By DENISE ROLAND for The Wall Street Journal
Proton-beam therapy machines, such as this one in the Czech Republic, are used in treating cancer patients. PHOTO: PETR DAVID JOSEK/ASSOCIATED PRESS
To see the explosive rise of proton-beam therapy, an expensive and controversial cancer treatment, look to the billboards of Belgium.
Ion Beam Applications SA, the Belgian company that leads the global market for huge proton-beam machines, is selling so many systems lately that it needs to boost its 1,200-strong workforce by 400 workers. It launched a big recruitment drive across the country this year, featuring radio and newspaper spots along with dozens of billboards and posters.
“It was very difficult to escape the IBA campaign,” said Chief Executive Olivier Legrain.
Proton-beam therapy is a form of cancer radiotherapy that uses positively charged particles to kill tumor cells. Unlike traditional radiotherapy using X-rays, protons can be programmed to deposit most of their energy in the tumor, minimizing damage to surrounding, healthy tissue. X-rays, in contrast, lose energy as they move through the body, meaning that tissue between the tumor and the beam will receive a higher dose of radiation than the tumor itself.
The technology has been around since the 1980s, but until recently demand was muted due to high cost and limited evidence that it makes financial sense. Proton-beam therapy centers can cost up to $200 million to build and are more expensive to operate than traditional radiotherapy. While that higher price tag is justified for treating childhood cancers and a small number of adult cases, such as tumors in the base of the skull, the jury is still out on its cost-effectiveness for most common cancers. For some countries, that meant it was cheaper to send patients abroad for treatment: since 2008, the U.K. has sent its patients to centers in the U.S., which has led the way in adopting proton-beam therapy.
For years, that combination put proton-beam therapy in a Catch-22: Hospitals were unwilling to make a multimillion-dollar bet based on thin evidence, but without more treatment centers, there was no way to gather enough evidence to prove the technology was worthwhile.
In the past five years, though, the total number of proton-beam therapy rooms world-wide has nearly doubled to 171, according to IBA. In 2014 and 2015, deals involving a total of 66 new treatment rooms were signed, compared with just 17 in the previous two-year period.
Several factors came together to spur higher demand for the technology. For one, IBA and other providers, such as Hitachi Ltd. and Varian Medical Systems Inc., developed compact centers that take up less space and cost between a quarter and half as much to install. The installation of these systems costs $40 million to $50 million.
“We couldn’t have justified building a big proton-therapy center,” said Marc Decramer, head of Belgian hospital UZ Leuven, which earlier this year announced plans to introduce the technology.
He said that while evidence on the cost effectiveness of proton therapy was still thin, having the facility, which should be operational by mid-2018, would make the hospital “part of the club” by enabling its researchers to run clinical studies comparing proton-beam therapy with traditional radiotherapy.
“It’s more than prestige,” he said. “We need to invest to make sure we remain ahead of others. It’s also an opportunity to do research with this setup.”
Also boosting adoption were some health systems’ decisions to absorb the expense of building a center rather than sending patients overseas for treatment. In 2013, the U.K. agreed to spend £250 million ($360 million) to install large treatment centers at two hospitals in England so it could stop sending patients to the U.S.
A breakthrough in 2012 by scientists at the University of Pennsylvania also helped spur demand for the technology, IBA’s Mr. Legrain said. The researchers used a technique known as pencil-beam scanning, which programs the proton so that it fills the three-dimensional shape of the tumor. Previously, radiation oncologists used a less precise method to direct the beam toward the roughly two-dimensional outline of the tumor.
The advance “unleashed the promise of proton therapy” by making it possible to try the approach in several tumor types that had been off-limits, Mr. Legrain said. That has given advocates more evidence of proton therapy’s cost-effectiveness. A paper published in the journal Cancer earlier this year concluded that proton-beam therapy could be cost-effective for brain tumors in children and specific types of breast, lung, and head and neck cancer, but that so far the evidence was “greatly limited.”
A 2013 study estimated that for prostate cancer patients, proton therapy cost $32,428 per treatment, versus $18,575 for traditional radiotherapy. But advocates believe proton therapy could prove less expensive than traditional radiotherapy in the long term by cutting costs for treatment of side effects from traditional radiotherapy.
Guidelines issued in 2014 by the American Society for Radiation Oncology also helped bolster the case for proton-beam therapy. They recommended that health-care insurers cover proton-beam therapy for all forms of cancer patients—not just those for whom the treatment has a proven cost-benefit—if they are participating in a clinical trial.
Todd Ketch, executive director of the National Association for Proton Therapy, an industry body, said that insurance coverage for proton-beam therapy in the U.S. was mixed. While some insurers “clearly value both the short- and long-term benefits of proton therapy for certain patients fighting cancer,” others require patients to “navigate daunting administrative approval and appeals processes to obtain coverage,” he said.
Justin Bekelman, a radiation oncologist at the Hospital of the University of Pennsylvania, which has been using proton-beam therapy since 2010, said the treatment had “tremendous potential, but we haven’t finished our work to demonstrate what it can do.” He added: “I can never imagine a world without proton therapy at this point, but I’m not convinced it’s better for everything we do.”
Source: The Wall Street Journal. View the original article here