An Evidence-Based Review of Alternating Electric Fields Therapy for Malignant Gliomas
Wong ET, Lok E, Swanson KD. An Evidence-Based Review of Alternating Electric Fields Therapy for Malignant Gliomas.Curr Treat Options Oncol. 2015 Aug;16(8):353. doi: 10.1007/s11864-015-0353-5.
Opinion Statement: Glioblastoma is a deadly disease and even aggressive neurosurgical resection followed by radiation and chemotherapy only extends patient survival to a median of 1.5 years. The challenge in treating this type of tumor stems from the rapid proliferation of the malignant glioma cells, the diffuse infiltrative nature of the disease, multiple activated signal transduction pathways within the tumor, development of resistant clones during treatment, the blood brain barrier that limits the delivery of drugs into the central nervous system, and the sensitivity of the brain to treatment effect. Therefore, new therapies that possess a unique mechanism of action are needed to treat this tumor. Recently, alternating electric fields, also known as tumor treating fields (TTFields), have been developed for the treatment of glioblastoma. TTFields use electromagnetic energy at an intermediate frequency of 200 kHz as a locoregional intervention and act to disrupt tumor cells as they undergo mitosis. In a phase III clinical trial for recurrent glioblastoma, TTFields were shown to have equivalent efficacy when compared to conventional chemotherapies, while lacking the typical side effects associated with chemotherapies. Furthermore, an interim analysis of a recent clinical trial in the upfront setting demonstrated superiority to standard of care cytotoxic chemotherapy, most likely because the subjects' tumors were at an earlier stage of clonal evolution, possessed less tumor-induced immunosuppression, or both. Therefore, it is likely that the efficacy of TTFields can be increased by combining it with other anti-cancer treatment modalities.
Eric T Wong received an unrestricted grant from Novocure for the investigation of the cell biology effects of TTFields; participated in the registration trial for recurrent glioblastoma and the PRiDe dataset; and has received sponsored clinical research through grants from AngioChem, AstraZeneca, Cephalon, Eli Lilly, Northwest Biotherapeutics, Novartis, Pfizer, and Plexxikon.
Edwin Lok declares that he has no conflict of interest.
Kenneth D. Swanson received an unrestricted grant from Novocure for the investigation of the cell biology effects of TTFields and has also received a reimbursement for travel expenses for training on use of laboratory equipment and an honorarium for a lecture at Novocure headquarters to present the results of basic research studies.Open Access Paper: http://bit.ly/1JUqIjR
"The calculated electric field in the brain varied mostly between 0.5 and 2.0 V per cm and exceeded 1.0 V per cm in 60% of the total brain volume ... The electric field values predicted in this model brain are in reasonably good agreement with those that have been shown to reduce cancer cell proliferation in vitro. The electric field distribution is highly non-uniform and depends on tissue geometry and dielectric properties. This could explain some of the variability in treatment outcomes."
Joel M. Moskowitz, Ph.D., Director
Center for Family and Community Health
School of Public Health
University of California, Berkeley
Electromagnetic Radiation Safety
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