Jeff Bordock, president and CEO of Advanced Particle Therapy, uses his 10 years of proton therapy experience to help centers get off the ground and stay financially sustainable. He spoke with DOTmed Business News about business strategies and why he thinks proton therapy is worth the cost.
DMBN: How did you get into the proton therapy world?
JB: My partner and I have been involved for about 10 years with proton therapy, just kind of by default. It was an interesting field, and we started taking a good hard look at it, and over time, we were able to identify a business plan tied to a solution of providing a fully integrated center to a clinical partner, either a major health care system, or a medical academic institution. That’s where we started, and we’ve stayed with it.

DMBN: Tell me more about your work at Advanced Particle Therapy.
JB: We provide a turnkey center to a clinical partner. We arrange for all of the debt and equity financing, and we engage the clinical partner through a long-term agreement to operate the center and to integrate it into their overall health care services, and more specifically their cancer center. We work with them to select the proton therapy equipment, to design the building for efficiency and inpatient throughput, we build it, and then we turn it over to the clinical partner to operate, and we jointly manage it with them. So right now we have four centers in various stages of development. As I mentioned earlier, all of our clinical partners are major players in their specific regions. Our center in San Diego is with Scripps Health Care. That center started seeing patients in July. We’ll start treating with protons in the first part of October. We also have one with the University of Maryland in Baltimore. That center is about 90 percent complete as far as the building, and we’re waiting for the equipment to come in and start being installed in January. We’re under construction with a center in Atlanta that will be operated by Emory Healthcare. We’re looking to break ground in October with a center with the University of Texas Southwestern Medical Center in Dallas. Each takes about three years to build.

DMBN: I know the financial side of opening a proton center can be challenging. How do you help centers through that process?
JB: Our centers are investor owned. So we have private investors for equity, some private investors for debt and we bring on some institutional debt. It’s a function of having a very comprehensive and realistic business plan, having an interactive financial model that will support that plan and allow real time adjustments to it, and then I think the other thing that’s important is selecting the appropriate clinical partner to operate the center and put their name on the building. When we first started the Scripps project, we had never built one, our contractor had never built one, Varian hadn’t delivered that equipment into the U.S., so the investors had lots of questions about whether we could really get the job done. It’s beautiful, fantastic, it’s a great center, and it turned out just the way we wanted it to. Now Maryland is ahead of schedule, and Georgia is ahead of schedule, because we learned a lot. The thing that’s comforting for the investors is about who’s going to operate it, how long have they been around. You look at the University of Maryland, it’s the oldest public medical school in the country, and the radiation oncology department in terms of grants is rated number one in the country. So partners like that, and Emory, Scripps, University of Texas, all of them, they’re not positioned to fail. And protons aren’t going to replace other types of photons, and other types of cancer treatments. It’s another tool that we feel is very useful, and that’s how our partners look at it too.

DMBN: What makes you personally believe in proton therapy?
JB: Having lived in southern California for quite some time, and being close to the Loma Linda center, I’ve seen the results in real life, if you will. I’m not a scientist, I’m not a doctor, but the physics is pretty simple once you look at it. If you’re able to deliver energy to the tumor, and kill the cancer cells, but spare the surrounding tissue, that’s a good thing. You can control the dose to the tumor, and it effectively kills the cancer cells, but it spares the surrounding organs and tissues that are healthy. And that’s where I see this being so important, for things like pediatric patients, brain tumors, breast tumors, lung tumors, things like that.

DMBN: Do you feel like people still have a lot of misconceptions or negative views towards proton therapy, especially in terms of prostate cancer treatment?
JB: Yes. It’s all about prostate cancer. I haven’t seen anybody question the efficacy of proton for pediatric patients, because it just works so well. I think it’s about prostate, because quite frankly, photons work quite well for prostate cancer, and we admit that. And they have for years. So as for the comparison between photons and protons for prostate caner, you can argue the plusses and minuses there. But now with the latest type of delivery for protons, which is pencil beam scanning and intensity modulated proton therapy, where you can focus the proton much more accurately and deliver the dose by managing the intensity — that’s something that hasn’t even been around with protons for a while. That’s going to be a game changer even in the prostate argument. All of the new centers, the ones we’re doing, the ones that the Mayo Clinic is doing, all of those centers are going to have pencil beam and IMPT [intensity-modulated proton therapy]. That’s a big difference.

Another issue is that there aren’t a lot of clinical trials comparing and proving the difference. The reason has been twofold. Number one, if I’m a 65-year-old man and I’ve done my homework, and I truly believe that protons is what I want, I don’t want to go into a randomized trial when I go to a proton center. The second thing is that there are only a handful of proton centers around. There’s not a lot of available beam time. And so if you’re treating patients with protons you don’t have the chance to do all these trials. But with more centers, we’re going to be able to do clinical trials across the board, with all types of cancers. We’re actively supporting a research group of all these centers that are working to do that. More protons, means more beam time, and will probably mean more information that patients as well as their doctors can have to make the right decision.

DMBN: What are your thoughts on the ProCure center that ran into financial trouble? How can centers avoid that kind of problem? [When one of the ProCure Treatment Centers Inc. locations missed a $3.6 million interest payment, partner Cadence Health bought out the company.]
JB: I think they’re coming from a different place, and we’re coming from a different place. It’s unfortunate what happened. You know, it’s nice to have a proton center, but you have to have the right personnel in the proton center to run it. You also need patients to make it financially sustainable, so if you build a center with a regional hospital or a physician’s group as your core, you don’t have 500,000 lives under management that you can evaluate to send the right people to protons. With the major medical academic institutions comes a different level of expertise I believe, and also a much more robust patient base. If you have a group of treating radiation oncologists who are investors and operators of a center, they’re not referring patients there, they’re treating patients that are being referred there, and if you don’t have the referrals that’s difficult.

DMBN: What are your predictions for the future of proton therapy?
JB: Our four clinical partners that we have meet now at least twice a year. We all meet together — the physicians, the physicists and the administrative people — for a couple days twice a year. And the exchange of information is not only for medicine and for treatment, but also for center management and things of that nature. That sharing of information is something that we’re hoping to see all of the centers start doing, and see a big growth in how to more effectively use protons.