Electronic Health Reporter

By Yves Archambault, strategic initiative director, Varian.

It’s hard to imagine what it can be like to go through cancer treatment, even when being treated with the latest adaptive therapy technology. You walk into the clinic, lay perfectly still inside a long, narrow tunnel-like machine…for about 45 minutes or so, as your clinician uses an MR-linac system to visualize and treat the target area. Uncomfortable? Yes. Slow and resource-intensive? Definitely. Expensive? Certainly. This is adaptive therapy today.

Despite its barriers to entry, adaptive therapy is often dubbed as the “holy grail” of radiation therapy as long-term clinical adaptive therapy follow-up has shown significant improvement in terms of tumor control and low toxicity profile cancers below the respiratory system including prostate cancer. Additionally adaptive therapy has proven to offer dosimetric benefits, especially with head and neck cancers and cancers below the respiratory system.

Not all Cancer Cells Are Created Equal

Adaptive therapy is a type of radiation cancer treatment that evolves over time in response to the temporal and spatial variability of tumor microenvironment and cellular phenotype. It accounts for macro fluctuations in the tumor’s shape and position due to changes in nearby organs. Adaptive therapy also considers physiological changes, like bladder fluctuations. With adaptive therapy, a clinician regularly adapts his or her treatment approach based on how the patient responds or changes throughout the treatment process, adjusting it to better target the cancer. It takes daily variabilities into account. Unlike adaptive therapy, standard treatment follows a strictly detailed, rigid plan that is set in place at the beginning and tracks a pre-defined schedule, not accounting for unpredictable anatomy changes.                            

Adaptive therapy creates a personalized treatment strategy guided by the individual patient’s experience. Updated details about the patient’s internal anatomy and treatment response are constantly being evaluated and are used to adjust the course of treatment. In adaptive therapy’s current state, the slow process, significant capital equipment, hours of training, and need for extensive involvement from a highly skilled clinician makes it unattainable for many.

Limitations Should Not be Ever-Limiting

The reality is, as healthcare advances, we must adapt. Whether it’s the way clinicians interact with patients, how we’re tracking prescriptions, or new innovations that incorporate automation, industry is challenged to evolve and grow alongside such advances.

This begs the questions, “What does the future of adaptive therapy look like? Is there reason to hope it will evolve and dismiss its current patient and doctor limitations?” 

In cancer care, the future is now. It is time to remove these barriers and redefine adaptive therapy, so the experience becomes more accessible, comfortable, and executed with more efficacy for both patients and clinicians. An intelligent, accessible adaptive therapy approach has the potential to improve patient outcomes that can result in a longer disease-free life expectancy for patients. Additionally, it may help open the door for more opportunities, research and advancements in cancer treatment.

We would be remiss not to acknowledge the fact that it will take time to overcome these limitations, drive clinical adoption and see results. This present reality, however, should not keep us from building its future today. 

Nobody Said Change Was Easy 

As with any change or clinical evolution, there are roadblocks to adoption. Clinics may choose to remain conservative when it comes to new treatment methods and hold out until additional statistically-significant data surface. Additionally, the time, resources and training needed to implement new, or unknown, technologies can hinder initial adoption. 

Policies around payment and reimbursement will also likely be an obstacle for the clinical community. There are protocols, processes, and standards that clinics must follow when implementing treatment adjustments and changes. The frequent changes made during adaptive therapy require authorization from a radiation oncologist, which can be time-consuming, tedious, and costly. But every patient is unique, and it has been proven that one size does not fit all when it comes to cancer treatments.

The Adaptive Complexity of Cancer Requires Intelligent Advancement

We expect the challenges to be worthwhile, as the future of adaptive therapy has the potential to offer patients a better experience overall—faster, more comfortable, and more accessible treatment. Additionally, faster treatment will open the door to hopefully allow clinicians to treat more patients each day. The AI and automation that the future of adaptive therapy will incorporate may also empower clinicians to do more in less time. Finally, as the future of adaptive therapy may be more affordable, clinicians across the globe would be able to leverage the technology in order to deliver better patient experiences. 

It’s a continuous process and we’re hopeful of advancements as we continue to build and improve on what was done before. It is amazing to see how far adaptive therapy has come in even the last two years. The future of adaptive therapy will offer a personalized, long-term treatment strategy that can offer better experiences to clinics large and small, and most importantly, to patients of every kind.