Proton therapy report advises caution

The limited evidence on the comparative effectiveness of proton-beam therapy, especially in comparison to other radiation-based treatment modalities, undermines the value of this up-and-coming technology, according to a comparative effectiveness report by the Agency for Healthcare Research and Quality.

The aim of the technical brief was to survey the current evidence on proton beam therapy. The AHRQ review found that 75% of studies reported adverse events but did not adopt established scales to evaluate these adverse events. Also, most studies did not compare the technology with alternatives nor did they report significant differences in cancer-specific survival or overall survival. Visit www.effectivehealthcare.ahrq.gov for the complete report from AHRQ.

Oncology News International spoke with Hadley Ford, CEO of ProCure Treatment Centers, who offered his take on the AHRQ report and what it means for the future of proton therapy. Q: What is the general state of research with proton therapy including clinical trials and comparative effectiveness as well as cost- effectiveness studies?

Mr. Ford: When discussing research on proton therapy, it's important to keep in mind that until very recently, there has been only a small patient base to study in the U.S. Loma Linda University opened its treatment center in 1990; Massachusetts General Hospital in Boston opened in 2001. Other centers opened between 2003 and 2009.

With more patients, there is more research underway. For example, at ASTRO 2008, there were 44 presentations, posters, or panel discussions on proton therapy compared to 28 in 2007. Many of these papers favorably compared protons to alternative therapies and supported the efficacy of proton therapy.

We also are seeing more clinical trials being initiated. ProCure centers will provide data on our patients in a cooperative research effort with the University of Pennsylvania in Philadelphia after it opens its proton center this fall. There is much going on that reinforces and supports the case for proton-beam therapy.

Q: What is your overall impression of the AHRQ report?

Mr. Ford: It's a good report as far as it goes, but it doesn't go far enough. The report states that protons and photons are both radiation and that they both kill tumors. The significant difference between the two, and the area the report did not discuss in depth, is side effects and complications. Little attention was paid to the cost of treating the side effects of photon-based therapy. These costs are very real, substantial, and ongoing: recurring or secondary tumors, developmental disabilities, organ damage, loss of IQ, incontinence, and tissue toxicity. This issue must be addressed if you are going to really examine the comparative cost/benefit of proton therapy vs other forms of treatment.

Q: What do you think about the development of less expensive technologies for proton therapy?

Mr. Ford: We are big supporters of any innovations that reduce the costs associated with developing a center. All medical technologies decrease in cost as they are deployed. ProCure has already developed new technology that is dramatically reducing the cost of constructing proton therapy centers. Two of ProCure's initial innovations are the robotic patient positioning system and inclined beam room-a treatment room that can treat 80% of the tumors treated with a gantry, the industry standard, but at significantly less construction and equipment costs. ProCure and many others are working diligently to further reduce development costs.

Q: Given the current economic climate and the controversy over healthcare reform, does the AHRQ report help or hinder the advancement of proton-beam therapy?

Mr. Ford: The report correctly assesses the current research, showing the effectiveness of protons and the potential to spare healthy tissue; the report clearly states protons offer much better dose distribution.

The questions AHRQ raises are "Does proton therapy work compared to what and at what cost?" These are very important questions. Our leaders are relying on AHRQ and others to provide substantive information about treatments. We will participate in the research AHRQ says is needed, but it's important to point out that there is much convincing evidence that proton therapy works well.

Proton therapy is a powerful weapon in fighting cancer. This report will not deter us from our mission to make proton therapy available to patients. We plan to continue to build centers until there are no more waiting lists and no more patients being turned away.