2024-07-23 06:01:07
Avoiding mutilating surgeries in rectal and skin cancer, or dozens of radiotherapy sessions in breast cancer, the promise is enticing. This is the global interest surrounding Clerad, a French SME specializing in oncology probes, since the publication in September 2023 in “The Lancet” of a trial proving the effectiveness of its Papillon + machine.
This machine uses the technique of “contact radiotherapy,” which irradiates at low energy very close to the tumor. 81% of trial participants, who had early-stage rectal cancer, avoided surgery and their tumor disappeared.
These are spectacular results. The Gustave Roussy Institute (IGR) purchased a machine and treated its first patients on June 25: it has just launched a trial on more advanced rectal cancers. It’s a prestigious showcase, and Clerad is reaping expressions of interest.
Papillon Effect
Its machine is the only one for rectal cancer and the first versatile machine, competing with existing ones for contact radiotherapy for skin (eyelid, lip, tip of the nose, etc.) and favorable prognosis breast tumors, where irradiation during surgery replaces the conventional 15, 25, or 33 sessions of radiotherapy.
The Papillon effect has begun. In June, two machines were sold in Sweden, and three major American centers, including a world reference, Memorial Sloan-Kettering (New York), have expressed interest, along with various centers in Europe and 3 in France, where there are still only 5 Papillon + machines.
Cardiac Toxicity
Contact radiotherapy is not new but remains rare. “Of the 8,000 cases per year in France of medium-low rectal cancer, 20%, or 1,600, have small tumors similar to those in the published trial. But in 2023, only 80 were able to benefit from this technique,” laments radiotherapist Jean-Pierre Gérard, the father of the trial and the first version of Papillon released in 2009, prior to the current version in 2022.
For rectal cancer, only the Lacassagne Center in Nice, where he was the director (he is now a medical advisor to Clerad), and the private radiotherapy centers Orlam in Mâcon and Villeurbanne are using it. All three are joining the new trial launched by IGR at 12 centers on more advanced tumors, measuring 3.5 to 6 centimeters. “With the IGR trial, 50% of patients can hope to preserve the rectum, which translates to about 4,000 per year,” estimates Jean-Pierre Gérard.
But to get the practice off the ground, the social security must raise its tariff. For the private sector, it is a flat rate of 87 euros for the 3 sessions necessary for rectal cancer. “I am working at a loss. Papillon + costs 600,000 euros; the procedure needs to be revalued so that centers can equip themselves,” warns radiotherapist Nicolas Barbet from Orlam.
In breast cancer as well, contact radiotherapy remains rare in France, while it has been developing elsewhere since the German company Zeiss released a machine in 2000, which competes with Papillon +. In 2022, in 35 countries, 45,000 women had already benefited from it, “avoiding about 2,000 deaths not directly linked to breast cancer,” estimates researcher Jayant S. Vaidya from University College London (UCL).
Contact radiotherapy indeed improves overall survival at 12 years compared to conventional radiotherapy, which exposes healthy tissues to cardiac toxicity when the left breast is treated.
No Tariff
Due to not being recommended by the High Authority of Health outside clinical trials, for breast cancer, “contact radiotherapy is not funded by social security, unlike in most European countries,” exclaims Emmanuel Barranger, director of the Lacassagne Center, one of the few practicing it.
Yet, conventional radiotherapy is expensive for social security. Not so much in the private sector (it’s a flat rate of 4,500 euros) as in the public sector, which enjoys a session-based rate, paid at 754 euros, which can add up to 25,000 euros for 33 sessions. This does not encourage innovation, the Court of Auditors pointed out in 2022.
Conventional radiotherapy also incurs high costs for the healthcare system due to patient transport. This was highlighted by Dr. Christophe Scherer from the breast clinic (Elsan) in Clermont-Ferrand, who sought from his local health insurance fund to receive the radiotherapy flat rate regardless of the actual procedure. Thus, “10% to 15% of the thousand women per year that we operate, who are of good prognosis, receive contact radiotherapy. But we are the only private institution practicing it,” he explains, calling for the technique to be valued so that it can proliferate. “The issue is therapeutic de-escalation and the preservation of patients’ quality of life,” emphasizes Emmanuel Barranger. There is hope that the ongoing renegotiation of radiotherapy tariffs will correct the situation. Clerad is ready.
Revolutionizing Cancer Treatment: The Future of Contact Radiotherapy
Recent advancements in oncology present promising alternatives to conventional cancer treatments. A notable development is the Papillon + machine from Clerad, which employs contact radiotherapy to target tumors with precision. This innovative approach focuses on minimizing the adverse effects associated with traditional treatments, such as extensive surgeries and multiple radiation sessions.
The Rise of Contact Radiotherapy
As demonstrated in a groundbreaking The Lancet trial, 81% of participants with early-stage rectal cancer avoided radical surgery, showcasing the potential of contact radiotherapy. Unlike conventional methods that often expose healthy tissue to harmful radiation, the Papillon + machine operates at low energy, delivering targeted treatment directly to the tumor site.
Global Adoption and Interest
The international response to Clerad’s technology has been overwhelming, with significant interest from prestigious medical institutions worldwide, including the renowned Memorial Sloan-Kettering Cancer Center in New York. As more centers recognize the benefits of contact radiotherapy, the appliance is expected to gain traction beyond France, with installations in Sweden and various centers across Europe.
Economic Implications and Accessibility
Despite its advantages, the adoption of contact radiotherapy faces economic hurdles. Currently, its financing is limited by the lack of support from social security systems, particularly in France. Advocacy for increased reimbursement rates is crucial to facilitate broader access and encourage more healthcare providers to invest in this technology. With treatment costs significantly lower than those associated with conventional radiotherapy practices, there appears to be a strong case for healthcare reform in this area.
The Role of Survival Rates and Quality of Life
Research indicates that contact radiotherapy not only enhances survival rates for breast cancer patients by reducing unnecessary exposure to surrounding tissues but also helps maintain a better quality of life post-treatment. Emphasis on patient-centric care and the minimization of treatment disruptions will likely guide future trends in cancer therapy, including personalized approaches that prioritize fewer interventions with equally effective outcomes.
Looking Forward
As the healthcare landscape evolves, the ongoing negotiation for better reimbursement policies may lead to the widespread adoption of technologies like the Papillon + machine. The integration of innovative treatment modalities alongside traditional practices could redefine oncology, enhancing patient outcomes while aligning financial incentives within the healthcare system.