As approximately 24 million people worldwide are expected to get cancer each year by 2030, according to Cancer Research UK, the race to find more effective and cheaper therapies has led to proton therapy, a type of radiation that uses protons rather than X-rays to treat cancer.
Like standard X-ray radiation, proton therapy is radiation therapy that is based on an external beam that painlessly delivers radiation through the skin from a machine to the cancer. The advantage over a standard X-ray treatment is that the therapy focuses the ray directly onto the tumor without damaging surrounding healthy tissue. The treatment uses 60 percent less radiation that normal X-rays, allowing for higher doses to be directed to the tumor and increasing the chances that all the tumor cells can be targeted, Cancer UK says.
However, this therapy requires highly specialized, expensive equipment: an accelerator to create the proton beams; a centrifugal machine, called a gantry, that is needed to treat the tumor from a variety of angles as the patient lies on a bed; and the room hosting the gantry, which has to be three stories high with walls that are two to three meters thick. Because of its high costs, just a few medical centers in the world can afford the equipment, and just one percent of eligible cancer patients globally have access to this therapy.
Enter Israeli startup P-Cure, which says it has devised a way to halve the costs of proton therapy by doing away with the expensive gantry.
Proton therapy has huge benefits “but the price is unbearable,” said Michael Marash, the founder and CEO of Lod-based P-Cure. “The biggest problem is the use of the centrifuge. So we have developed a technology that avoids the use of the gantry,” reducing the costs of the treatment but also increasing its benefits. The technology will allow both patients and physicians greater access to the treatment, he said.
There are today 2,500 centers in the US and 8,000 centers globally that provide X-ray treatment, but just 20 centers offering proton treatment for children, prostate, lung, base of skull tumors and liver cancers among others, as the high costs make the treatment prohibitive to many. The therapy is covered by Medicare and state insurers in the US.
“Proton therapy is the next type of radiation therapy and is expected to replace the X-rays, which burn the tumor but also everything in their path,” said Marash, who set up P-Cure 10 years ago. “The holy grail is to get the beam directed to the tumor in a targeted way. The proton beam is like a virtual scalpel, and can be directed directly to the tumor.”
Pinpointing the beam directly onto the tumor before each treatment, when the patient is seated, increases the results and does away with the need for a gantry, he said.
“You don’t need a rotating gantry if you know exactly where the tumor is and its shape,” said Marash. “We adapt the shape of the beam to the changes we see in the patient.”
The technology uses a diagnostic CT and a real time X-ray to allow a precise mapping of the of the tumor. A software program integrates all of the information and offers a precise treatment that can be adapted according to what is revealed. At the core of the P-Cure solution “is the software that controls and integrates all of the information and keeps the beam focused on the tumor,” Marash said.
While proton therapy using a gantry costs around $40 million, for both the equipment and the construction of a treatment room, the cost of installing a P-Cure based proton treatment system would cost $20 million-$25 million, also for both the equipment and construction of a treatment room. This brings the cost of the proton therapy equipment down almost to the level of the existing X-ray solutions, said Marash.
The size of the room can also be 10 times smaller than a room with a gantry, data provided by the company shows.
P-Cure has raised $10 million to date from private investors including Joe Kanfer, the owner and CEO of GoJo Industries and an active figure in the US Jewish community. The company has installed a system at Northwestern Medicine Chicago Proton Center and will be installing two additional ones at a private hospital in London this year.
The product received US Food and Drug Administration (FDA) clearance in August. P-Cure has also reached a collaboration accord with Philips Healthcare for a joint development of a product, along with accords for future collaborations with hospitals in Korea and in Israel.
“If we are able to visualize the cancer in the treatment position before every single treatment, it allows us to reduce exposure to non-targeted sites,” Dr. Nasiruddin Mohammed, a radiation oncologist at the Chicago Proton Center at Northwestern Medicine, in a video featuring the P-Cure machine which it has installed.
Large medical equipment manufacturers like Varian, IBA, Sumitomo, Toshiba, Mitsubishi and Hitachi make the gantries today. “They are not our competitors but our partners in bringing the proton therapy solution to all eligible patients,” said Marash, who immigrated to Israel from Belarus in his 20s and has a doctorate from the Weizmann Institute.
The company, which employs 15-20 people in Israel and has offices in the US, is now in the process of raising funds to help it increase its scope of customers globally and in Israel and to scale up its manufacturing facility in Israel. Currently no hospital in Israel uses proton therapy and most patients need to travel to the US for it.
The Health Ministry in Israel is in the process of evaluating the appropriate model for offering proton therapy nationally, said Marash. The P-Cure solution, “due to its compactness, economic and potential clinical advantages, can be a perfect option for Israeli patients,” he said.