title: Alternating electric tumor treating fields for treatment of glioblastoma: rationale, preclinical, and clinical studies.
abstract: OBJECTIVE Treatment for glioblastoma (GBM) remains largely unsuccessful, even with aggressive combined treatment via surgery, radiotherapy, and chemotherapy. Tumor treating fields (TTFs) are low-intensity, intermediate-frequency, alternating electric fields that have antiproliferative properties in vitro and in vivo. The authors provide an up-to-date review of the mechanism of action as well as preclinical and clinical data on TTFs. METHODS A systematic review of the literature was performed using the terms "tumor treating fields," "alternating electric fields," "glioblastoma," "Optune," "NovoTTF-100A," and "Novocure." RESULTS Preclinical and clinical data have demonstrated the potential efficacy of TTFs for treatment of GBM, leading to several pilot studies, clinical trials, and, in 2011, FDA approval for its use as salvage therapy for recurrent GBM and, in 2015, approval for newly diagnosed GBM. CONCLUSIONS Current evidence supports the use of TTFs as an efficacious, antimitotic treatment with minimal toxicity in patients with newly diagnosed and recurrent GBM. Additional studies are needed to further optimize patient selection, determine cost-effectiveness, and assess the full impact on quality of life.
authors.affiliation: Departments of1Neurosurgery.|2Oncology.|5Karmanos Cancer Institute, Wayne State University, Detroit, Michigan.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Mittal
authors.affiliation: Departments of1Neurosurgery.
authors.forename: Neil V
authors.initials: NV
authors.lastname: Klinger
authors.affiliation: Departments of1Neurosurgery.
authors.forename: Sharon K
authors.initials: SK
authors.lastname: Michelhaugh
authors.affiliation: 3Neurology, and.|5Karmanos Cancer Institute, Wayne State University, Detroit, Michigan.
authors.forename: Geoffrey R
authors.initials: GR
authors.lastname: Barger
authors.affiliation: 6Department of Neurological Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York; and.|7Department of Biomedical Engineering, Cornell University, Ithaca, New York.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Pannullo
authors.affiliation: 3Neurology, and.|4Pediatrics.|5Karmanos Cancer Institute, Wayne State University, Detroit, Michigan.
authors.forename: Csaba
authors.initials: C
authors.lastname: Juhász
mesh_terms: D001932:Brain Neoplasms / Q000473:pathology / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000379:methods*; D005909:Glioblastoma / Q000473:pathology / Q000628:therapy*; D006801:Humans; D016896:Treatment Outcome
keywords: GBM = glioblastoma; LYG = life years gained; MDR = multidrug resistant; NSCLC = non–small cell lung cancer; NovoTTF-100A; OS = overall survival; Optune; PFS = progression-free survival; QALY = quality-adjusted life year; QOL = quality of life; TMZ = temozolomide; TTF = tumor treating field; TTP = time to disease progression; alternating electric fields; newly diagnosed glioblastoma; oncology; recurrent glioblastoma; tumor treating fields