Proton therapy demand wave drives expansion of Belgium’s IBA

(Reuters) – When Yves Jongen stood at the controls of his proton therapy machine 15 years ago to treat a cancer patient for the first time he was petrified.

Now Jongen’s company IBA is hiring 400 engineers to cope with demand for the technology, increasing its workforce by a third, and expanding its production capacity to make up to 30 machines a year, from a maximum of 8 now.

“It is such a responsibility to send a beam of potentially lethal particles into the body of a fellow human being. It is exciting but scary at the same time,” he said.

Proton therapy made the front pages in Britain last year when 5-year-old Ashya King was removed from hospital by his parents, against the advice of doctors, and flown to Prague for treatment using an IBA-made machine.

There are only 170 proton therapy treatment rooms worldwide to handle about 1% of radiation therapy patients.

But there is already a consensus on the technology’s benefits for certain types of patients, such as children and young adults with spinal cord and base of brain tumours and a growing belief that it could also limit side effects.

King’s family say he is now free of cancer.

A spin-off of the Catholic University of Louvain’s nuclear physics department, IBA began life making cyclotrons to produce radioisotopes for hospitals and radiopharmaceutical companies.

“We would sell one machine a year and enjoy ourselves a lot doing it,” said Jongen, 68, who founded IBA in 1986.

IBA’s offices on the edges of a university campus, near a roundabout decorated with parts of Belgium’s first ever cyclotron, are bursting at the seams, with offices split into ever smaller cubicles.

Proton therapy originated in the physics labs of the post-war period when scientists first described how protons could radiate tumours with more accuracy than standard x-ray therapy.

The technology at the time was not good enough to tackle tumours deep inside the body, however, and in the late 1980s Jongen was urged by an oncologist to “revolutionise cancer therapy” by applying his cyclotron technology to proton therapy.

Jongen needed to create a cyclotron strong enough to speed up particles to two thirds of the speed of light. On a flight back from Australia inspiration struck and when he got off the plane he had sketched a basic framework for the new machines.

When IBA opened its first centre at the Massachusetts General Hospital in Boston in 2001, it was the first to install a ready-made product outside of the big nuclear physics centres.

Nowadays, the group competes with U.S. group Varian as well as Japanese heavy industry groups Hitachi, Mitsubishi and Sumitomo, and is market leader outside of Japan, a position it hopes to consolidate with the introduction of a much more compact version of its machines.

EXPANDING MARKETS

Scientific uncertainty about where proton therapy is useful and where it is not, may in part explain why studies have shown vastly differing estimates for demand, ranging from just 1.5% in Britain to 20% in the United States.

“Researchers always assumed that there were benefits to proton therapy over traditional radiotherapy, but only over the past years have we had a string of medical studies to effectively prove this in the field,” said Roderick Verhelst, analyst at private bank Degroot Petercam.

Medical studies are focusing on using proton therapy in gastric, liver, lung, and pancreatic cancers as well as left breast cancer, in order to minimize damage to the heart.

There are, however, also cases in which experts believe that proton therapy’s higher cost may not be justified.

“There are examples where using proton therapy wouldn’t bring an advantage as the side effects are already small with conventional therapy,” said Stephanie Combs, head of radiation oncology at Munich’s Rechts der Isar Hospital.

Proton therapy’s costs have also hampered its growth.

The powerful cyclotrons behind the technology weigh some 220 tonnes and need to be housed in a bunker, meaning therapy centres occupy entire hospital wings.

The machines, which can take years to build and calibrate, have a price tag in excess of 100 million euros ($112 million), setting a high threshold for smaller hospitals to invest.

In response, IBA was the first to shrink the cyclotron to less than a quarter of its original weight, while still delivering the energy needed. These compact systems, which come at a quarter of the cost, allow smaller hospitals to install them alongside traditional radiation therapy machines.

“Other companies have signed contracts to install such compact systems but have yet to deliver a fully operational treatment room,” Verhelst said.

According to IBA’s own forecast, a worldwide increase to 20% of radiation patients treated with proton therapy would require the number of installed rooms to rise above 2,500.

In the first half of 2016, IBA’s order intake grew by about a third to 143.6 million euros ($160 million). Since 2014 its share price has quintupled. ($1 = 0.7612 pounds) ($1 = 0.8957 euros)

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