"Radiotherapy still has a role to play"
Interview with Accuray

Californian company Accuray develops high‑precision radiation therapy equipment. On a recent trip to Switzerland, CEO Suzanne Winter answered questions from Swissquote Magazine.

By Bertrand Beauté

For the layman, there is something fascinating about Accuray’s CyberKnife System. Like diving into the future or a science fiction book. Yet, the device is very real. More than 350 units of this robotic arm have been installed worldwide, delivering high‑energy X‑rays to destroy cancerous tumours with extreme precision. Five of those are in Switzerland: Lausanne University Hospital (CHUV), Geneva University Hospitals (HUG), Clinique de Genolier, Inselspital in Bern and Klinik Hirslanden in Zurich.

Developed by the American company Accuray, CyberKnife can be used to treat tumours located in critical areas like the brain, or in organs that move during radiation, such as the lungs, liver and prostate. Featuring an imaging guidance system and artificial intelligence‑driven Synchrony technology, the device continuously locates the position of the tumour and tracks it in real time. Between two radiation deliveries, the robot arm moves around the patient to find the best angles to reach the cancer cells. "When tumours are treated with radiation therapy, the goal is to destroy the malignant cells while sparing as much of the surrounding healthy cells as possible. This is a particularly sensitive point when dealing with critical organs such as the brain," says Professor Oscar Matzinger, head of Radiation Oncology Services at Clinique de Genolier. "CyberKnife significantly improves precision, which means fewer side effects."

Is that enough to guarantee Accuray’s success? Suzanne Winter, the American firm’s CEO, firmly believes it is. The financial markets are much less certain. Introduced on the stock market in 2007 at $20 per share, Accuray’s shares have lost almost all their value and are now trading at around $1.5. On a trip to Switzerland in April for the opening of Accuray’s training centre at the Genolier Innovation Hub, Suzanne Winter passionately defended her company. She met with us for an interview.

Why did you choose to set up your training centre in the canton of Vaud, and what will it be used for?

In radiation therapy, training medical staff is crucial. Workers need to fully understand the radiotherapy equipment they use, so that they can provide patients with the best possible care. Until now, Accuray has had three training hubs around the world, in China, Japan and the United States. So we needed an equivalent facility for Europe, and we decided to set it up here in Genolier. Our projections predict that around 500 specialists from all over Europe will be trained here every year. As for the canton of Vaud, our relationship with the region goes back a long way. We set up our international headquarters in Morges in 2011 (ed. note: Accuray Incorporated is still in Sunnyvale, California). This is where we manage our business for the entire EIMEA (Europe, India, Middle East and Africa) region, which generates nearly 35% of our revenue. So it was logical for our European training centre to be located near Morges.

Accuray develops and sells radiation therapy systems for cancer treatment. How are they different from the products of your competitors?

We sell two radiotherapy systems, Radixact and CyberKnife. Radixact is an all‑in‑one system that combines CT imaging and helical delivery. This means that continuous 360‑degree radiation is delivered to patients with extreme precision, and the doctor can use the imaging to adjust treatment in real time. Radixact is recommended for targeting and treating larger tumours anywhere in the body. CyberKnife is a fantastic and unique piece of equipment. Using its robotic arm, it accurately tracks tumours that can move and targets them with extreme precision in critical areas such as the lung or prostate.

With both Radixact and CyberKnife, radiation exposure of healthy tissue is considerably reduced, and so are the side‑effects associated with radiotherapy. As a result, higher doses can be delivered with each session, reducing the overall number of sessions. With these machines, a tumour can be treated in five sessions, compared with 30 to 40 with a conventional machine. More than 1,000 of our machines are installed worldwide. Device sales generate 55% of our revenue, while 45% comes from associated services (training, maintenance, etc).

"AI becomes a decision‑making tool for doctors, so that they can adapt the treatment if necessary"

How do you use artificial intelligence (AI)?

Our systems integrate AI to optimise the precision of radiotherapy, by synchronising and adapting treatments to tumour and patient movement in real time. For example, when a tumour is located on a lung, the patient breathes normally during radiotherapy. AI can be used to predict tumour motion caused by breathing, so that the X‑ray beam is always directed at the cancer cells and spares healthy tissue. In addition, between two radiotherapy sessions, some tumours will change shape or size. AI recognises these changes and becomes a decision‑making tool for doctors, so that they can adapt the treatment if necessary.

Despite revenue growth (4.1% for the 2023 financial year ended 30 June 2023), Accuray is still making a loss and had to shed 6% of its workforce in October 2023. What is your response to analysts and investors who are sceptical about Accuray?

We are confident in our business model. The WHO forecasts 35 million new cancer cases in 2050, a 77% increase from the current period. And 60% of these patients are likely to be treated with radiation therapy. Demand for our products is expected to be high in the future, especially as many governments are introducing anti‑cancer plans to beat the disease.

It’s true that we had to lay off part of our workforce last year, and we will do everything we can to avoid that. But this should enable us to be more efficient and to achieve profitability as early as our 2025 financial year (ed. note: the 2024 financial year will end on 30 June 2025). Our order book has never been as strong as it is now. So I’m very confident that we’re going to create value for our shareholders over the next few years. We’re in a good position in terms of fundamentals, and I think the markets will eventually notice that.

Radiotherapy machines are very expensive. How do you convince hospitals to trust a small company like Accuray, rather than going to a giant like Siemens?

Convincing the medical community to use our equipment has been a challenge in the past. But today, Accuray is recognised because our machines give doctors capabilities that competitors’ devices do not.

Might you be bought out by one of your major competitors?

If we were to receive such an offer, we would consider it. But for the time being, we plan to continue developing on our own.

The fight against cancer is in the midst of a revolution, with innovative treatments emerging such as immunotherapy and messenger RNA vaccines. Could these new treatments eventually replace radiotherapy?

No, I don’t think so. Radiotherapy still has a role to play. Around 60% of cancer patients receive X‑ray treatment. Chemotherapy and new drugs then round out radiation therapy. They don’t replace radiation surgery – they complement it; they improve it. Plus, people are living longer with cancer, which opens up new opportunities for precision radiotherapy to treat recurrence. I truly believe in the future of this technology.

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