P-Cure currently has one clinical trial center operational in Israel. While ProTom did not exhibit at ASTRO I discussed their progress in Adelaide, Australia, with them during a meeting. The Bragg Center is continuing the works now. Varian also has ongoing developments in Norway, the U.S., Japan, and Indonesia.

In total, the rate of new facility development has slowed down, partly due to the impact of the COVID-19 pandemic, which caused a drop of up to 30% in patient numbers at existing centers. This discrepancy with cancer incidence rates raised concerns among investors. The complex landscape of reimbursement schemes further hindered financing even for centers with promising business plans.

The capital cost of proton therapy emerges as the most frequently cited hurdle to patient access. Encouragingly, significant strides have been made to reduce system size and enhance clinical treatment quality. For instance, the Mevion S250i proton therapy system is notably more compact than the IBA ProteusOne. The Mevion FIT system, co-developed with Leo Cancer Care, represents a leap toward cost reduction and aims to fit within a linac vault, potentially serving as a linac replacement.

Leo Cancer Care has been the driver behind the Mevion FIT system. They have developed the upright treatment system “Marie” and tirelessly explain the clinical benefits of reduced organ motion, the added patient experience benefit, and the economic advantages versus a legacy gantry system. Leo Cancer Care has also has announced strategic collaborations with THERYQ for Very High Energy Electron radiation therapy for FLASH, and with Aviko Radiopharmaceuticals and Neutron Therapeutics for Boron Neutron Capture Therapy.

While Leo Cancer Care has the FDA 510(k) clearance pending on the upright treatment system, the complete and integrated Mevion FIT system is not yet available for clinical use.

After several years of development, P-Cure has introduced an upright proton therapy Adaptive Proton Therapy Solution, designed to fit into linac vaults. This October marked the first ASTRO appearance since P-Cure received FDA approval for its system. Notably, P-Cure estimates a cost roughly half that of legacy gantry systems, coupled with reduced maintenance expenses. P-Cure currently markets its system in Israel and the U.S., with plans to expand into other regions.

Mevion FIT remains somewhat smaller than P-Cure's Adaptive Proton Therapy Solution. Both systems are engineered to fit within existing linac vaults, albeit requiring some additional floor space for auxiliary systems. Each installation necessitates a feasibility assessment to determine necessary changes to shielding walls, mechanical, and electrical systems.

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