Q & A with Leonard Arzt - executive director of the National Association for Proton Therapy

By Loren Bonner; HealthCareBusiness news, DotMed.com

Leonard Arzt, executive director of the National Association for Proton TherapyThe National Association for Proton Therapy (NAPT) will hold its second annual conference March 31-April 3, 2014, at the Ritz-Carlton, Pentagon City in Arlington, Va. The need for the conference has grown as more proton centers crop up around the country. There will be discussions on the challenges associated with developing these new facilities as well as the economics and current policy issues surrounding proton therapy, and the current state of clinical trials and studies for proton therapy. Leonard Arzt, executive director of NAPT, gives us a glimpse of what is sure to be an important discussion about proton therapy and what we can look forward to at the show.

HCBN: What kind of year has it been for proton beam therapy?
LA: Plenty of upbeat news to report, as well as challenges with certain insurers. We can proudly point to new centers that opened, which are now providing expanded access in new areas of the country for cancer patients who could benefit from proton therapy. Up in the Pacific Northwest, ProCure's Seattle Cancer Care Alliance center opened in the spring of 2013 and is the only proton center in a seven-state region. By March, 2014, SCCA will have treated far more than 100 patients.

Another milestone occurred in St. Louis. The Siteman Cancer Center at Barnes-Jewish Hospital/ Washington University treated its first patient with the world's first proton system of its kind — a single vault lowercost system developed by Mevion. In Tennessee, Provision Proton Center treated its first patients as the new year began. The proton community is looking forward to Scripps Health in San Diego treating its first patient by the time this article goes to press, followed soon by McLaren in Flint, Michigan.

I fully expect several more centers with one-room compact machines to begin treating patients in 2014. I also foresee centers opening in Shreveport, La., Baltimore and at St. Jude in Memphis later this year.

HCBN: What progress has the treatment seen in the past year?
LA: We've seen increased use of pencilbeam scanning and IMPT (Intensity Modulated Proton Therapy) in the past year. According to Dr. William F. Hartsell, medical director at CDH Proton Center in Chicago, new protocols are being introduced in the radiation therapy oncology group with a specific focus on evaluating proton therapy for brain and lung tumors. Dr. James Cox at M.D. Anderson, who specializes in treating lung cancers, will speak about proton therapy for lung cancer as the keynote on April 1st at the National Proton Conference.

Research in proton therapy is also becoming more mainstream. For example, according to Dr. Hartsell, in women with locally advanced breast cancer, the typical treatment includes surgery and chemotherapy. Adding conventional radiation therapy to that treatment improves their chances of cure, and decreases the risk of breast cancer recurrence, but also increases the risk of heart disease, lung problems, and second cancers in those women who have been cured. That is a dreadful trade-off. Proton therapy offers the potential to provide the same benefits as standard radiation while minimizing those long term risks.

HCBN: I'm sure there are still many challenges you're up against. Are there new reimbursement or regulatory issues people should be aware of?
LA: Yes, it's been a challenging year with insurance issues. Medicare contractors and commercial payors continue to evaluate the benefits of proton therapy as the clinical evidence continues to evolve. While some insurance companies in 2013 looked to comparative effectiveness research and cost effectiveness of the therapy for certain disease sites (including prostate cancer), others inappropriately denied their members a freedom of choice. This is a high priority and an ongoing issue that we meet head-on almost every day.

HCBN: This year, ASTRO commented on the debate regarding the use of proton therapy for prostate cancer, saying that it should not be routinely recommended for prostate cancer outside of a prospective clinical trial or registry. What's your reaction to that?
LA: NAPT responded to ASTRO in 2013 with a press release. In it, we stated that: Patients and physicians have a number of options when approaching prostate cancer. We believe that all options, including proton therapy, should be available through an informed decision making process. The choice of treatment will have an enormous impact on the patient's health and ability to enjoy his life. Patients have a right to know what
is available to them. An expert panel of the American College of Radiology concluded that proton therapy is equally appropriate and as beneficial as IMRT, 3-D conformal X-ray therapy, and brachytherapy in treating Stages T1 and T2 prostate cancer.

Consistent with the statement from ASTRO that suggests prostate patients referred for proton therapy should be in "prospective clinical trial or registry," most prostate patients cancer patients currently being treated with proton therapy in the U.S. are in a clinical trial or a registry. Surely all prostate cancer patients deserve the opportunity to choose a therapy that causes fewer side effects during treatment and fewer adverse changes in their long-term lifestyles.

HCBN: Do you expect a high turn-out at NPC2014?
LA: Yes we do. Capacity is 250. We will get close to that. NPC2014 is the premier proton therapy event of the year. Anybody who wants to learn more about the advantages of proton therapy will have that opportunity. The best of the best in the proton community will be on hand.

HCBN: What will be some of the important topics at NPC2014?
LA: Attendees will certainly be interested to learn what Christopher Pericak has to say about the state of the proton therapy marketplace in today's health care reform climate. Proton pioneer Dr. James Cox will kick off the conference with a keynote speech about "where we are headed." Dr. Elise Berliner, from the U.S. federal agency on health research and quality, will address patient registries. Additionally, the economics of proton therapy, planning, developing and launching a proton center, innovations in design, equipment and engineering, plus treating breast, head and neck cancers, and more will be featured.

Another highlight will be the announcement of the results of a 2014 NAPT/Dobson DaVanzo report on an in-depth "quality of life" survey of nearly 4,000 prostate patients treated with proton therapy at multiple centers across the U.S.

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