PHILADELPHIA INTERNATIONAL MEDICINE® NEWS BUREAU
Contact: Leonard N. Karp
lkarp@philadelphiamedicine.com
215-735-3989
In this month's edition of the PIM News Bureau:
1. Fox Chase Cancer Center Offers "Personalized Vaccines"
2. Jefferson Study Indicates Diagnostic Ultrasound Can Help Detect Wear in the UCL
3. Esquenazi Named Chair of Physical Medicine and Rehabilitation at MossRehab
Fox Chase Cancer Center Offers "Personalized Vaccines"
Philadelphia - Surgeons and medical oncologists at Fox Chase Cancer Center, a member of Philadelphia International Medicine®, have embarked on a unique, multi-center clinical trial for patients with advanced renal cell carcinoma or kidney cancer offering them a “personalized vaccine” to determine whether it will prevent cancer recurrence after surgery.
The vaccine, called Oncophageâ, is made by Antigenics, Inc. The U.S. Food and Drug Administration has approved the use of the vaccine in clinical trials and has recently granted “fast-track” status to the investigation of the vaccine as a treatment for patients with kidney cancer.
For kidney cancer patients with advanced disease, the standard of therapy is to surgically remove the tumor, or if the cancer is too extensive, remove the entire organ. Chemotherapy or radiation therapy is not generally recommended as a follow-up after surgery because additional or adjuvant therapy hasn't been proven effective for these patients.
“If the entire tumor is removed, we don't administer adjuvant therapy for these patients,” said Naomi Haas, MD, principal investigator and medical oncologist at Fox Chase Cancer Center. “In this randomized clinical trial, we're trying to ascertain whether patients will possibly benefit from the personalized vaccine, which should stimulate the patient's own immune system to fight against cancer recurrence.”
“Patients who have positive lymph nodes or whose kidney tumor is excessively large are generally considered 'high-risk' for cancer recurrence,” said Robert Uzzo, MD, co-investigator for the study and surgical oncologist at Fox Chase Cancer Center. “Preliminary results have shown that these personalized vaccines are promising, but we need to conduct further studies before making this the standard of care for patients with advanced kidney cancer,” he added.
In the trial at Fox Chase Cancer Center, all of the patients undergo surgery to remove the cancerous tissue in the kidney. “The decision to remove the entire kidney or just the affected portion depends on tumor size and proximity to the main arteries that feed the kidney,” said Uzzo. “We do everything possible to preserve the kidney so the patient can maintain function and avoid potential dialysis in the future,” he said.
Surgeons remove the patient's cancerous tissue and send it to Antigenics, where the personalized vaccine is prepared by isolating heat shock proteins. Heat shock proteins are naturally occurring proteins generated by cells, especially when cells are stressed or shocked. Since tumor cells have abnormal proteins, the heat shock proteins isolated from these cells have abnormalities as well.
When these proteins are re-injected as a vaccine, the body can recognize them as abnormal and will create an immune response against the proteins and the tumor cells that carry them. The vaccine should re-train the patient's immune system to identify and repress the cancer if it were to recur.
Approximately eight weeks after surgery, one group in the randomized clinical trial receives the personalized vaccine administered once a week for four weeks, then once every other week. The other group receives the standard therapy without vaccine and is closely monitored for tumor recurrence by expert medical oncologists. Patients in both groups are given regular CT scans so physicians can determine if the cancer recurs.
“If found effective, administering personalized vaccines after surgery for patients with advanced kidney cancer could potentially extend their lives and improve their quality of life,” said Haas. “We're hoping that this therapy will prove to repress cancer recurrence in these patients.”
Jefferson Study Indicates Diagnostic Ultrasound Can Help Detect Wear in the UCL
For years, professional and weekend athletes alike have suffered from injuries occurring in the main ligament on the inner side of the elbow called the ulnar collateral ligament (UCL). From major league baseball pitchers to javelin throwers, repeated overhand throwing causes stress and tension in the elbow and can lead to significant damage.
A new study by radiologists and sports medicine specialists at Thomas Jefferson University Hospital, Philadelphia, published in the April issue of Radiology, indicates that diagnostic ultrasound can help detect wear and tear that occurs in the UCL.
The trial, led by co-investigators Levon N. Nazarian, MD, Thomas Jefferson University Hospital ultrasound specialist and professor of Radiology, Jefferson Medical College of Thomas Jefferson University, and John McShane, MD, clinical assistant professor of Family Medicine and director, Primary Care Sports Medicine in the department of Family Medicine, Jefferson Medical College, used dynamic sonography to reveal the abnormalities of the anterior band of the UCL in 26 major league professional baseball pitchers.
“Our study shows the wear and tear that occurs on the UCL in baseball pitchers, even those who have no symptoms,” said Dr. Nazarian. “This information can then be used as a baseline for comparison if the pitcher injures himself. We then re-image the elbow to see if any changes have taken place and decide if the pitcher needs surgery or other treatment.”
Small tears in the ligament can eventually grow into one large tear. This could ultimately produce so much damage that the ligament is unable to hold the bones together strongly enough while the pitcher is throwing.
In the future, this approach may be able to predict who is at higher risk for injury. However Dr. Nazarian points out that long-term studies would be necessary before any conclusions could be drawn.
In a previous study, Dr. Nazarian had determined that diagnostic ultrasound can help treat tendon problems such as “tennis elbow.” Using ultrasound as a guide, a needle is inserted into the areas that contain scar tissue. The needle is then used to break up and puncture the scar tissue and smooth any bony calcification. An injection of cortisone is then given to the area to enable the body to break up or dissolve the scar tissue, and lay down new tissue that is more elastic and lengthened, causing less stress and tension.
Esquenazi Named Chair of Physical Medicine and Rehabilitation at MossRehab
Alberto Esquenazi, MD, a nationally-recognized clinician and health care innovator, was recently appointed chairman, Physical Medicine and Rehabilitation at MossRehab, a member of Philadelphia International Medicine. In addition to his new role, he will continue his responsibilities as MossRehab's director, Gait and Motion Analysis Laboratory and co-director, Institute for Mobility Evaluation and Treatment.
With part of his right arm amputated due to a chemical accident, Dr. Esquenazi has dedicated his medical career to helping others in a similar situation. He serves as clinical director, Regional Amputee Center at MossRehab. He is also an advisor to the Centralized Amputation Rehabilitation Unit at the Walter Reed Army Medical Center in Washington, DC and the Secretary of the U.S. Veterans' Affairs appointed him to the Advisory Committee on Prosthetics and Special Disabilities Program.
Fluent in Spanish, Dr. Esquenazi is an associate professor of Physical Medicine and Rehabilitation at Jefferson Medical College, Thomas Jefferson University and professor at Drexel University in the Department of Bio-engineering.
Dr. Esquenazi received his medical degree at the National Autonomous University of Mexico in Mexico City and is board-certified in physical medicine and rehabilitation. He is a fellow of the American Academy of Physical Medicine and Rehabilitation and the American Academy of Cerebral Palsy and Developmental Medicine. Dr. Esquenazi is a member of the American Society of Biomechanics, the North American Society Gait and Clinical Movement Analysis and the International Society of Prosthetics and Orthotics. Dr. Esquenazi has lectured and published worldwide in his area of expertise.
Recognized as a national leader in medical rehabilitation, MossRehab provides high-quality, compassionate medical care for individuals with physical disabilities. MossRehab treats many types of physical disorders, including traumatic brain injuries, stroke, aphasia, amputation, spasticity/impaired movement, spinal cord injuries and orthopedic injuries.
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,
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