A small Minden company has found its niche in the ever-advancing battle against cancer, and for the company's president, Jeff Bordok, the battle is personal.
"I lost my father to cancer. My wife lost her father to cancer. It touches everyone, and to be able to provide a better treatment alternative is very rewarding," he said. "When I get around doctors, patients and survivors, I see how important it is to make this happen."
The 63-year-old Gardnerville resident, president and CEO of Advanced Particle Therapy, just returned from San Diego where his company is breaking ground on the 102,000-square-foot, $185 million Scripps Proton Therapy Center, expected to open in the spring of 2013.
To be built through a partnership among Scripps Health, Scripps Clinic Medical Group and Advanced Particle Therapy, the cancer center will be only the second hospital-based proton therapy center in the West and will have the capacity to treat about 2,400 cancer patients annually.
"This is our first big center," Bordok said. "Our clients are major academic institutions and health care providers. We provide a fully integrated solution for proton therapy and deliver the completed project to a clinical partner. We design it, fund it, build it and equip it, then the clinical partner takes it over."
Bordok said proton therapy centers are not only expensive to build, but require a significant amount of planning.
"There are seven proton centers in the country, and the average time it takes, from when the process starts to when the first patient is treated, is about eight years."
In the case of the Scripps center, Advanced Particle Therapy raised about $60 million from investors, about $40 million from private investors and $20 million from large companies. The remaining $125 million came from borrowing. The small company itself has about a 15 percent share in the project.
"It's easier to finance when you have skin in the game and money to risk. On the debt side, you get better terms," Bordok said. "Our investors get the lion's share of the net revenue. The returns are very high. Reimbursement rates for proton therapy are high from Medicare and private insurers, and there's also people who come from all around the world with cash."
Bordok said reimbursement rates are high because proton therapy, while expensive, is effective.
"It delivers all the energy to the actual site of the tumor, not before or after, so that surrounding tissues aren't damaged," he said. "They (reimbursers) know what the cost is to build one, but they also know what the results are."
A 15-year Carson Valley resident, Bordok doesn't come from a medical background, though he has plenty of medical expertise on his team. Rather, he spent 12 years in law enforcement as a sergeant in the Palm Springs Police Department and later as an agent in the Drug Enforcement Agency in Los Angeles. When an injury sustained in the line of duty halted his career path, Bordok, already armed with a master's in business administration, became a stock broker. In 1995, a business opportunity led him to Carson Valley, where he and wife Barbara decided to stay. Another opportunity in 2001, this time in the proton therapy market, led him to form Advanced Particle Therapy, LLC, in an office in Minden.
Working with construction partners, medical equipment manufacturers, doctor advisory boards and investor parties, the company has found its niche in an extremely specialized market.
"It's difficult figuring out how to put $200 million into a center," Bordok said.
He said despite the economy, his company is expanding, adding employees, and switching from a "one-in-a-row" model to simultaneous projects. Yet even though he has several irons in the fire at this point, including a prospect in Nevada, Bordok still approaches the Scripps center in San Diego as his crowning achievement.
"It was kind of a 'Field of Dreams' moment: 'Build it and they will come,'" he said.
Knowing there were two interested clinical partners in the region, Advanced Particle Therapy went out on a limb: they bought the land for the center and started the design process independently. Fortunately, Scripps soon signed on.
"Returns are good for investors," he said. "Unfortunately, there are too many cancer patients. Every one of the seven proton therapy centers in the U.S. has a 7-9-week waiting period."
Bordok hopes the cost of proton therapy will come down in the future as more centers are built and construction becomes more efficient.
"At capacity, the Scripps center can only take about 10 percent of the patients in that market," he said. "We're running 16 hours a day, 6 days a week, but there is only so much beam time."
Nonetheless, Bordok believes every minute of machine time is worth it. Whereas conventional X-ray radiation requires 45 or more treatments and poses several secondary risks, proton therapy requires about 30 treatments, each lasting about 20 minutes, after which the patient is free to leave.
Bordok explained how it works. A 90-ton, 30-foot-wide steel cyclotron, manufactured in Germany, accelerates injected hydrogen gas particles at 60 percent the speed of light, stripping off the negative charge of the atoms, and leaving positively charged particles ready for the "beam line."
"The speed is controlled by a series of magnets," Bordok explained. "There is a lot of treatment and planning beforehand, so that doctors know exactly where the tumor is."
A pencil-beam scan allows doctors to "paint" the tumor with ionizing energy, layer by layer.
"What's so important is that it delivers all the energy just to the tumor," Bordok said. "Protons can be used for radio-resistant tumors: when the tumors have been treated with X-rays but keep growing back. Protons are also very effective in certain areas, in the head, neck and brain, and especially in pediatrics. With a child, conventional radiation carries the risk of collateral damage to the growing tissues."
At the same time, Bordok said, each diagnosis is different, and proton therapy shouldn't replace other treatments that may work, including radiation, chemotherapy or surgery.
"It works in conjunction with these other treatments," he said. "We call it the 'halo effect.' A proton center brings all these other things with it. Scripps is actually building a conventional radiation oncology center as well. Proton therapy doesn't necessarily replace these treatments, but augments them, and vice versa."
The Scripps center will have five treatment rooms, two with "fixed-beam" machines, and three with 150-ton steel rotational gantries, which enable doctors to deliver the beam from any angle.
"It's quite a process," Bordok said. "It's this huge thing, yet so precise."