Actr-11. Overall Survival in Glioblastoma Patients Treated With Optune® Correlates With Compliance: Consistency Across Studies

Abstract

NEURO-ONCOLOGY • NOVEMBER 2017 diagnosed glioblastomas (GBM). However, the optimal cycles of adjuvant TMZ remains controversial. Until December 2013 we treated patients with GBM with maximum 24 cycles of adjuvant TMZ (24C group, N=122), and after January 2014 changed our treatment policy to maximum 12 cycles (12C group, N=26). The aim of this study was to explore an impact of extended TMZ treatment on outcome with comparison between 12C group and 24C group. METHODS: Between May 2006 and March 2016 we included 148 patients with newly diagnosed GBM whose number of cycles of adjuvant TMZ was available. In 119 patients, IDH1/2 mutations and MGMT promoter methylation status were analyzed by direct sequencing and pyrosequencing, respectively. Methylation was defined as positive when the mean level of methylation at the 16 CpG sites examined was greater than 16%. RESULTS: The median survival time (MST) and progression free survival (mPFS) were 18.1 months and 9.9 months, respectively. The median number of adjuvant TMZ cycles was 6, and 31 patients (20.9%) received 13 cycles or more. The MST and mPFS did not differ significantly between 12C group and 24C group (30.3 vs 18.1 months, p=0.26, 12.3 vs 9.6 months, p=0.23, respectively). The time from the end of 12 cycles to progression did not differ between patients who completed 12 cycles and stop and those who continued more than 12 cycles (progression free survival rate at 6 months: 62.5% vs 66.7%, p=0.65). Multivariate analysis indicated that age, extent of resection, postoperative Karnofsky performance status, and MGMT promoter methylation were associated with prolonged survival time, but not the number of adjuvant TMZ cycles (p=0.28). CONCLUSIONS: Extended TMZ beyond 12 cycles did not prevent tumor recurrence and was not associated with improved outcome.

Prevention and Management of Dermatologic Adverse Events Associated With Tumor Treating Fields in Patients With Glioblastoma

“…Patient or physician concerns regarding dermatologic AEs should not be a barrier to starting or continuing TTFields therapy, since these are the only treatment-related AEs and are mild-to-moderate in severity in the vast majority of cases. Continuity of treatment is highly correlated with TTFields efficacy (26,54). Physicians should thus consider referral to a dermatologist in patients with challenging skin conditions rather than discontinuing treatment.…”

“…Physicians should thus consider referral to a dermatologist in patients with challenging skin conditions rather than discontinuing treatment. In addition, continuous use of prophylactic measures, combined with early identification and appropriate management of dermatologic AEs, can help patients maximize TTFields treatment time (54). Use of appropriate skin care strategies and medications to mitigate dermatologic AEs, removal of arrays to check scalp, and proactive skin AE prevention education, as well as balance of time on and off therapy, will help minimize treatment interruptions and maximize treatment adherence.…”