A TURNING POINT FOR PROTON THERAPY

Proton therapy has significant benefits for cancer patients. An increasing number of papers and studies point to its proven ability to target tumor cells more precisely and enable a higher dose of radiation delivered to the tumor, but less radiation to nearby healthy cells, with obvious advantages for patient care.

These advantages result in potentially milder side effects, and cut the risk of developing secondary cancers due to radiation. Yet that prompts key questions: why isn’t proton therapy taking off across the United States, Europe, and the rest of the world as predicted a few years ago? And why haven’t the advantages of this approach been seamlessly integrated into routine, everyday radiotherapy?

Patient access

It is, unfortunately, a field that has been dogged by issues: cost and scale of installations; centers going bankrupt or closing down because patient access failed to meet expectation; and insurers becoming reluctant to reimburse for proton therapy. Proton therapy, for all its advantages, is a field with major barriers to entry. That includes cost of equipment and shielding, time from project start to first patient treated, and significant space requirements.

We can talk further still about the benefits of precision targeting of the beam protecting neurological functions, minimizing radiation to vital organs, and reducing risks for children with cancer, who often suffer lasting side effects from radiation toxicity. Proton therapy – for tumors of the brain, spinal cord, liver, prostate and pancreas – is painless, but with a typical course of treatment being five days a week for several weeks, the importance of centers being accessible for patients is paramount.

Economics of therapy

Further disadvantages often relate more to the economics of proton therapy, rather than the treatment itself. With few proton therapy centers – because of scale of investment required, massive gantries and 360 shielding requirements – patients have to wait longer for treatment, or travel further for therapy, often leaving their support network behind.

The size of traditional gantries (where patients lay supine) and accompanying infrastructure is another major challenge for centers looking to add proton therapy to its suite of cancer care. Put all this together and the result is too few proton therapy centers. And those that do deliver care are often in large, academic, institutions. It is a concerning scenario, given the growing need for cancer care against a backdrop of ageing populations, and also recognition that despite the expense, proton therapy does offer effective treatment to cancer patients.

A new generation of upright proton therapy

This is where Leo Cancer Care and our Marie™ system offers a solution, potentially changing the landscape for proton therapy for good – indeed, truly democratizing delivery of such care. Our unique upright positioning system – named after Marie Curie, who spearheaded research into radioactivity – takes up a fraction of the space of traditional installations. It can be installed more quickly, often into existing facilities, and costs less than equipment from other major vendors.

In addition, Leo’s system is beam agnostic and compatible with a range of accelerator vendors’ equipment. We have seen already across the United States, how major health providers are acknowledging the benefits of such a system, which brings a new dimension to cancer treatment by keeping the radiation beam fixed and slowly rotating the patient while supported in an upright position. And, they are entering into landmark agreements with us that will make a difference to patients everywhere. But why do these announcements matter, and why should the radiation therapy sector care, or take note?

Natural position

The University of Wisconsin, UW Health, has begun construction on a new medical center in Madison, Wisconsin, in partnership with Leo Cancer Care and Hitachi to deliver proton therapy using our groundbreaking upright treatment technology. Upright is a more natural position for the human body with evidence suggesting less organ movement during the treatment leads to improved radiation delivery and allows for better interaction and communication with care teams.

Motion is always an issue in radiation therapy so the clinical literature showing a reduction in organ motion upright, compared to supine, is incredibly promising. Centre Leon Berard, our partner in Lyon, is also in the process of submitting its first paper on the Leo technology showing improved patient comfort, reduced setup times and fantastic setup reproducibility compared to supine patient positioning. Recent research also indicates greater planning flexibility, with the potential for reducing the number of treatment sessions.

Lightbulb moment

Today, centers looking to introduce proton therapy treatments, are recognizing the benefits of this concept, which has the potential to make proton treatment more effective, more accessible and much more patient friendly. In a sense, rotating the patient is logical – after all, if you need to change a lightbulb, you don’t hold the lightbulb and rotate the house. It always makes sense to rotate the lighter object. We’re applying that simple concept to modern radiation therapy by rotating, for example, a 100lb patient instead of a 100-tonne gantry.

Elsewhere, McLaren Health Care will install two upright units at the McLaren Proton Therapy Center in Flint, Michigan, with the first patients set to receive care within two years. McLaren has ordered two ‘Marie™’ units that will fit into an area earmarked for a single conventional rotating gantry at its existing proton center. Our goal is to enable the treatment of more patients with proton therapy, so doubling the number of treatment rooms for half the cost of adding a gantry. Add to this the workflow efficiency benefits we are seeing in Lyon, and this is going to easily double the number of treatment slots available to patients whilst halving the investment for McLaren.

Democratizing proton therapy

At Leo, we are not just opening the door for proton therapy for patients at large academic institutions; this really is about democratizing proton therapy and bringing it to a wider patient population and into community cancer centers.

Larger academic centers, however, are also recognizing the benefits of this smaller proton therapy footprint. Stanford Medicine, the renowned Silicon Valley medical center and early pioneer in modern radiation therapy, was facing siting challenges for a new proton therapy unit until they turned to Leo Cancer Care for our upright solution. This recent and very significant development offers further confirmation of the upright approach as Stanford University Medical Center in Palo Alto, California, will be among the first to take advantage of the Leo Cancer Care partnership with MEVION and replace a conventional linear accelerator with the new, significantly smaller, MEVION S-250 FIT.

The smaller and more cost-effective solutions – which includes Leo Cancer Care’s innovative upright positioning system and CT scanner and MEVION’s smallest-in-the-world, self-shielded proton accelerator – could bring a new lease on life to the sector. Designed to fit into an existing LINAC (Linear Accelerator) vault, this industry disruptive technology will bring proton therapy to more patients than current configurations, while saving tens of millions of dollars.

These developments are important and may well serve as a blueprint for the future of proton therapy treatment rooms, taking particle therapy to people and places that need it most. And while these three providers may have different approaches, scale and patient demographic, are all striving to deliver better care for their patients.

Less expensive devices

The proton therapy landscape has a checkered history, littered with stories of overspending and poor return on investment, against a backdrop of increasing patient demand as cancer incidence rises. While some providers are looking to invest to expand proton beam therapy centers to cope with rising patient demand, others continue to struggle in failing to meet targets, and with insurers hesitating to cover certain procedures, several US proton therapy facilities have lost money, defaulted on debt, or even closed.

This is not solely a US phenomenon. In the UK, Rutherford Health closed its five clinics after going into liquidation when the number of cancer diagnoses dropped during the pandemic, causing cash flow problems. It is clearly a sector in need of good news.

Changing the proton therapy landscape

With a new era on the horizon for proton therapy, all the signs point to a need for a truly smaller and smarter way to navigate this challenging market. Enter the Marie™solution, which fits into a significantly smaller footprint than a single conventional rotating gantry.

Our system features: dual-energy diagnostic quality CT at the treatment isocenter to enable real-time adaptive therapy and is partnered with a stationary fixed beam delivery system, and has a sophisticated patient positioning system, allowing for imaging and treating of all particle therapy-specific anatomical sites in the upright position.

The Leo Cancer Care technology is not yet available for clinical use, pending regulatory approval. We are now at an advanced stage of acquiring a CE and 510K for the Marie™ system, which is compatible with a range of beam vendors.

That is why these announcements and agreements between Leo and major healthcare providers matter and are so significant. Yet over and above the financial benefits of upright therapy and fixed proton beams, the overwhelming feedback of those participating in implementing this new paradigm is that it is a more human way to treat cancer patients.

Patient comfort and enhancing the caregiver/patient relationship sit at the core of this advancement which is destined to offer better and more effective care to patients when they need it most. Above all, at Leo Cancer Care we strive to play a pivotal role in democratizing care by making proton therapy available to more patients.