Tumor treating fields for glioblastoma: should it or will it ever be adopted?

Abstract

Purpose of review The purpose of this review is to discuss how a new treatment modality, tumor treating fields, may be incorporated into the oncologic care for patients with glioblastoma. Recent findings Tumor treating fields are a new treatment modality available to patients with newly diagnosed and recurrent glioblastoma. Alternating electric fields are delivered via a wearable, removable device affixed to the scalp of patients with supratentorial glioblastoma. With continuous use, the application of tumor treating fields combined with temozolomide chemotherapy has been shown to improve overall survival compared with temozolomide alone in patients with newly diagnosed glioblastoma. Adverse events attributable to the device are limited to localized skin reactions. Despite compendium guidelines in support of its use and Food and Drug Administration (FDA) approval, tumor treating fields have been slow to be adopted in the neuro-oncology community. Critics have raised concerns about the generalizability of the study data, patient quality of life, and mechanism of action of this therapy. Summary Tumor treating fields are available for the treatment of both newly diagnosed and recurrent glioblastoma and represent a new category of treatment modalities in oncologic therapy. This novel device has received FDA approval but has been slow to be adopted into clinical practice.

Take Advantage of Glutamine Anaplerosis, the Kernel of the Metabolic Rewiring in Malignant Gliomas

“…In the last years, tumor-treating fields (TTFields) have gained a lot of attention. This device therapy is based on the delivery of low-intensity alternating electric field to the tumor, interfering with GBM cell division and organelle assembly [ 109 ], but the cytotoxic mechanism is not fully understood [ 110 ]. In a randomized clinical trial developed by Stupp et al, TTFields treatment in combination with temozolomide resulted in increased OS and PFS [ 109 , 111 ].…”

“…In a randomized clinical trial developed by Stupp et al, TTFields treatment in combination with temozolomide resulted in increased OS and PFS [ 109 , 111 ]. Therefore, this method is Food and Drug Administration (FDA)-approved in newly diagnosed and recurrent GBM, however, the neuro-oncology community have been reluctant regarding its widespread adoption [ 110 , 112 ]. Skepticism regarding this device mainly concerns the limited understanding of the mechanism of action, the clinical trial design, and the effect on the patient’s quality of life [ 112 ].…”

Tyrosine Kinase Inhibitors for Glioblastoma Multiforme: Challenges and Opportunities for Drug Delivery

“…TTFields was approved by the FDA for recurrent GBM in 2011 and for newly diagnosed GBM in 2015 [ 7 ]. However, it is expensive, has minimal survival benefits, and poor patient compliance [ 7 , 9 , 10 ]. Since the last decade, extensive research is ongoing to identify novel targets for the treatment of GBM in the drug discovery field.…”

Research progress of anti-glioma chemotherapeutic drugs (Review)

“…TMZ forms part of the standard chemotherapeutic strategy for the treatment of glioma. However, drug resistance to TMZ and toxic effects (myelosuppression and delayed thrombocytopenia) limit its efficacy, which highlights the importance of exploring the novel treatment options ( 61 , 62 ). Previous preclinical studies ( 63 – 65 ) applied nanoparticles as carriers in an attempt to effectively deliver chemotherapeutic drugs to the glioma region by crossing the BBB, and minimize drug resistance ( 62 ).…”