Proton therapy, a very precise kind of radiotherapy to treat cancer, has only recently become available to patients in the UK and it is still reserved to a narrow group of patients.
Before joining Advanced Oncotherapy PLC (LON:AVO), Serandour worked for 15 years as an advisor to some of the largest as well as some of the most innovative healthcare firms and saw first-hand how technologies have changed the healthcare landscape.
How has, in your experience, the oncology market adapted to the ever-growing need? And what are, in your opinion, the most promising developments anticipated in this field?
NS: For years, the focus in cancer treatment was on curtailing the growth, metastases and recurrence of tumours.
This was often achieved with a lot of side-effects, that severely and permanently affected patients’ lives.
Think about radiotherapy for brain cancer in paediatric patients.
This procedure destroyed cancer cells, but at the same time hit healthy tissues, which significantly decreased the cognitive skills and impaired the growth and development of those young patients.
Currently, cancer therapies are focused on achieving the same effectiveness, but with less collateral damage.
Modern cancer treatments, such as minimally invasive surgery, immunotherapy or particle therapy, are more targeted and individually adapted to each patient’s case.
In radiotherapy, specifically, this shift of focus led to the use of heavy particles, such as protons, instead of X-rays.
Due to their physical properties, protons can travel through healthy tissue with minimum effects and release most of their destructive energy at the tumour level.
With more clinical data and a lower cost, the market of proton therapy can only go into one direction: becoming the modality of choice for most cancer patients.
Currently, proton beam therapy seems to be a niche treatment. How big is the actual demand for proton therapy in your opinion?
If you consider the US market as a good proxy, up to two-thirds of cancers are treated with radiotherapy.
This means that approximately 12 million cancer patients worldwide should receive some form of radiotherapy every year.
In comparison, the number of patients who receive proton beam therapy is less than 1% of the pool of patients treated under radiotherapy with a global capacity of only about 60,000 patients to be treated with proton beam therapy every year. Today, most patients have to undergo conventional radiotherapy with the long-lasting side-effects that we know.
The reasons why only a few selected cancer patients receive proton beam treatment are manifold.
The most important is cost. Opening and running proton therapy facility demands a significant investment.
Not only because the current technology is expensive, but most importantly because the construction of the building is complex and requires that a significant proportion of the footprint is dedicated to the shielding for protecting patients and staff from the ionizing radiation.
The maintenance of such accelerators, all bundled into one unit, is equally complicated.
The resulting high cost for the treatment and the associated low number of patients mean that it is very difficult to run large-scale clinical studies for the efficiency of proton therapy.
But these studies are necessary to convince insurers (public and private alike) to reimburse proton therapy.
What is the solution that you propose?
There are various ways that Advanced Oncotherapy is investigating to address this issue.
First, we will make proton therapy equipment much cheaper to install, build and service.
On our first site at 141-143 Harley Street, a two-room centre equipped with LIGHT [Advanced Oncotherapy’s proton beam therapy system] will fit into two adjacent Grade-II-listed Georgian buildings with a footprint of approximately 3,800 square feet.
Compare this with approximately 33,000 square feet for 4 rooms at the UCLH proton centre.
We can fit a proton therapy centre in such a small space because of the unique properties of our system.
One of the biggest challenges in building a proton therapy facility is protecting the environment from stray radiation.
This is done by building a maze of concrete walls which can be up to 6 metres thick.
LIGHT is based on a linear accelerator with high efficiency and therefore stray radiation is minimal.
For our system, we only need walls that are no more than 1.5m thick to keep the radiation contained in the accelerator room.
Moreover, our accelerator comes in modules with no part heavier than 2 tonnes.
Each module can be installed through a lift.
We don’t need huge cranes to put the accelerator into place.
In addition to the project cost, an important consideration for the clinics is the improved operational performance of their centres.
Thanks to the linear feature of LIGHT, our research team can develop treatment plans using techniques that significantly reduce the time of treatment.
The latest advance in this field is FLASH therapy.
Can you tell us more about this FLASH technique?
Currently, a proton beam therapy patient would typically have to come to the treatment centre 25 times.
With FLASH, he or she could receive the necessary treatment in one visit.
To do so, a machine needs to deliver a dose of 40/60 Gray per second instead of the traditionally 2 Gray per minute that currently used machines can deliver.
Can you imagine the benefit for patients, hospitals and payers with such a higher dose rate?
We have recently released a paper showing that our LIGHT system is capable of FLASH therapy for a wide range of tumours.
In this respect, we have a tremendous advantage over the currently used systems based on cyclotrons.
Let me illustrate why this is the case.
For the FLASH treatment a machine has to deliver to the patient hundreds of thousands of protons in less than half a second.
Now, a cyclotron is able to do that, but only at maximum energy, that is only for tumours in a very specific and deep location in the body.
For tumours located anywhere else the energy of the beam must be reduced and in the process most of the protons are lost.
With our system no energy reduction is needed and more than 95% of the protons accelerated are expected to reach the tumour independent of its location.
Are you saying that one day the 12 million cancer patients you have mentioned before can be treated with only one visit?
This is indeed the goal.
Of course, at the moment FLASH is an experimental treatment and more studies need to be performed before the technique is widely adopted.
But much progress has already been done in the field and I don’t see how the progress can be stopped.
I believe that LIGHT will shake up the proton therapy market.
The minimal investment requirement from operators using LIGHT, means that proton therapy can become more widely available to small to mid-size clinics.
By offering an affordable compact system, we are looking to shift the paradigm and open a whole new market.
This sounds very ambitious. How do you plan to achieve this?
If you look at the over 80 institutions who have invested into proton therapy to date, those are generally prominent university-backed research centres, located in wealthy metropolitan areas.
At the same time, it is a well-known fact, that family support and treatment of proximity are essential for patients.
Ideally, patients should have no more than 45 minutes travel time to their treatment.
We are following what economists call the Blue Ocean Strategy.
The underlying principle of this concept is this: instead of entering into an existing market with well-established producers, a company should strive to expand market boundaries and reach beyond the existing demand and supply by introducing completely new products.
This is what companies like Facebook and Amazon have done by redefining markets in which they operate and creating new ones.
In our case, this means that instead of entering the proton therapy market with another costly cyclotron-based machine, we propose a completely new technology, which opens up a whole new universe in treating diseases with protons.
Because our LIGHT system has been designed to significantly reduce the treatment cost of patient and it can be installed in small to mid-size health care centres throughout the country, every patient ought to benefit from a proton therapy centre in their vicinity which is expected to drive patients’ demand for this treatment.
When, in your opinion, will this vision become reality?
Very soon. I think that proton therapy technology follows the same path as the MRI technology went through in imaging.
Initially, its use was restricted to academic research laboratories.
Then a major improvement, ‘line scan imaging’, allowed images to be captured in minutes rather than hours.
Soon the first commercial MRI machine from Toshiba was introduced to the market.
Today the sale of MRI machines is a giant global business worth US5bn per annum.
I believe that proton therapy today is at the same inflection point.
It took 50 years to build the first 20 centres, but that number has increased four times over the last 15 years.
As Albert Einstein put it: “The world cannot be changed without changing our thinking”.
And in my opinion the change in the way doctors think about proton therapy is happening right now.
Not so long ago, no one thought we would do shopping with a computer or we would have self-driving cars, etc.
The healthcare industry is following the same transformation and as this is happening, this will create new needs and new markets.
We have to be ready and anticipate what will happen.