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Advanced Oncotherapy: Democratising proton beam therapy

In April, Advanced Oncotherapy PLC (LON:AVO) announced the appointment of Moataz Karmalawy as a chief commercial officer and president of the firm’s US arm. He joined from Varian Particle Therapy, where he served as general manager of the worldwide particle therapy business. Here, in his first interview since joining the business, Moataz talks to Proactive Investors
Q&A wooden blocks
Your questions answered by Moataz Karmalawy

Q: How and when did you first start working for the proton therapy industry?

MK: I have been working in the Proton therapy industry for over 10 years and I witnessed first-hand the tremendous technological leap that was made in the field. Protons have the ability to deliver a uniform radiation dose at an extremely precise depth while sparing the healthy tissue surrounding the tumour. A study conducted jointly at the University of Pennsylvania and Washington University in St. Louis shows that contrary to radiotherapies based on photons, proton therapy can spare patients from severe side effects due to treatment, including pain, difficulty swallowing, difficulty breathing, and nausea, amongst others – often severe enough for patients to be hospitalised.

Therefore, proton beam is the ideal choice for oncologists and radiotherapists when a patient’s tumour is located close to sensitive organs, such as the optic nerve, the brain, or head and neck tumours. Children benefit most from proton therapy as they are still growing and damages to parts of their body can severely interfere with their development.

My motivation for doing this is because I’m passionate and I want to make sure that Proton therapy becomes widely available to all – not just the lucky few.

Q: You said that proton therapy can save and improve patient’s lives. Why isn’t it then the prevailing method of radiotherapy?

MK: Unfortunately, the current technology to deliver proton therapy is extremely expensive. Moreover, the machine used for the treatment is not only very costly but also very large which leads to many logistical difficulties. Radiotherapy systems based on photons cannot be simply replaced by proton machines. Instead to set up a proton treatment centre, often the hospital has to build an entirely new facility to house the equipment. The funds needed for this investment can be in excess of USD 100 million.

With approximately 80 centres open to date, the global capacity to treat patients with proton therapy is around 60,000 patients a year, which is forcing patients to travel long distances for treatment. Proton therapy has the potential to become a standard treatment option in radiation oncology for many indications as evidenced by multiple studies, thus, proton therapy needs to be made much more widely available and accessible.

Q: In your opinion, what is necessary to make proton therapy more widely available?

MK: We will certainly not get there by incremental improvements to the current technologies. We need a completely new approach, to think outside the box. One way to do that is to change the way the protons are accelerated. Since the accelerator and costs associated with its installation are one of the major factors contributing to the almost prohibitive cost of proton therapy, there is a lot to be gained if we can exchange the current designs with a new accelerator that is smaller, cheaper and more efficient.

The ultimate goal is to drive the cost per patient to a level equal or less than conventional Photon radiation therapy. This will require more efficient ways of treating patients including fractionation schemes which we, at Advanced Oncotherapy, are very well positioned to deliver.

Q: How does Advanced Oncotherapy’s technology contribute to this goal?

MK: Advanced Oncotherapy’s technology (LIGHT) has the potential to lower the cost of Proton centres development and to make it more affordable and accessible. The system is smaller and needs less shielding, which considerably reduces the cost of setting up a proton therapy unit. Another advantage is its modularity, which means that it can be adapted to the existing building structures. The combination with an in-room diagnostic CT for positioning allows for superior imaging which is key in delivering best in class treatments.

But this is only the beginning. LIGHT has the potential to decrease the cost of Proton therapy treatment and to deliver better outcomes for many patients. This stems from the fact that LIGHT is based on a linear accelerator that offers technical advantages such as the ability to switch energy electronically 200 times per second and to deliver a minimal beam size.

Q: How does the linearity of LIGHT translate into a better treatment of moving targets?

MK: LIGHT’s proton beam can be moved up to 200 times per second, allowing for more accurate targeting of moving tumours. Furthermore, beam energy can be adjusted at source, requiring no absorbers or energy reduction devices.

This is also an advantage for adaptive radiotherapy where the treatment plan is regularly changed to account for the changes in the patient’s anatomy during treatment. And it has the potential to reduce the total number of fractions the patient receives, which makes the therapy shorter and less cumbersome for the patient. These are all major improvements.

The LIGHT system will serve as a platform for long term development and opens a whole new realm of possibilities for cancer treatment.

Q: When will patients be able to benefit from these advantages?

MK: Operationally, the organisation is being set up to meet the expected high demand. The ability to accelerate the proton at an energy sufficient for the treatment of moving targets back in 2018 was a turning point. Advanced Oncotherapy is now focused on finalizing the development of our unit at our STFC Daresbury site, ahead of the CE mark regulatory approval. We expect to treat the first patient by end of 2020.

We are working very hard to bring our technology to the market. We are well aware of the large number of patients that don’t have access to Proton treatment. To give you an example: every day, in the UK, 12 children are diagnosed with cancer! We need to move fast to help bring our technology to market and I hope that by joining Advanced Oncotherapy, I will be able to contribute to a better treatment, better outcomes, and a better future for all. 

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