Tumor treating fields: a new treatment for glioblastoma

Figures & data

Table 1. Clinical efficacy and compliance of TTF.

Reference	Intervention	Patients, N	Median OS (95% CI)	Median PFS (95% CI)	PFS 6 Months,%	OS 1 Year,%	OS 2 Years,%	OS 3 Years,%	Compliance, %
Newly diagnosed GBM
Stupp et al. (EF-14) [8]	TTF + TMZ TMZ	466 229	20.9 (19.3–22.7) 16.0 (14.0–18.4)	6.7 (6.1–8.1) 4.0 (3.8–4.4)	56% 37%	73% 65%	43% 31%	26% 16%	75%
Lu et al. [16]	TTF + TBI TTF + BBC	8 12	32.5 (17.0–49.0) 17.8 (13.3–19.9)	6.6 (3.7–9.2) 5.1 (3.3–6.1)
Lazaridis et al. [17]	TTF + CCNU + TMZ	16		20					83 %
Song et al. [18]	TTF + TMZ + RT	10		6.9					Concurrent phase 83.5% Maintenance phase 77%
Bokstein et al. [15]	TTF + TMZ + RT	10		8.9 (2.1–12.9)	58.30%				79.3 %
Olubajo et al. [19]	TTF + TMZ	9	14.9 (10.4–24.33)	5.5 (3.2–8.7)					89%
Cappelli et al. [20]	TTF + TMZ + RT	87	17.10 (0.60–1.53)	10.2 (0.66–1.94)
Recurrent GBM
Lu et al. [16]	TTF + TMZ TTF + BBC	18 30	18.9 (10.7–25.3) 11.8 (8.6–15.8)	10.7 (6.7–20.8) 4.7 (3.6–6.3)
Korshoej et al. [21]	TTF + SR Surgery	15	15 (9.6–16.2)	8.8 (6.2–13.2)	64%	64%			90%
Zhu et al. (EF-19) [22]	TTF BSC	192 117	7.4 6.4			42% 23.40%
Fallh et al. [23]	TTF + BEV	23	10.5	4.1		46%

Abbreviations: P, prospective; R, retrospective; RCT, randomized controlled trial; RCT-PH, post hoc analysis of RCT; TTF, Tumor-Treating Fields; TMZ, temozolomide; BSC, best standard of care; BEV, bevacizumab; TCCC, 6-thioguanine + lomustine + capecitabine + celecoxib; BBC, bevacizumab ± irinotecan or lomustine; TBI, temozolomide + bevacizumab + irinotecan; RT, radiotherapy; SR Surgery, skull-remodeling surgery; SRS, stereotactic radiosurgery; PP, per-protocol population; PFS, progression free survival; OS, overall survival.

Figure 1. The Optune system. Left: The Optune TTF delivery system consists of four transducer arrays, a field generator and a power source. Right: a patient wearing the Optune system. Images taken from Novocure, 2020 [27].

Stupp R, Taillibert S, Kanner A, et al. Effect of tumor-treating fields plus maintenance temozolomide vs maintenance temozolomide alone on survival in patients with glioblastoma: a randomized clinical trial. JAMA. 2017;318(23):2306–2316.

 PubMed Web of Science ®Google Scholar

Lu G, Rao M, Zhu P, et al. Triple-drug therapy with bevacizumab, irinotecan, and temozolomide plus tumor treating fields for recurrent glioblastoma: a retrospective study. Front Neurol. 2019;10:42.

 PubMed Web of Science ®Google Scholar

Lazaridis L, Schäfer N, Teuber-Hanselmann S, et al. Tumour treating fields (TTFields) in combination with lomustine and temozolomide in patients with newly diagnosed glioblastoma. J Cancer Res Clin Oncol. 2020;146(3):787–792.

 PubMed Web of Science ®Google Scholar

Song A, Bar-Ad V, Martinez N, et al. Initial experience with scalp sparing radiation with concurrent temozolomide and tumor treatment fields (SPARE) for patients with newly diagnosed glioblastoma. J Neurooncol. 2020;147(3):653–661.

 PubMed Web of Science ®Google Scholar

Bokstein F, Blumenthal D, Limon D, et al. Concurrent tumor treating fields (TTFields) and radiation therapy for newly diagnosed glioblastoma: a prospective safety and feasibility study. Front Oncol. 2020;10:411.

 PubMed Web of Science ®Google Scholar

Olubajo F, Thorpe A, Davis C, et al. Tumour treating fields in glioblastoma: is the treatment tolerable, effective, and practical in UK patients? Br J Neurosurg. 2022;24:1–7.

 Google Scholar

Cappelli L, Kanyne A, PAn PC, et al. Chemoradiation treatment with or without concurrent Tumor-Treating fields (TTFields) in patients with newly diagnosed glioblastoma (GBM). Int J Radiat Oncol Biol Phys. 2022;114(3):e68.

 Web of Science ®Google Scholar

Korshoej AR, Mikic N, Hansen FL, et al. Enhancing tumor treating fields therapy with skull-remodeling surgery. The role of finite element methods in surgery planning. Annu Int Conf IEEE Eng Med Biol Soc. 2019.2019;6995–6997.

 PubMedGoogle Scholar

Zhu J-J, O'Donnell R, Ram Z. EF-19, a post-approval registry study of tumor treating fields (TTFields) in recurrent glioblastoma (rGBM). J Clin Oncol. 2020;38(15_suppl):e14536–e14536.

 Web of Science ®Google Scholar

Fallah J, Chaudhary RT, Rogers LR, et al. Clinical outcomes of the combination of bevacizumab and TTFields in patients with recurrent glioblastoma: results of a phase II clinical trial. J Clin Oncol. 2020;38(15_suppl):2537–2537.

 Web of Science ®Google Scholar

Novocure. Novocure reports fourth quarter and full year 2019 financial results and provides company update. Available from https://www.novocure.com/novocure-reports-fourth-quarter-and-full-year-2019-financial-results-and-provides-company-update/. 2020.

 Google Scholar

Data availability statement

The authors confirm that the data supporting the findings of this study is available within the article.