over the next five years through a $650 million expansion plan. CHOP, one of the world's foremost pediatric hospitals and research centers, announced the plans recently to accommodate the growing demand for inpatient and outpatient services. CHOP will be constructing a new inpatient "South Tower," which will house patient floors and expand the emergency department. Groundbreaking is expected in June. The hospital is also planning a 10-floor addition to its Abramson Research Center; a 450,000-square-foot ambulatory care and research center; and a major expansion of the operating rooms, clinical labs, pediatric imaging center and additional diagnostic and support space. Other plans in a second phase scheduled to begin next year is the construction of an expanded cardiac center, pediatric oncology center and operating rooms. Also, pathology and clinical labs and educational spaces will be renovated. The capital projects at CHOP are needed because the hospital is experiencing rapid growth. During the past five years, outpatient visits have more than tripled to 750,000 visits annually. More than 20,000 patients are admitted annually and occupancy during peak winter months runs at about 95 percent of capacity. In addition, the expansion program will assist CHOP in reaching its goal "to seek cures for all childhood illnesses. To accomplish this goal, we must continue to provide the best available health care facilities for our dedicated staff," said Steven M. Altschuler, MD, president and CEO of CHOP. More than 500 clinical studies are currently underway at CHOP in fields ranging from fetal surgery to gene therapy. The hospital ranks second among pediatric academic research centers in funding from the National Institutes of Health, and its total research budget tops $70 million annually. Research is expected to double during the next five years. Through PIM, CHOP works closely with international patients to ensure their medical and support service needs are met while in Philadelphia.
MossRehab to spearhead research into more effective treatment for brain injuries
MossRehab Hospital, a member of PIM, is spearheading a more comprehensive research effort aimed at providing better care for people with brain injuries. Each year, thousands of people experience brain injuries that affect mental processes such as awareness, perception, reasoning, memory and judgment. These cognitive impairments impact people of all ages - from teenagers involved in automobile accidents to older individuals who suffer strokes. Without the ability to think clearly, reason, organize and remember, people with brain injuries are not able to return to work, school, community and other normal activities of daily life. Despite the recent advances of medical science, there is often no single, proven course of treatment for a cognitive disorder. Doctors and therapists may try various treatment options in an effort to find the one approach that offers the best results. "It's not the ideal way to conduct therapy, but it's the only way we have right now," said John Whyte, MD, PhD, director of Moss Rehabilitation Research Institute. "The reason is that few cognitive treatments have been systematically studied. As a result, clinicians can't predict which treatment will work best for each patient." However, a grant ward from the National Center for Medical Rehabilitation Research to the Moss institute is designed to improve care for people with brain injuries. Moss will play a major role in developing what promises to be a new era in cognitive therapy research. The grant seeks to enhance the scope, quality and efficiency of research and professional training. Moss is only one of four centers nationwide selected to receive the award. "The two principal functions of the grant are to increase the volume of high-quality cognitive rehabilitation research and to train researchers who will specialize in this area," said Dr. Whyte. Initial research will focus on treatments for common cognitive disorders following traumatic brain injury and stroke. These include attention deficits, hemispatial neglect and aphasia.
Fox Chase Cancer Center, a member of PIM and a comprehensive cancer center designated by National Cancer Institute, was one of the four sites involved in the multi-center study that found a new drug demonstrated effectiveness in treatment of an advanced form of soft-tissue sarcoma by shutting down the molecular activity needed for a tumor's growth. The drug, STI-571 or Gleevec (Novartis), that inactivates a protein linked to the growth of some cancers, has shown evidence of being effective for an inoperable or advanced form of gastrointestinal stromal tumors (GIST). Although this is not a common tumor, the concept of controlling a cancer by shutting down the molecular activity needed for the tumor's growth may apply to other cancer types. The results of a multi-center clinical trial for GISTs were presented recently at the American Society of Clinical Oncology's 2001 Annual Meeting. Soft-tissue sarcomas are rare cancers that originate in connective tissue such as muscle and fat. Gastrointestinal stromal tumors originate in the stroma, the connective tissue that supports the foundation of various organs in the intestinal tract. Normal cells in the gastrointestinal stroma are believed to initiate the contractions basic to the digestive process. Alterations in a gene in these cells called c-KIT can produce inappropriate enzyme activity that leads to the growth of a tumor. In the GIST trial presented at ASCO, 148 patients were enrolled. Of these, 145 were evaluated for side effects and 86 patients were evaluated for response. The patients ranged in age from 18 to 83 years old, with the median age being 54. Fifty-five of the participants had received previous chemotherapy, 16 had received radiation therapy and 94 had had surgery. To be eligible, patients had to have gastrointestinal stromal tumors that could not be removed surgically or else had spread beyond the original site-tumors considered incurable by the standard treatment combination. They also had to have evidence that the c-KIT protein was expressed by their tumor. Half the study participants started with a daily dose of 400 milligrams of STI-571 and half received 600 milligrams daily. Patients on the lower dose whose cancer continued to progress were allowed to switch to the higher dose. An analysis of patients' response to STI-571 found that more than half (59 percent) responded to STI-571. Patients receiving the higher 600-milligram dosage had a slightly higher response rate (68 percent). However, the difference in response rate has not been shown to be statistically different from the 400-milligram dose. Stable disease was seen in 26 percent of patients and 13 percent had tumors that continued to progress. "It's important to note that none of the patients who have had an objective response to this drug have shown disease progression," said Dr. Margaret von Mehren, principal investigator for the study at Fox Chase and a co-author of the ASCO paper. "These results validate the concept of molecularly-targeted therapy for an advanced solid tumor." Relatively few patients in the study experienced severe side effects. These included abnormal gastrointestinal bleeding (5 percent), abnormal liver function tests (3 percent), a low number of white cells (neutropenia) in the blood (3 percent), infection (2 percent) and swelling or edema (3 percent). "What we don't know about STI-571 is whether or not this will actually have an effect on the overall survival of people with this sarcoma," von Mehren said. "This study has only been under way for less than a year now. Many questions remain, but for now we are hopeful." It is estimated that 5,000 Americans a year develop GISTs, usually in the stomach or small intestine. Although many sarcomas can be treated successfully with a combination of surgery, radiation and chemotherapy, people with GISTs that cannot be completely removed by surgery do not usually respond to standard sarcoma drugs. STI-571, however, has the ability to target the c-kit enzyme; many patients with GIST tumors have been found to have mutations in the gene for this enzyme. The mutation results in c-kit continually giving the cell a growth signal. STI-571 attaches to the targeted enzyme in a way that inhibits its growth activity but leaves normal cells unharmed. Side effects have been much milder than those associated with many chemotherapy agents. "Before now, people with gastrointestinal stromal tumors had few options," said von Mehren. "STI-571 demonstrates great possibilities." The Food and Drug Administration approved Gleevec on May 10, 2001 for treatment of chronic myeloid leukemia (CML). The drug shows promise in the treatment of patients with CML and GIST, according to two New England Journal of Medicine reports published April 5. The journal reported on results of STI-571 treatment for a woman with a gastrointestinal stromal tumor that had recurred in her liver and abdomen with more than 28 tumors. Dramatically, after six months, the largest liver tumors had shrunk by 70 percent, six tumors vanished and no new ones were seen. That one-person study led to two multi-center trials to see if STI-571's promise would hold true for other people with GIST. A grant from the drug's manufacturer, Novartis Pharmaceuticals, supported the study presented at ASCO. The second study, sponsored by the National Cancer Institute in collaboration with the Southwest Oncology Group and the Eastern Cooperative Oncology Group, is now open to GIST patients at Fox Chase with Dr. von Mehren as the principal investigator.
Philadelphia International Medicine is an organization that provides medical and patient support services to international patients. It also provides continuing medical education and health care training and education to international physicians, administrators and other practitioners. As the international department of several Philadelphia-area hospitals, international patients gain access to physicians and hospitals rated among the best in the world through one telephone call to PIM. You can reach PIM by calling 1-215-735-3575; fax, 1-215-790-1267; or e-mail, physicians@philadelphiamedicine.com. You can find out more about PIM through its Website at www.philadelphiamedicine.com.
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