Tumor Treating Fields Technology: Alternating Electric Field Therapy for the Treatment of Solid Tumors

Benson, Laura

doi:10.1016/j.soncn.2018.03.005

Cited by 30 publications

(41 citation statements)

References 28 publications

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“…Arrays should be changed at least 2 times per week, approximately every 3 days, although some patients may benefit from more frequent replacement (e.g., with hyperhidrosis or quick hair growth). Patient and caregiver education is an essential part of risk reduction, and oncology nurses play a critical role in educating patients and caregivers on how to integrate TTFields therapy into their daily life; this can subsequently improve acceptance and adherence (45,(48)(49)(50). Nurses should educate patients on what to expect at treatment initiation, emphasizing the importance of communicating any changes in skin condition to healthcare professionals as soon as possible.…”

Section: Prophylactic Interventionsmentioning

confidence: 99%

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

et al. 2020

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Importance: Tumor Treating Fields (TTFields) are an anti-mitotic treatment approved for treating newly diagnosed and recurrent glioblastoma, and mesothelioma. TTFields in glioblastoma comprise alternating electric fields (200 kHz) delivered continuously, ideally for ≥18 h/day, to the tumor bed via transducer arrays placed on the shaved scalp. When applied locoregionally to the tumor bed and combined with systemic temozolomide chemotherapy, TTFields improved overall survival vs. temozolomide alone in patients with newly diagnosed glioblastoma. Improved efficacy outcomes with TTFields were demonstrated, while maintaining a well-tolerated and manageable safety profile. The most commonly-reported TTFields-associated adverse events (AEs) are beneath-array dermatologic events. Since survival benefit from TTFields increases with duration-of-use, prevention and management of skin AEs are critical to maximize adherence. This paper describes TTFields-associated dermatological AEs and recommends prevention and management strategies based on clinical trial evidence and real-world clinical experience. Observations: TTFields-associated skin reactions include contact dermatitis (irritant/allergic), hyperhidrosis, xerosis or pruritus, and more rarely, skin erosions/ulcers and infections. Skin AEs may be prevented through skin-care and shifting (∼2 cm) of array position during changes. TTFields-related skin AE management should be based on clinical phenotype and severity. Depending on diagnosis, recommended treatments include antibiotics, skin barrier films, moisturizers, topical corticosteroids, and antiperspirants. Water-based lotions, soaps, foams, and solutions with minimal impact on electrical impedance are preferred with TTFields use over petroleum-based ointments, which increase impedance. Conclusions: Early identification, prophylactic measures, and symptomatic skin AE management help patients maximize TTFields usage, while maintaining quality-of-life and optimizing therapeutic benefit. Lacouture et al. Managing TTFields-Associated Skin Adverse Events Implications for practice: TTFields confer a survival benefit in patients with glioblastoma that correlates positively with duration of daily use. Skin events (rash) are the primary treatment-related AE that can limit duration of use. The recommendations described here will help healthcare professionals to recognize, prevent, and manage dermatologic AEs associated with TTFields treatment. These recommendations may improve cutaneous health and support adherence to therapy, both of which would maximize treatment outcomes.

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Section: Prophylactic Interventionsmentioning

confidence: 99%

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

et al. 2020

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“…The author is not aware of a study showing full disappearance of GBM tumors in mice/rats treated with TTF and it seems that this treatment went directly to clinical trials without such demonstration. The efficacy of TTF was assessed clinically on patients with recurrent or newly diagnosed GBM (Benson, 2018 ). In particular, in a phase III clinical study involving 466 patients (EF-11), the addition of TTFields to standard therapy was shown to increase median overall survival from 15.6 without TTF to 20.5 months with TTF, to improve patient quality of life, and to lower incidence of serious adverse events (Stupp et al, 2015 ).…”

Section: The Different Gbm Treatments Commercialized or Under Developmentioning

confidence: 99%

Glioblastoma Treatments: An Account of Recent Industrial Developments

Alphandéry

2018

Front. Pharmacol.

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The different drugs and medical devices, which are commercialized or under industrial development for glioblastoma treatment, are reviewed. Their different modes of action are analyzed with a distinction being made between the effects of radiation, the targeting of specific parts of glioma cells, and immunotherapy. Most of them are still at a too early stage of development to firmly conclude about their efficacy. Optune, which triggers antitumor activity by blocking the mitosis of glioma cells under the application of an alternating electric field, seems to be the only recently developed therapy with some efficacy reported on a large number of GBM patients. The need for early GBM diagnosis is emphasized since it could enable the treatment of GBM tumors of small sizes, possibly easier to eradicate than larger tumors. Ways to improve clinical protocols by strengthening preclinical studies using of a broader range of different animal and tumor models are also underlined. Issues related with efficient drug delivery and crossing of blood brain barrier are discussed. Finally societal and economic aspects are described with a presentation of the orphan drug status that can accelerate the development of GBM therapies, patents protecting various GBM treatments, the different actors tackling GBM disease, the cost of GBM treatments, GBM market figures, and a financial analysis of the different companies involved in the development of GBM therapies.

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“…Since TTFields only exert a therapeutic effect when the device is actively utilized and, thus, do not have a half-life [63], increased treatment adherence is expected to be associated with improved survival in patients with GBM [64][65][66]. In a post hoc analysis of the EF-11 trial, monthly maximal usage duration of ≥ 75% (i.e., ≥ 18 h/day averaged over a 4-week cycle) was associated with significantly longer median OS compared with a daily time of usage of G 75% (7.7 vs 4.5 months, respectively; p 0 0.042) [64].…”

Section: Treatment Adherencementioning

confidence: 99%

Tumor Treating Fields in the Management of Patients with Malignant Gliomas

Ghiaseddin

Shin

Melnick

et al. 2020

Curr. Treat. Options in Oncol.

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This article is part of the Topical Collection on Neuro-oncology Keywords Tumor treating fields I CNS tumors I Malignant glioma I Glioblastoma I Alternating electric fields I Optune® Opinion statement Malignant gliomas remain a challenging cancer to treat due to limitations in both therapeutic and efficacious options. Tumor treating fields (TTFields) have emerged as a novel, locoregional, antineoplastic treatment modality with favorable efficacy and safety being demonstrated in the most aggressive type of malignant gliomas, glioblastoma (GBM). In 2 large randomized, controlled phase 3 trials, the addition of TTFields was associated with increased overall survival when combined with adjuvant temozolomide (TMZ) chemotherapy in patients with newly diagnosed GBM (ndGBM) and comparable overall survival compared with standard chemotherapy in patients with recurrent GBM (rGBM). TTFields target cancer cells by several mechanisms of action (MoA) including suppression of proliferation, migration and invasion, disruption of DNA repair and angiogenesis, antimitotic effects, and induction of apoptosis and immunogenic cell death. Having several MoAs makes TTFields an attractive modality to combine with standard, salvage, and novel treatment regimens (e.g., radiotherapy, chemotherapy, and immunotherapy). Treatment within the field of malignant gliomas is evolving to emphasize combinatorial approaches that work synergistically to improve patient outcomes. Here, we review the current use of TTFields in GBM, discuss MOA and treatment delivery, and consider the potential for its wider adoption in other gliomas.

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Tumor Treating Fields Technology: Alternating Electric Field Therapy for the Treatment of Solid Tumors

Cited by 30 publications

References 28 publications

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

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

Glioblastoma Treatments: An Account of Recent Industrial Developments

Tumor Treating Fields in the Management of Patients with Malignant Gliomas

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