TTFields: where does all the skepticism come from?

European Association for Neuro-Oncology (EANO) guideline on the diagnosis and treatment of adult astrocytic and oligodendroglial gliomas

“…57 The trial was terminated early when the first cohort of 315 randomized patients was analysed and a survival benefit was reported (hazard ratio 0.74 (95% CI, 0.56-0.98); log-rank p=0.03). Questions regarding mode of action, interpretation of data and impact on quality of life have been raised, 58 and the place and cost-effectiveness of TTFields in the standard of care for newly diagnosed glioblastoma remain to be defined. 59 Standards of care for patients with recurrent glioblastoma are not well defined.…”

A Review on Tumor-Treating Fields (TTFields): Clinical Implications Inferred From Computational Modeling

“…However, the forces and torques that the EF exerts on the intrinsic dipoles of tubulin are too small to have a significant effect on tubulin alignment. This analysis demonstrates that although the biological effects of TTFields on cells are well documented, there is still a need for in-depth biophysical studies to elucidate the physical mechanisms by which TTFields exert their biological effects [21].…”

“…These factors include age, Karnofsky performance status, the extent of the resection, and morphological, histological, and genetic characteristics, such as isocitrate dehydrogenase (IDH) and O(6)-methylguanine-DNA methyltransferase (MGMT) tumor mutation status [40], [41]. When treating with TTFields, it is reasonable to assume that in addition to the factors mentioned above [21], the distribution and intensity of the induced EF in the brain and tumor also influence treatment outcome. The field distribution and intensity may vary significantly between individuals depending on the size, shape, and electrical properties of the head, brain, and tumor.…”

Current management of cerebral gliomas

“…9 The mechanism for the supposed effect remains unclear; there is no blinded randomised controlled trial and it requires purchase of expensive disposables, causing scepticism among many neuro-oncologists. 23 It is unlikely to be introduced to Australia in the foreseeable future.…”