CAN PHILLY CURE CANCER?

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http://www.philly.com/mld/dailynews/new ... 897222.htm

Posted on Wed, Jun. 15, 2005

CAN PHILLY CURE CANCER?

CITY'S APT TO PLAY ROLE IN TREATMENT OF DISEASE, BUT PROGRAMS UNDER THREAT

By MICHAEL HINKELMAN

hinkelm@phillynews.com

WHEN Dr. Ronald E. Myers, a prominent cancer researcher at Thomas Jefferson University, recruited a leading scientist last year from Beth Israel Hospital in New York, Philadelphia gained a brilliant new mind.

Dr. Kathryn M. Kash is known for cutting-edge work in a heart-wrenching field: the stress that weighs on otherwise-healthy women with a family history of breast or ovarian cancer.

And the city got another bonus, one that it didn't expect.

That one researcher brought an entire convention to her new home. Two hundred international cancer researchers met in Philadelphia for two days last week to discuss the role of genes in hereditary cancer - and the psychological impact it has on patients.

It was the first time that the prestigious meeting was held in the United States.

"Good things happen when you can invest in good people," said Myers.

And there sure is a lot of that going on in Philly's cancer biz right now.

High-end cancer research has quietly become one of Philadelphia's most important - and lucrative - industries, attracting top doctors and scientists to the region and pouring hundreds of millions of research dollars into the economy yearly.

It's also putting Philly in the forefront of the search for cures.

In fact, it's not farfetched to say that if there is a way to stop cancer - or, as is more likely with this disease, a series of promising treatments - someone from Philly is likely to play a role:

• Philadelphia has four prestigious National Cancer Institute-designated cancer centers; no city in the United States has more (see map).

The head of one - Fox Chase Cancer Center - also chairs the NCI Board of Scientific Advisors. A former scientist at Fox Chase won the Nobel Prize in chemistry last year.

The other cancer centers are at the University of Pennsylvania, Thomas Jefferson University and the Wistar Institute. These institutions won the sought-after "cancer center" designation because of the depth and promise of their cancer research.

• That designation leads to lots of money.

Together, the four cancer centers, two other cancer-focused teaching hospitals in the city and the Children's Hospital of Philadelphia spend nearly $400 million - every year - on cancer research, according to a Daily News analysis.

Much of that money is spent on employing thousands of people in jobs related to the cancer biz, from principal investigators to researchers and support personnel.

• Meanwhile, more than 30 companies in the region - from small start-ups to big pharmaceutical companies - are working on new cancer drugs, selling cancer drugs or trying to grow their cancer business.

• And, as Kash's story illustrates, the city is becoming a hot spot for meetings of top cancer researchers, where promising cancer-fighting ideas are shared. Also last week, the biannual "Era of Hope" meeting brought 1,700 scientists, doctors, breast-cancer survivors and policymakers together for four days to discuss advances in breast-cancer research.

All of this effort is already paying off for patients. Researchers at the University of Pennsylvania, for example, recently revealed that two cancer drugs, used together, increased survival among patients with the dread diagnosis of advanced colorectal cancer.

So what could possibly be wrong with this rosy scenario, in which the region prospers and its residents live healthier lives?

It's suddenly threatened on several fronts.

And that has the leaders of Philadelphia's cancer industry convinced: They'll have to rethink - and soon - how this region protects and promotes its cancer biz.

The money slows down

If cancer were pro football, let's say, our team would have just gotten a nasty surprise out of its television deal.

After years of fat increases, the budget for NCI - the chief funder of cancer research in Philadelphia - is getting leaner.

President Bush proposed an increase in the NCI's budget of only .04 percent next year, to $4.8 billion - a decrease, actually, after inflation. That follows another less-than-inflation "increase" this year.

As television revenues are to sports, this money is no small matter to Philly's cancer biz. The four cancer centers here depend on the feds to fund anywhere from 66 to 91 percent of all their research. Even a flat NCI budget would be bad news.

That funding crunch comes as a bigger change is afoot: The feds are rethinking their approach to cancer research. In the past, the NCI actually encouraged its 60 cancer centers and their investigators to compete with each other, by awarding grants from the same federal pot of money.

Now, the feds want these same scientists and institutions to collaborate and share research data.

This will not be an easy change; cancer researchers are reared to beat each other to scientific discovery.

But the feds insist they are serious. NCI director Dr. Andrew von Eschenbach - who is a Philadelphia native and says he wants to cure cancer within 10 years - said big programs could lose their designation as NCI cancer centers, and all the accompanying money, unless they can demonstrate real evidence of collaboration.

"If we are to eliminate suffering and death due to cancer, we are going to have to win as a team," he said. "In the past, cancer research was a lot like golf. Now, it's about basketball."

Some in Philly may have seen this coming.

A group of business and academic leaders here, organized by Philly tech-boosters Innovation Philadelphia, set out in 2003 to call attention to the region's standing as a place for breakthrough cancer research.

The group suggested two ideas, both based on collaboration among the four cancer centers: A place on the Web for patients and doctors to learn about Philly's groundbreaking research, and a regional center that would speed discoveries in university labs into drugs for patients.

The ideas were published in Innovation Philadelphia's "Road Map for Regional Growth." CEO Richard A. Bendis called them the "next steps for establishing the Greater Philadelphia Region as a global cancer research center."

But the suggestions were largely ignored.

"The cancer centers think [collaboration's] a zero-sum game," said Barbara Schilberg, president and chief executive of BioAdvance, the region's state-funded effort to help turn biotech discoveries from university labs into products on the market. "If they collaborate, they think they're going to lose market share."

Of course, things change fast once the NCI starts talking about flat budgets and kicking cancer centers off their list.

Now, collaboration is "a goal all of us have or we'll be out of business as NCI-funded cancer centers," said Dr. Russel E. Kaufman, president and chief executive of the Wistar Institute.

State money shrinks, too

If new pressure from the feds isn't enough, cancer-center directors have another reason to work together: A once-stable source of state money is being threatened.

Since 2001, Pennsylvania has allocated almost $303 million for biomedical research, much of it for cancer. That money comes from a fund that was set up after 46 states, including Pennsylvania, settled a massive lawsuit in the late 1990s against the four largest tobacco companies.

All of Philly's cancer centers use at least some of this money to recruit top researchers or bolster other public and private investments.

Penn has used its tobacco settlement money to fund 58 research projects, which created 100 jobs at its Abramson Cancer Center, said Dr. John H. Glick, the center's director.

He said the money helps to fund what he calls "light-bulb ideas."

"When a researcher comes up with a promising idea, it can often take 12 to 18 months to accumulate enough preliminary research data before you can apply for a federal grant," he said. "So we are able to use this as seed money so that when an investigator comes up with a light-bulb idea that is really great, we can get it funded, fast."

Fox Chase Cancer Center has used its share of tobacco money from the state to woo junior investigators, build facilities and buy new lab equipment. Wistar got $3.4 million last year to develop a blood test for lung cancer (see sidebar).

But Gov. Rendell wants to reduce by 6 percent - or $21 million - the amount of tobacco-settlement money now earmarked for biomedical research next year. He'd use the money instead for health insurance for uninsured, working Pennsylvanians and home health care for seniors.

Worthy causes, but it's a trade-off that people promoting the region as a place to cure cancer say we can't afford.

"That would send a very bad message. Pennsylvania would be taking a step backward if that happens," said Fritz Bittenbender, president of Pennsylvania BIO, an organization that promotes the biotech industry in the state.

Cancer-center directors and others have been lobbying state lawmakers to scuttle Rendell's proposal.

Eric Arneson, chief of staff for Senate Majority Leader David Brightbill, R-Lebanon, called the proposal "stunningly shortsighted" and said there's not much support in the Senate for it.

But Rendell is resolute. "We have made our proposal to the Legislature, and they have a choice to make, too," Budget Secretary Michael Masch said. "It's not an easy one."

In any case, Masch said the tobacco-settlement fund would have about $358 million to disburse next year - $26 million less than this year - so either way, there will be less money for cancer research.

Which will send Philly's cancer-biz leaders scrambling. They'll be looking for new sources of money, including from private foundations - a source that some other cancer centers in the country tap more successfully than do Philadelphia's.

The competition swarms

Meanwhile, other states aren't blithely standing by and watching us gorge on our bountiful cancer biz.

They're trying to eat our lunch.

Top cancer researchers in Philly are constantly being wooed by other institutions outside the state. Last year, the director of the Kimmel Cancer Center at Jefferson, Dr. Carlo M. Croce, left for Ohio State University. A replacement still hasn't been named.

Myers said he has been recruited by the Winship Cancer Center at Emory University in Atlanta. He said he was offered a salary and $150,000 a year in extra money for five years - he called it "play money."

The Georgia Cancer Coalition, a statewide booster group flush with millions of dollars, provides grants of $50,000 to $150,000 per year for five years to institutions that lure big-name cancer researchers to the Peach State. The funds may be used for any purpose that advances the researchers' work.

Thus far, the major cancer centers in Philadelphia have recruited far more leading researchers than they've lost.

But keeping them is a continuing challenge. Myers said a colleague of his at Harvard University recently told him that Harvard, which is affiliated with the Dana-Farber Cancer Institute and has a huge endowment, offers young researchers the moon to come to Boston.

"They support them for five years to get started - salaries, along with lab costs and so forth. That's the competition. If we want to be able to attract topnotch, high-quality researchers and promising investigators, we have to compete against programs like these," Myers said.

Meanwhile, other, nearby wannabe centers for cancer research are putting their promotional machinery into overdrive.

The Cancer Institute of New Jersey in New Brunswick became an NCI-designated center in 1997. Five years later, it was recognized by the NCI as a "comprehensive center," the fastest any cancer center achieved that top recognition. It gets $18 million a year in state support.

Meanwhile, the Connecticut Cancer Partnership, a coalition of hospitals, doctors, public-health officials and cancer organizations, wants lawmakers to pony up $1 million to establish a statewide network that would link cancer patients with trials of new treatments - a boon not only for patients, but for researchers and even drug-makers.

Organizers there are trying to tap nonprofit organizations for funds, too.

Dr. Robert C. Young, president and chief executive of Fox Chase Cancer Center, said he thought Pennsylvania "had grown a little complacent" about the opportunities afforded by biomedical research.

He said it's puzzling that the state "wants to pull chips off the table" at the same time other places are stepping up.

"The opportunity for somebody who has additional chips at this point in time to really make an impact is huge," Young said.

Perhaps if the cancer-research community did a better job of telling its story here, there would be less reason to worry.

The need to promote

Philadelphia is already the East Coast "nerve center" for the largest NCI-sponsored clinical trials - that is, research studies that test new cancer treatments or methods of cancer prevention or detection on patients.

But did you know that?

The Philly-based Coalition of Cancer Cooperative Groups is responsible for enrolling about 50 percent of all patients in clinical trials in the United States and Canada. It includes nine groups - four of which are in Philadelphia - that administer clinical trials.

The Philadelphia-based groups employ hundreds of clerical workers, Internet-technology professionals and patient-advocacy specialists in offices here. The groups periodically bring in investigators from all over the country for meetings.

The majority of breakthroughs in new therapies are done within these groups, said Dr. Walter J. Curran Jr., clinical director of the Kimmel Cancer Center at Jefferson and chair of one of the groups. And since Philly's the headquarters, cancer patients here have a good chance of getting into a study.

Still, few people outside the cancer-research community know about the coalition or its work.

"We've never been able to, or tried to, develop a huge marketing and public-relations pitch. We just haven't had the resources," said Dr. Robert L. Comis, chairman of the coalition.

Only about 3 percent to 5 percent of adult cancer patients nationally enroll in research studies, experts said. Some are wary they'll be "guinea pigs," Comis said, but Curran said another major problem is that many of them simply don't know about the studies or where they are being conducted.

OK, here's another question: Ever heard of the Pennsylvania Cancer Alliance?

It's an organization of the NCI-funded cancer centers in the state that was formed in 1998 to make sure the state spent its tobacco-settlement windfall on health care. Since then, the group has focused its efforts mostly on lobbying state lawmakers once a year not to mess with the tobacco-settlement money.

But that hasn't prevented this year's funding crisis, and the group has done little to raise its public visibility or tell the story of what the cancer centers are doing to try to cure cancer. It still doesn't even have a Web site.

"The political world probably doesn't know [this story] as well as it should, and neither does the business world," Curran said. "We probably haven't done a good job of letting them know."

This insiders-only approach is a common one in the cancer biz. Even the cancer-center directors admit they meet face to face only occasionally - typically at out-of-town professional meetings or NCI meetings in Washington.

New signs of hope

The good news is, all of the current challenges - including the NCI's new interest in collaboration, funding crunches and competition from other states - may finally be changing attitudes.

Remember those ideas that business and academic leaders floated in 2003 about a one-stop shop on the Web for Philly cancer patients - and researchers? And a center that would speed discoveries in labs to the clinic?

Well, they're in vogue now.

The Pennsylvania Cancer Control Consortium, or PAC3, says it plans to develop such an online portal in the next six months at which patients and doctors can access information about all cancer-research studies in the state involving patients.

And Jefferson's Myers is quietly shopping a proposal at Jefferson to establish a regional Center for Healthcare Decision-making, where patients could come to get hands-on assistance and advice about how to cope with major health-care decisions.

There also are real signs of collaboration in the industry. Fox Chase, Wistar, Penn and BioAdvance, among others, have joined forces to submit a proposal to the National Institutes of Health to establish a regional Center for Translational Research here.

In human language, the center, if approved, would link major research institutions in Philadelphia with hospitals throughout the region and "translate" what seems promising in a lab into real cures for real patients.

Dr. Garett FitzGerald, director of the Institute for Translational Medicine and Therapeutics at Penn, said he was "surprised and gratified" that so many institutions collaborated on the proposal.

"I think you're going to see more and more of that because as cancer research becomes big science, we have to move from an institutional capability to a more regional capability," he said.

Meanwhile, Fox Chase, Drexel and others have submitted a proposal to the NCI to establish a Center of Cancer Nanotechnology Excellence here.

The NCI has earmarked $91 million over the next five years to fund five elite centers around the country to study cancer and nanotech - the science of molecule-sized innovations. It could bring upwards of $25 million to the region.

Again, we have competition: Other cities, including Atlanta, are also vying for the nano-cancer money. Maryland, Virginia and the District of Columbia have combined forces to work on nano-cancer.

The awards are to be made in the fall, an NCI spokesman said.

These and other efforts, if they work, would strengthen Philly's cancer biz for the next century. They could even lead to cures.

And that's a possibility that rallies together even the highly competitive titans of the industry.

Wistar's Kaufman came here three years ago from Duke University, where he saw firsthand the fruits of collaboration between the state's research institutions and industry.

He now serves on the Greater Philadelphia Chamber of Commerce's CEO Council of Growth and is also on the boards of BioAdvance and the University City Science Center.

"I do that because I think it's important we all work together," he said. "I can be perfectly successful as a cancer-center director sitting here at Wistar and pulling the shades down and just having our scientists be creative."

But that's not really an option when teamwork could accomplish much more.

"We have a greater challenge," he said, "a greater cause."

[ginnyde]

I always knew I was proud to have been born and raised in Philadelphia.

Really, I have always known we have many excellent hospitals. Temple Univ Hospital is a leading heart hospital, Jeff is a leading orthepedic hospital and on and on.

[Maryanne]

Looking right at ya Ginny.

Yea.... Philly!!!!!!!!

Maryanane