For decades, Stanford Health Care had been trying to install a state-of-the-art proton therapy machine to add to its range of high-tech cancer treatments. But try as he might, he just couldn’t find a place to put one.
Proton therapy machines, which deliver targeted radiation to cancerous tumors, are massive gadgets. They typically need a facility the size of a three-story football field to accommodate them, and construction costs are equally gargantuan: between $50 million and $100 million. Even for a prestigious institution like Stanford, the obstacles to installation were daunting, particularly given Palo Alto’s expensive real estate and lack of space for such construction.
“The closest we got was several years ago when we worked out an agreement with the Palo Alto VA hospital that is near us,” Stanford radiation oncology professor Dr. Billy Loo said. a Forbes. “Approvals went all the way to the top of the VA administration in Washington, but as the project progressed month by month, the cost estimates increased. It became totally unfeasible.”
Three years ago, Stanford found an alternative: Startup Leo Cancer Care had developed a variation on the design of the standard proton therapy machine. Instead of rotating the radiation beam around a patient who was placed in a bed, he designed a chair in which a seated patient rotated around the beam. That seemingly simple change had transformative consequences. It helped trim the space requirement to approximately 1,700 square feet from more than 29,000 square feet, a reduction of more than 90%. That made it significantly less expensive and easier to fit where they wanted it, even with the extensive radiation protection proton therapy machines required.
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Stanford teamed up with Leo Cancer Care, which makes the chair and imaging technology, with Mevion Medical Systems, which had developed a small proton accelerator, and in 2024 they began building the new facility. Dr. Loo hopes its use will help Stanford doctors treat cancers more effectively with fewer risks. “The concept is very simple, but the implementation is quite sophisticated,” Loo said. “It has a big impact.”
It’s early days for Leo Cancer Care yet and this is a tough, capital-intensive business. But the West Sussex, United Kingdom and Middleton, Wisconsin-based company, which has raised a total of $150 million at a $280 million valuation, including a recent $40 million round led by Catalio Capital Management, is gaining steam.
“Particularly in the early days, people said, ‘This is just a swivel chair,’ and ‘Why hasn’t anyone thought of this before?’ But often the simplest ideas are the best.”
Leo Cancer Care co-founder and CEO Stephen Towe
Revenue reached $11 million last year, and is expected to double this year. Major hospitals and health systems began signing deals for Leo’s flagship product, called Marie (after Nobel laureate Marie Curie), which combines a vertical patient positioning system and a CT scanner, even before it received FDA clearance for it in July. It works in association with beam delivery systems supplied by Mevion, Sumitomo, Hitachi and others. The company now counts Mayo Clinic, BayCare in Florida and proton therapy pioneer Loma Linda University Health among its clients. And now it has an order book of $85 million, he said he co-founder and CEO Stephen Towe a Forbes.
“Everyone in the space is looking at Leo,” said PR Yu, whose solo VC firm Yu Galaxy was one of his first investors. “They are already revolutionizing the industry.” Towe expects to reach $200 million in revenue within three or four years, and said Leo is “actively pursuing an IPO,” perhaps as early as late 2026, depending on market conditions.
The number of proton therapy machines in use today is small: only 46 centers of today and little more of 100 in all world, Towe said, while the global need for them is closer to 2,000. Proton therapy provides greater guidance in cancer treatment, allowing patients to receive effective therapy with less damage to normal tissue and a lower risk of radiation, but its cost has been prohibitive.
Fixed beam systems like Leo’s cost between $17 million and $22 million, compared to $30 million or more for the traditional configuration, Towe said. But the biggest cost savings comes from construction: Leo’s chair with a smaller accelerator can fit in a large room on a single floor; They don’t need three floors to accommodate them. He estimates the average cost savings for everything is around $35 million to $40 million, and in some cases closer to $70 million. That, combined with easier installation requirements, should make them more available. “There is a massive global need for these,” Towe said. “We’re just not getting proton therapy to patients. The reason is 100% cost. It’s always made clinical sense, but it doesn’t make financial sense.”
Towe, 34, became interested in radiation oncology when his father died of bowel cancer while he was an 18-year-old undergraduate at Keele University in England. After earning his bachelor’s degree in mathematics and physics in 2012, he spent almost five years working for Swedish radiotherapy firm Elekta, including leading a team that was working on combining imaging with radiotherapy for cancer treatment. It was an exciting idea in theory. But practically it was unwieldy and slow. “What we had developed was bigger, more expensive, more complicated and could treat fewer patients per hour,” he said. “We had fallen into the trap of developing something bigger and more interesting.”
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The old way of doing things required gantries that could weigh up to 600 tons for some types of treatment. “That’s about 80 elephants worth of equipment. It’s absolute bonkers.”
Leo Cancer Care co-founder and CEO Stephen Towe
The experience left him wanting to find a different solution. For proton radiation therapy, the equipment is huge and complex. Cancer patients lie down, whether supine or prone, and enormous gantries, weighing hundreds of tons, rotate around them. A proton therapy gantry can weigh 100 to 200, while one used in another form of cancer treatment, known as carbon ion, can weigh 600 tons. “That’s about 80 elephants worth of equipment,” Towe said. “It’s absolutely bonkers.”
Researchers at the University of Sydney in Australia were working on an alternative, and in 2017 Towe moved there from the United Kingdom, despite never having set foot in the country before, to join the research effort. The company soon spun off from the University of Sydney with the help of Rock Mackie, an emeritus professor of medical physics and human oncology at the University of Wisconsin-Madison and serial entrepreneur.
Courtesy of Leo Cancer Care
“It wasn’t much at the time. It was basically a couple of patents,” said Mackie, 70, who is now Leo’s president. But he had been successful in founding other companies before, and, as he recalled, “I was quite passionate about the vertical position.” Decades ago, doctors treated patients in an upright position, but because CT scanners required them to lie down, that was reversed when that imaging technology was adopted in the 1970s and 1980s, he recalled. But Mackie felt there would be clinical and cost advantages to sitting.
By rotating a seated patient around the beam, the machine itself could be smaller, while also being more comfortable for the person being treated. Better yet, research now shows that patients who remain upright, whether sitting or standing, are easier to treat because their organs move less, allowing treatment to be even more targeted.
In 2022, McLaren Health Care, which has 12 hospitals in Michigan, plus a network of ambulatory surgery centers and imaging centers, was the first to sign with Leo Cancer Care. The health system’s efforts over the past 15 years to establish a proton therapy center had been a nightmare, as the company it worked with went bankrupt and a major supplier had to be sued, recalled Greg Lane, McLaren’s chief administrative officer. “It got to the point where the CEO and I were sitting there saying, ‘We have two options, either we throw away the money we have to finish this thing or we tell the board we’re going to write down $55 million and not finish the project,’” he said. “We both looked at each other and said, ‘Hell no, let’s finish this.’”
The center finally opened about five years ago, and, Lane said, it has become quite successful, leading them to want to expand without going through the same grueling process again. The team, who already knew Mackie, examined Leo’s technology and ultimately signed an agreement to invest in and help develop the machine. “We don’t have the power of the Stanford brand, but we signed the first contract with Leo,” Lane said. Today, construction is done, and Lane hopes to begin treating patients in December.
“Particularly in the early days, people said, ‘This is just a swivel chair,’ and ‘Why hasn’t anyone thought of this before?’ But often the simplest ideas are the best,” Towe said. “It now allows us to go and completely push the boundaries of new things we can add to this platform because we have fundamentally simplified it.”
This article was originally published in Forbes US
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