A device attached to a patient’s scalp which delivers a continuous dose of low-intensity electric fields is able to slow the growth of a deadly brain tumor, a new clinical trial suggests.

The new treatment for glioblastoma uses alternating electric currents called tumor-treating fields (TTFields), delivered through an array of insulated electrodes affixed to a patient’s shaved scalp.

Except for occasional breaks and weekly electrode changes, patients wear the device at all times. Connected by a cable to a small battery-powered device, the electrodes continually deliver an electrical field to brain tissue.

TTFields Therapy

In the trial, combining the TTFields therapy with standard maintenance chemotherapy allowed for a significant improvement in both progression-free and overall survival in patients with recently diagnosed glioblastoma.

Patients who received TTFields did better than patients who did not: the median survival time for those receiving the TTFields therapy was 20.9 months versus 16.0 months for patients who did not, with a substantially higher fraction of patients alive at two, three, or four years after diagnosis.

“This trial establishes a new treatment paradigm that substantially improves the outcome in patients with glioblastoma, and which may have applications in many other forms of cancer. With TTFields therapy combined with radiation and temozolomide chemotherapy, up to 43 percent of glioblastoma patients will survive longer than two years.

In a disease where, until 2004, the great majority of patients died within one year, this is yet another example how systematic and interdisciplinary research will benefit patients in everyday care,”

says lead author Roger Stupp, professor of neurological surgery and of medicine at Northwestern University’s Feinberg School of Medicine and Northwestern Medicine chief of neuro-oncology in the neurology department.

Temozolomide Chemotherapy

Previous research had demonstrated that TTFields will inhibit tumor growth and selectively affect dividing cells, ultimately leading to cancer cell death and tumor growth inhibition.

In the current study, 695 patients were randomly assigned to either receive the TTFields in combination with temozolomide, a chemotherapy drug, or the chemotherapy drug alone. Overall, 466 patients received the TTFields-chemotherapy combination, and 229 received the chemotherapy treatment alone.

There was no difference in the rate of adverse events between the two groups, except for mild to moderate skin irritation on the scalp, which was experienced by slightly more than half of patients receiving the TTFields therapy.

A preliminary report from this trial was published in 2015; this report describes the final analysis.

Roger Stupp, Sophie Taillibert, Andrew Kanner, William Read, David M. Steinberg, Benoit Lhermitte, Steven Toms, Ahmed Idbaih, Manmeet S. Ahluwalia, Karen Fink, Francesco Di Meco, Frank Lieberman, Jay-Jiguang Zhu, Giuseppe Stragliotto, David D. Tran, Steven Brem, Andreas F. Hottinger, Eilon D. Kirson, Gitit Lavy-Shahaf, Uri Weinberg, Chae-Yong Kim, Sun-Ha Paek, Garth Nicholas, Jordi Burna, Hal Hirte, Michael Weller, Yoram Palti, Monika E. Hegi, Zvi Ram Effect of Tumor-Treating Fields Plus Maintenance Temozolomide vs Maintenance Temozolomide Alone on Survival in Patients With GlioblastomaA Randomized Clinical Trial JAMA. 2017;318(23):2306–2316. doi:10.1001/jama.2017.18718

Image: olaf scheffers

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