Tumor treating fields: a novel treatment modality and its use in brain tumors

Hottinger, Andreas F.; Pacheco, Patrícia; Stupp, Roger

doi:10.1093/neuonc/now182

Cited by 149 publications

(132 citation statements)

References 29 publications

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“…In addition, only 13% of patients treated with TTFields reported a medical device site reaction, and none was severe. Patients usually tolerate the Optune device well, without adverse effects on quality of life, cognitive or functional capabilities with equal cognitive, emotional, physical and social functioning scores, and superior global health status ratings to the control arm demonstrated in the EF-14 study [26,27]. These data support the continued use of TTFields plus chemotherapy after first recurrence.…”

Section: Discussionmentioning

confidence: 75%

Tumor-treating fields plus chemotherapy versus chemotherapy alone for glioblastoma at first recurrence: a post hoc analysis of the EF-14 trial

Kesari

Ram

2017

CNS Oncol.

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Background: This post hoc analysis of the EF-14 trial (NCT00916409) of tumor-treating fields (TTFields) plus temozolomide versus temozolomide alone in newly diagnosed glioblastoma compared the efficacy of TTFields plus chemotherapy (physician’s choice) versus chemotherapy alone after first recurrence. Methods: Patients on TTFields plus temozolomide continued TTFields plus second-line chemotherapy after first recurrence. Some patients on temozolomide alone crossed over after approval of TTFields for recurrent GBM. The primary efficacy outcome was overall survival (OS). Results: After disease progression, 131 patients received TTFields plus chemotherapy and 73 chemotherapy alone. Thirteen patients in the original temozolomide-alone group crossed over to receive TTFields plus chemotherapy after disease progression, resulting in 144 patients receiving TTFields plus chemotherapy and 60 chemotherapy alone. Median follow-up was 12.6 months. Bevacizumab, alone or with cytotoxic chemotherapy, was the most frequent treatment. Median OS in the TTFields plus chemotherapy group was significantly longer versus chemotherapy alone (11.8 vs 9.2 months; HR: 0.70; 95% CI, 0.48–1.00; p=0.049). TTFields showed a low toxicity safety profile, as previously reported, with no grade 3/4 device-related adverse events. Conclusion: TTFields plus chemotherapy after first disease recurrence on TTFields plus temozolomide or temozolomide alone prolonged OS in patients in the EF-14 trial.

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Section: Discussionmentioning

confidence: 75%

Tumor-treating fields plus chemotherapy versus chemotherapy alone for glioblastoma at first recurrence: a post hoc analysis of the EF-14 trial

Kesari

Ram

2017

CNS Oncol.

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“…It' s a locoregionally antimitotic treatment that delivers low-intensity, intermediate-frequency (200 kHz), alternating electric fields, through four transducer arrays, consisting of nine insulated electrodes applied to the shaved scalp and connected to a portable device (11).…”

Section: Conceptmentioning

confidence: 99%

“…Therapeutic options need to be carefully weighted, taking into account tumor size and location, previous treatments, age, Karnofsky performance score (KPS), patterns of relapse, and prognostic factors. The association of tumor-treating fields (TTFields) with TMZ represents the first major advance in the field of GBM therapy in approximately a decade and should be considered for newly diagnosed patients with no contraindications (11).As a disease with such a poor prognosis, treatment of GBM should go beyond improving survival and aim at preserving and even improving the quality of life (QoL) of both the patient and the caregiver.…”

Section: Introductionmentioning

confidence: 99%

Current Standards of Care in Glioblastoma Therapy

et al. 2017

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Glioblastoma (GBM) is the most common primary malignant brain tumor in adults. Regardless of ideal multidisciplinary treatment, including maximal surgical resection, followed by radiotherapy plus concomitant and maintenance temozolomide (TMZ), almost all patients experience tumor progression with nearly universal mortality and a median survival of less than 15 months. The addition of bevacizumab to standard treatment with TMZ revealed no increase in overall survival (OS) but improved progression-free survival (PFS). In newly diagnosed GBM, methylation of the O6-methylguanine-DNA methyltransferase (MGMT) promoter has been shown to predict response to alkylating agents, as well asgnosis. Therefore, MGMT promoter status may have a crucial role in the choice of single modality treatment in fragile elderly population. No standard of care is established in recurrent or progressive GBM. Treatment alternatives may include supportive care, surgery, re-irradiation, systemic therapies, and combined modality therapy. Despite numerous clinical trials, the identification of effective therapies is complex because of the lack of appropriate control arms, selection bias, small sample sizes, and disease heterogeneity. Tumor-treating fields plus TMZ represent a major advance in the field of GBM therapy, and should be Standards of Care in Glioblastoma Therapy 198 considered for patients with newly diagnosed GBM with no contraindications. As a disease with such a poor prognosis, treatment of GBM should go beyond improving survival and aim at preserving and even improving the quality of life of both the patient and the caregiver.

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“…As a recent example, partly based on in vitro studies and in vivo observations in mice and rabbits, in 2015 the FDA approved Tumor Treating Fields (TTF) as a therapeutic modality for patients with newly-diagnosed glioblastoma (http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ ucm465744.htm) [65]. …”

Section: Summarizing Remarksmentioning

confidence: 99%

Glioma: experimental models and reality

et al. 2017

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In theory, in vitro and in vivo models for human gliomas have great potential to not only enhance our understanding of glioma biology, but also to facilitate the development of novel treatment strategies for these tumors. For reliable prediction and validation of the effects of different therapeutic modalities, however, glioma models need to comply with specific and more strict demands than other models of cancer, and these demands are directly related to the combination of genetic aberrations and the specific brain micro-environment gliomas grow in. This review starts with a brief introduction on the pathological and molecular characteristics of gliomas, followed by an overview of the models that have been used in the last decades in glioma research. Next, we will discuss how these models may play a role in better understanding glioma development and especially in how they can aid in the design and optimization of novel therapies. The strengths and weaknesses of the different models will be discussed in light of genotypic, phenotypic and metabolic characteristics of human gliomas. The last part of this review provides some examples of how therapy experiments using glioma models can lead to deceptive results when such characteristics are not properly taken into account.

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Tumor treating fields: a novel treatment modality and its use in brain tumors

Cited by 149 publications

References 29 publications

Tumor-treating fields plus chemotherapy versus chemotherapy alone for glioblastoma at first recurrence: a post hoc analysis of the EF-14 trial

Tumor-treating fields plus chemotherapy versus chemotherapy alone for glioblastoma at first recurrence: a post hoc analysis of the EF-14 trial

Current Standards of Care in Glioblastoma Therapy

Glioma: experimental models and reality

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