World's first physician-owned proton therapy unit goes online in Florida

In some circles, proton beam accelerators (PBAs) are looked on as a bad case of overreach by hospital systems scrambling to offer the latest and greatest in cancer care with little regard for health economics or outcomes. Until recently, the devices were massive units costing hundreds of millions of dollars; there are about 25 units in operation or various stages of commissioning across the country, and already there are questions whether the units are cannibalizing each other’s base of potential patients. David Shepard, then a physician at the Swedish Cancer Institute (Seattle), in a 2014 presentation, cited Amitabh Chandra, a health economist at Harvard’s School of Government statement that PBA is “the death star of American medical technology … it’s a metaphor for all the problems we have in American medicine.”

All that may be changing with the commercialization of PBA technology from Mevion Medical Systems (Littleton, MA), which has successfully commercialized a new PBA system at drastically lower size and cost. On April 30, it announced that one of its latest customers, the Ackerman Cancer Center, a physician-owned practice in Jacksonville, FL, has treated its first group of patients with a Mevion S250 unit. According to Joe Jachinowski, president and CEO of Mevion, the S250 is priced at around $25 million, and has been reduced, through patented Mevion technology, to a room-sized unit. Generally speaking, he says, the cost of PBA therapy is in the range of $15,000-40,000 per patient. At those levels of capital investment and cost of therapy, PBA might give biologics being commercialized for oncology, whose cost can range into six figures for some therapies for some cancers, a run for the money.

PBA, like the widely used X-ray technology in oncology, shines a beam of energized particles at a tumor to disrupt the tumor cells’ DNA, hopefully to kill the tumor. PBA, which has been around in research circles for decades, has the advantage of being focused tightly on the depth and “penumbra” (focal point) of the beam; it can be used for tumors that are close to vital physiological structures, and for children, because X-ray radiology can cause secondary cancers that show up later in life. So, the ideal candidate patients are those with head and neck cancers, and prostate cancer. The catch is, relatively little in the way of prospective, randomized clinical trials has been conducted; the efficacy of the technology is open to question. “With the growing number of PBA units, there is now the opportunity to conduct these studies,” notes Jachinowski.

Mevion has five other units in the process of being commissioned, at the Stephenson Cancer Center at the University of Oklahoma; MedStar Georgetown University Hospital in Washington; the Robert Wood Johnson University Hospital (New Brunswick, NJ); University Hospitals Seidman Cancer Center (Cleveland); and the University of Florida Health Cancer Center at Orlando Health. A unit at Barnes-Jewish Hospital and Washington University School of Medicine (St. Louis) is already operational.