Efficacy and Safety of Treating Glioblastoma With Tumor-Treating Fields Therapy

Abstract

Efficacy and Safety of Treating Glioblastoma With Tumor-Treating Fields Therapy Saria MG, Kesari S. Efficacy and Safety of Treating Glioblastoma With Tumor-Treating Fields Therapy. Clin J Oncol Nurs. 2016 Oct 1;20(5):S9-S13. doi: 10.1188/16.CJON.S1.9-13. Abstract BACKGROUND: Glioblastoma (GBM) is a highly aggressive astrocytoma with a dismal prognosis. Since 1976, only three chemotherapeutic agents have been approved for the treatment of GBM. Tumor-treating fields (TTFields) therapy, delivered via a noninvasive device, is a new therapy approved for use in patients with recurrent GBM and in combination with temozolomide for the treatment of newly diagnosed GBM. OBJECTIVES: This article reviews the mechanism of action and findings from preclinical and clinical studies supporting the use of TTFields for patients with newly diagnosed and recurrent GBM. METHODS: This article provides an overview of published literature on the efficacy and safety of treating GBM with TTFields. FINDINGS: For the first time in more than a decade, patients with GBM have a noninvasive treatment option that has been shown to increase progression-free survival and overall survival with minimal adverse events. ncbi.nlm.nih.gov Excerpts Compared with historic cancer treatment modalities, TTFields have an innovative mechanism of action. Nonbiochemical and nonablative, TTFields use frequency-specific, low-intensity, alternating electric fields to disrupt structures within the cancer cell during mitosis, leading to apoptosis. Specifically, TTFields technology takes advantage of the special characteristics, geometric shape, and the rate of dividing cancer cells, which make them susceptible to the effects of TTFields. TTFields alter tumor cell polarity at an intermediate frequency (100- 300 kHz). The frequency used for TTFields is specific to the target cell type (e.g., 200 kHz for gliomas). TTFields have been shown to disrupt the normal assembly of the microtubule spindle by exerting directional forces on polar intracellular elements, such as macromolecules and organelles. These processes lead to physical disruption of the cell membrane and to programmed cell death (Giladi et al., 2015) (see Figure 1). The pivotal, randomized phase III study leading to the FDA approval of Optune for recurrent GBM and the subsequent prospective, multicenter, open-label, randomized, controlled trial leading to the approval of Optune for patients with newly diagnosed GBM demonstrate that the addition of TTFields to maintenance TMZ chemotherapy significantly improves survival without increasing toxicities in patients with glioblastoma. The introduction of the second-generation device, which weighs about 50% less than the original device, is expected to improve GBM patient compliance. Trials are evaluating the safety and efficacy of TTFields in low-grade gliomas, solid tumor brain metastases, non-small cell lung cancer, pancreatic cancer, and other solid malignancies.

AI evidence extraction

Main findings

This narrative review summarizes preclinical and clinical literature on tumor-treating fields (TTFields) for glioblastoma. It reports that TTFields have been shown to increase progression-free survival and overall survival with minimal adverse events, and that adding TTFields to maintenance temozolomide significantly improves survival without increasing toxicities.

Outcomes measured

• progression-free survival
• overall survival
• adverse events/toxicities
• efficacy
• safety

Limitations

• Review article; no original study sample size reported in the abstract
• Methods described only as an overview of published literature; no systematic search strategy or inclusion criteria provided in the abstract

{
    "study_type": "review",
    "exposure": {
        "band": null,
        "source": "tumor-treating fields (TTFields) therapy device",
        "frequency_mhz": null,
        "sar_wkg": null,
        "duration": null
    },
    "population": "Patients with newly diagnosed and recurrent glioblastoma (GBM)",
    "sample_size": null,
    "outcomes": [
        "progression-free survival",
        "overall survival",
        "adverse events/toxicities",
        "efficacy",
        "safety"
    ],
    "main_findings": "This narrative review summarizes preclinical and clinical literature on tumor-treating fields (TTFields) for glioblastoma. It reports that TTFields have been shown to increase progression-free survival and overall survival with minimal adverse events, and that adding TTFields to maintenance temozolomide significantly improves survival without increasing toxicities.",
    "effect_direction": "benefit",
    "limitations": [
        "Review article; no original study sample size reported in the abstract",
        "Methods described only as an overview of published literature; no systematic search strategy or inclusion criteria provided in the abstract"
    ],
    "evidence_strength": "low",
    "confidence": 0.7399999999999999911182158029987476766109466552734375,
    "peer_reviewed_likely": "yes",
    "keywords": [
        "glioblastoma",
        "tumor-treating fields",
        "TTFields",
        "Optune",
        "alternating electric fields",
        "200 kHz",
        "temozolomide",
        "progression-free survival",
        "overall survival",
        "safety",
        "adverse events"
    ],
    "suggested_hubs": []
}

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