Boron Neutron Capture Therapy (BNCT) is a targeted radiotherapy that releases energy by reacting a boron-10 containing drug with a thermal neutron beam. Currently, there are more than 1,000 clinical experiences in the world, and the safety and efficacy are quite stable. In Taiwan, Taipei Veterans General Hospital, National Tsing Hua University and Sintong Biotech have cooperated in the clinical research of head and neck cancer and brain tumor to verify the efficacy and actively develop other indications. In addition, in order to assist patients with clinically critical conditions and no suitable treatment, the BNCT team also applied for emergency medical needs and treatments through this project to provide patients with another therapy option.
The rationale of BNCT
BNCT consists of two parts: one is a boron-10 containing drug and the other is a neutron beam source. The principle is that boron-10 containing drugs actively and selectively accumulate in tumor cells after intravenous injection, while normal cells contain low concentrations of boron-10. After irradiation with thermal neutron beams of appropriate energy, nuclear reactions occur between intracellular boron-10 and neutrons to produce high-energy alpha particles and lithium nucleus, which can specifically destroy tumor cells. Since the less boron is absorbed in the normal cells, the normal cells are less injured. Therefore, BNCT has significant benefits over traditional radiotherapy or radiotherapy plus chemotherapy：
- Good tumor response rate (radiotherapy and chemotherapy have limited effect on patients with recurrent brain tumors)
- It can be executed multiple times within the condition range (usually only 1-2 times)
- Mild adverse reactions (Good quality of life): mostly mild to moderate, the highest proportion is hair loss, brain pressure rise, etc.
Figure 1. Schematic diagram of boron neutron capture therapy: The tumor cells specifically absorb boron-containing drugs, and nuclear reactions occur after neutron irradiation, thereby eliminating tumor cells. The normal cells that do not absorb boron are less affected.(Lee, Chuang et al. 2017)
Clinical research data of BNCT
Clinical studies have pointed out that boron neutron capture therapy has been used in many fields such as: Glioblastoma, Malignant Meningioma, Spinal Glioma, Recurrent Head and Neck Cancer, Melanoma, Breast Cancer, Liver Metastasis, Children Brain Tumor, etc. Among them, brain tumors and head and neck cancers are the most described.
Taking the clinical data of BNCT for the treatment of recurrent head and neck cancer in 2016 by TVGH as an example: the response rate of the 17 subjects was as high as 70%, the adverse reactions were mild, and the condition and quality of life of most subjects improved. Even more exciting, six subjects were clinically judged to have complete responses after treatment of BNCT.
Taiwan Boron Neutron Capture Therapy Team
Taipei Veterans General Hospital (TVGH)：
- TVGH belongs to the National Medical Center in Taiwan and it has three tasks including patient medical service, medical personnel training and medical research and development. TVGH accommodates with the national medical policy to fulfill the government's responsibility to take care of people's health
- Department of Oncology, Department of Nuclear Medicine, Department of Neurosurgery and related nursing staff, responsible for tumor diagnosis, radiation dose calculation and patient care
National Tsing Hua University (NTHU)：
- Professor Fong-In Chou's team researches in BNCT for many years, assisting in measuring the concentration of boron in the blood on the day of treatment
- Tsing-Hua Open-pool Reactor (THOR) meets world class and provides good quality and stable neutron beam
- Nuclear Science & Technology Development Center (NSTDC) has a clean and simple treatment preparation room, equipped with monitoring system and communication equipment, to keep abreast of the patient's condition, and supplemented with light music, so that patients can receive treatment comfortably.
- Since the founding of TBC has been over 70 years, the product quality is excellent, and it is the oldest local biotechnology industry. It has passed PIC/S GMP certification in 2010, and its pharmaceutical manufacturing has reached international standards.
- Cooperated with TVGH and NTHU in BNCT clinical research since 2010, responsible for the development and preparation of boron-containing drug L-BPA-Fructose.