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| Xoft's miniaturized Axxent HDR X-ray source--Courtesy of Xoft |
As med tech companies set their sights on innovative devices to treat cancer, new, miniaturized products for nonmelanoma skin cancer are gaining ground as a viable alternative to surgery.
Devices used in surface electronic brachytherapy, or eBx, are catching on among patients who either can't or don't want to have surgery for nonmelanoma skin cancers, The Wall Street Journal reports. EBx procedures have jumped 20-fold in recent years to 24,000 in 2013, and devicemakers market products to "busy people" who "aren't interested in surgery," and to dermatology practices as a moneymaking device, according to a JAMA Dermatology article published last month.
More than 3.6 million Americans are diagnosed with basal or squamous cell cancers each year--more than all other cancers combined--and standard treatments range from topical creams to burning, freezing, radiation and Mohs surgery, a procedure that removes layers of tumor-containing skin until the cancer disappears.
But unlike more invasive procedures, eBx treatment includes a miniaturized X-ray source in a small, transportable mobile unit. Radiation is delivered directly to the site of the tumor by a mechanical arm and therapists can stay by the patient's side during the procedure.
Companies such as Xoft and Elekta are cashing in on the market, rolling out devices that offer alternatives to traditional surgery. Xoft, which leads the market with its Axxent eBx device, figures that about one in three patients with nonmelanoma skin cancers are potential candidates for the new treatment, including those individuals with cancer in prominent locations like the eyes, ears and nose. The company has sold about 100 units since 2011, mostly to dermatology practices, Ken Ferry, CEO of Xoft's parent company iCAD told the Wall Street Journal.
"We have a great, nonsurgical, painless alternative to what can be a very time-consuming and painful procedure, and we are getting very effective clinicial outcomes," Ferry said.
Sweden-based Elekta also has a competing device called the Esteya, but the company has installed fewer than 25 systems to date in the U.S., Jay Hoey, CEO of Elekta Holdings, North America, told the newspaper.
Even though the systems are taking off among patients and clinicians, some industry and medical leaders remain skeptical about their overall efficacy. Data for eBx systems is limited as the median follow-ups in current eBx studies are just a few months and most skin cancer recurrences and severe side effects can take four or more years to appear, the WSJ story notes. The American Academy of Dermatology recommends surgery as the best treatment for nonmelanoma skin cancer, saying more long-term data is needed to demonstrate the safety and effectiveness of the device.
And reimbursement for the devices is still an issue, as not all states cover eBx through Medicare and private insurance coverage varies. EBx treatment has a temporary billing code used for breast and brain radiation, and Medicare typically pays $770 to $1,600 per treatment. When all is said and done, eBx therapy hands practices as much as $24,000 per patient.
"We think radiation has a valuable role in the treatment of selected skin cancers," David Beyer, president-elect of ASTRO, the professional organization for radiation oncologists, told the WSJ. "But you as a consumer should get the treatment that's best for you, not best for your doctor."
- read the WSJ story (sub. req.)
- here's the JAMA Dermatology editorial