What Cancer Treatment Looks Like in the Future

03-30-2017 8:15 AM

Today we bring you an inside look into the future of cancer treatment. Thanks to Dr. Hak Choy for making time to talk to me. Dr. Choy is Professor and Chair of the Department of Radiation Oncology at The University of Texas Southwestern Medical Center. To learn more about The Mary Kay Foundation’s involvement with UT Southwestern, read about our partnership with Dr. Jerry Shay and our cancer grant review process.

TMKF: What is the next evolution for best cancer treatment?

Dr. Choy: Heavy ion radiation therapy, such as carbon ion therapy, represents the next quantum leap forward in cancer care, but is not currently available in the United States. This is the leading-edge radiation tool for cancer patients. However, the U.S. is still catching up with the rest of the world.

TMKF: What is carbon ion therapy?

Dr. Choy: Carbon therapy delivers targeted radiation treatment via accelerated nuclei of carbon atoms to destroy cancer cells in tumors — while leaving healthy tissue with minimal  damage.

TMKF: What are the advantages and disadvantages of carbon therapy?

Dr. Choy:  Carbon therapy can be more effective at killing cancer than conventional X-ray or proton therapy. It also has fewer reported side effects and a shorter course of treatment. The major disadvantage is the initial cost of building a facility capable of such unprecedented targeting precision and high potency.

TMKF: Wow. So where is carbon therapy available now?

Dr. Choy: China, Italy, Germany, Australia, Austria and Japan all have facilities. Japan and Germany have been using carbon ion therapy for the last 20 years.

TMKF: Why is the United States late to get on board?

Dr. Choy: Carbon ion therapy was first developed at the Lawrence Berkeley Lab at a nuclear physics research accelerator in the late 1950s. Treatment began in patients in the 1970s through 1993 when the center was shut down. A combination of an aging accelerator, and economic and social factors led the government to halt funding. Germans implemented the carbon ion irradiation at their nuclear research facility in Darmstadt at the same time. The world’s first dedicated carbon-ion medical facility, inspired by the work in California, was built in Chiba, Japan. It’s only been in the last five years that the U.S. government realized that we need to catch up.

TMKF: What made it easier for these other countries to build their carbon therapy facilities?

Dr. Choy: Governmental support. Essentially all carbon ion facilities in the world have been built with governmental support or a combination of private and government funds. In addition, Japan was able to build its centers cheaper than the United States could. They developed their systems at a “national lab,” then provided the technology to three Japanese companies to further develop, market and sell. The resulting competition drove down the price. The U.S. has fantastic capabilities and potential to do exactly the same, but it has not happened yet. Without such support, the only option would be to import the technology if the U.S. wants a well-tested, reliable system immediately.  Also, there’s much more regulation in the United States. We have a different philosophy of medicine that requires evidence-based clinical trials. Neither Germany nor Japan (nor the other countries) conducted rigorous, randomized clinical trials before building their carbon ion facilities. They convinced their governments to fund facilities almost exclusively based on the Berkeley data.

Another issue holding carbon therapy back in the U.S. is the lack of a reimbursement model. Government-funded programs and private insurance companies don’t know how to fund the heavy ion therapy. Other countries, due to their huge governmental support, did not need an established reimbursement model to keep their accounting books in the green.

TMKF: Where does all this leave the U.S. now with building a facility?

Dr. Choy: Well, as you see, there is a lot we’ll need to do to catch up. Thankfully, federal and state governments have wisely begun to realize the value and importance of carbon ion therapy. UT Southwestern Medical Center received one of two, $1 million federal planning grants from the National Cancer Institute to plan the country’s first research facility for carbon ion radiation therapy.

The U.S. Department of Energy awarded multiple startup grants to support technology development. UT Southwestern also received a two-to-one matching grant from the State of Texas to plan a therapeutic facility, not just its research-related components. All this detailed planning has just been completed at UT Southwestern.

TMKF: Are certain cancers better treated by carbon therapy?

Dr. Choy: Yes, carbon ion therapy has been shown to be effective for essentially all well localized tumors, especially cancers that exhibit radiation resistance when X-rays or protons are used. These include bone and soft tissue cancers, head and neck cancers, recurrent colorectal cancers, and lung and pancreatic cancers just to name a few.

In Japan, which has five active carbon ion centers, the percentage of pancreatic cancer patients who survived a year increased from 40 percent with convention therapy to 74 percent with carbon ion therapy. Two-year survival rates jumped from 17 percent to 54 percent.

However, even breast and prostate cancers — which are less difficult to manage with conventional radiation — could be more easily treated with carbon therapy with potentially fewer treatment sessions.

Currently, Germany and Japan use carbon ion therapy predominantly to treat only rare cancers and those very difficult to treat with conventional therapy. In the United States, we envision more widespread use.

TMKF: Would you use carbon therapy in addition to other forms of treatment?

Dr. Choy: Yes, it could be used with surgery, chemotherapy, or immunotherapy. Chemotherapy or immunotherapy treats the whole body to kill cancer cells we don’t easily see on image scans. But you don’t cure cancer with chemo or immunotherapy. Eventually, the tumors return. Carbon ion therapy has the potential to cure cancer.

TMKF: What’s the next step for UT Southwestern?

Dr. Choy: The initial phase of planning of both the therapeutic and research components of the heavy ion center have been completed. Now we seek funding from private and governmental sources to build the facility and to acquire the accelerator and heavy ion delivery technology.

To maximize the research potential and patient benefits, we plan to install the most modern and most advanced technology, which currently does not exist under one roof. To do that, we need less funds than would be needed for a single commercial airliner. This fantastic system can be realized for about $250 million total.

Strong evidence-based medicine requires a facility to conduct:

  1. the fundamental physics and biology research, and
  2. the needed clinical trials.

 

Image courtesy of Kanagawa Cancer Center and Toshiba

Image courtesy of NIRS and Toshiba

When patients head into a carbon ion treatment room, they see a nice clean look like these from Japanese facilities. Treatment room one (upper photo) can deliver carbon ions from horizontal and vertical directions. Treatment room two (lower photo) equipment can rotate around the patient, delivering treatment at all angles. Both rooms connect to an amazing accelerator room. Let's look at two of those now!

 

Image courtesy of CNAO

You’re looking at the “guts” of the CNAO synchrotron in Italy. The synchrotron is one type of machine (also known as an accelerator) that accelerates heavy ions to high speeds necessary to reach and treat deep-seated cancerous tumors. The patient never sees this room, which is about 78 meters in circumference. But all these colorful magnets, pipes and conveyors work together to bring the heavy ion beams into the treatment rooms on the other side of the walls.

 

Image courtesy of Kanagawa Cancer Center and Toshiba

Here’s another accelerator from an existing heavy ion center in Japan. Notice the pink boxes toward the left wall. These small but mighty magnets direct the 5mm diameter ion beam to the patient’s tumor to paint the entire tumor volume with the therapeutic radiation dose.

Stacy Graves is contributing editor of The Mary Kay Foundation℠ blog. You can connect with her at stacy@wordcoaching.com, Facebook, LinkedIn, Pinterest.