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Proton beam therapy, the silver bullet for cancer?

Radiotherapy remains the mainstay of cancer treatment, with over half of all patients undergoing radiation based treatment of some sort.
Proton beam therapy, the silver bullet for cancer?
“The tumours put up a smoke screen, meaning they essentially hide from the body’s defences."

There has been a great deal of coverage recently about the possibility of an ultimate cancer cure that uses the body’s own immune system to take out the killer disease, or finding its Achilles heel.

Researchers at University College London identified unique biological flags, common to every single cancer cell, which could be used to guide existing immunotherapies.

But any meaningful treatments emanating from this experimental branch of science are many years off- if they ever make it to the market at all.

“We’ve got lots more to see from immunotherapy, we are just at the tip of understanding how this really works and I think it has lots more potential to fight lots of different types of cancer,” said Dr Emma Smith, senior science information officer at Cancer Research UK.

The truth is that physicians still rely on technology that is almost a century old. Radiotherapy remains the mainstay of cancer treatment, with over half of all patients undergoing radiaton based treatment of some sort.

Unlike drugs and immunotherapies, radiotherapy is a physical process which destroys the cancer cells through targeted radiation, meaning there are fewer biological variables but can often result in unpleasant side effects.

“The role of radiotherapy will continue to be important in cancer treatment for the great bulk of patients,” said Dr Michael Sinclair, chief executive of London-listed Advanced Oncotherapy PLC (LON:AVO), which is at the forefront of experimental proton beam therapy.

“The research being done with immunotherapies is really excellent and I commend the team behind this breakthrough. We have known for some time that the body tries to attack the tumours themselves, but it’s a tough battle.

“The tumours put up a smoke screen, meaning they essentially hide from the body’s defences.

“Drugs enable the smoke screen to be removed, but one of the key setbacks is that it’s difficult to get it to work on a long term basis.”

Unlike current radiotherapies, proton therapy uses a particle accelerator to direct a much narrower beam of radiation at the cancer.

Due to their high rates of division, cancer cells are particularly vulnerable to this type of therapy as it actively destroys DNA.

“Proton beam therapy is by far the most precise and produces far fewer side effects and collateral damage, such as the problem of residual tumours you often find with other treatments,” said Sinclair.

However, there are fewer than 160 proton beam facilities worldwide, compared to the 18,000 x-ray based treatment centres globally. The reason for that is cost.

Currently machinery is enormous and costly to house and operate, requiring a lot of energy.

Neil Madle, spokesman for Varian Medical Systems (NYSE:VAR), a world leader in radiotherapy technology with over 60% of the UK market, reckons the advanced therapy is around ten times more expensive than current x-ray treatment.

“Facilities currently cost around US$25-$30mln and that is the cost of just one room,” he said.

“Early facilities were the size of football pitches, now they are the size of tennis courts, but they are going to get smaller and less expensive as the technology improves.”

No wonder Harvard University health economist Amitabh Chandra described proton therapy as the “Death Star” of cancer treatment technology.

“Until the cost comes down to around $10mln, only then will it be a viable alternative,” said Madle.

The primary focus of research in this area is to bring costs down by developing the second generation of proton therapy.

“Using linked linear accelerators, a similar process to the hadron collider, harnessing work done in association with CERN, our tech is designed to address the cost parameters of this type of treatment,” said Sinclair of Advanced Oncotherapy.

“The new and disruptive technology we are developing costs a fraction to operate and house, and uses significantly less energy.

“We see immense potential for proton therapy for the future of cancer treatment and we aim to address the cost parameters.”

Madle said Varian was working to a more conservative timescale and was conscious of the limitations of the treatment.

“For those suffering with cancer right now, we are aiming to make the treatment far more accessible,” he said.

“The two new proton centres opening in the UK, one in the North and one in the South, by 2018 will significantly reduce the cost burden to the NHS and allow UK patients to benefit from new treatments.”

At the moment there aren’t any centres in the UK. Where it is appropriate, the NHS pays for certain patients to go overseas for proton beam therapy.

Varian is working to create smaller and more efficient cyclotrons - the immense particle accelerator machinery used to fire the proton particles.

In France scientists at Nanobiotix PLC (EPA:NANO) have adopted a different but equally revolutionary approach to advancing radiotherapy.

They are focusing their efforts on maximising the effects of treatment, using ground-breaking nanoparticle technology.

A spin-off of the State University of New York, the group is combining nanoparticles small enough to enter cancer cells with x-ray radiation therapy.

The technique localises the beams and trials have shown it improves the efficacy of such treatments by around nine-fold.

The treatment poses a lower risk than classic drug development and other radiation-based therapies as it does not increase the damage done to healthy tissue.

It offers a faster and cheaper alternative to existing therapies. As the mode of action is physical, rather than chemical or biological, it can kill any type of cancer cell or tumour.

Nanobiotix’s technology significantly amplifies the effects of radiotherapy without theoretical limitations.

A silver bullet for cancer? Probably not. But Nanobiotix and proton beam therapy offer a real and imminent breakthrough in treatment rather than a pipedream.

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