Tumor treating fields: concept, evidence and future
Abstract
INTRODUCTION: Local control is fundamental, both for the curative as well as the palliative treatment of cancer. Tumor treating fields (TTFields) are low intensity (1 ? 2 V/cm), intermediate frequency (100 ? 200 kHz) alternating electric fields administered using insulated electrodes placed on the skin surrounding the region of a malignant tumor. TTFields were shown to destroy cells within the process of mitosis via apoptosis, thereby inhibiting tumor growth. TTFields have no effect on non-dividing cells. AREAS COVERED: This article reviews in vitro and in vivo preclinical studies, demonstrating the activity of TTFields both as a monotherapy as well as in combination with several cytotoxic agents. Furthermore, it summarizes the clinical experience with TTFields, mainly in two indications: one in recurrent glioblastoma multiforme: in a large prospective randomized Phase III trial TTFields was compared with best standard care (including chemotherapy): TTFields significantly improved median overall survival (OS) compared with standard therapy (7.8 vs 6.1 months) for the patients treated per protocol. Importantly, quality of life was also better in the TTFields group. The second indication was a Phase II study in second-line non-small cell lung cancer, where TTFields was administered concomitantly with pemetrexed. This combination resulted in an excellent median OS of 13.8 months. Interestingly, the progression-free survival (PFS) within the area of the TTFields was 28, however, outside the TTFields the PFS was only 22 weeks. EXPERT OPINION: The proof of concept of TTFields has been well demonstrated in the preclinical setting, and the clinical data seem promising in various tumor types. The side effects of TTFields were minimal and in general consisted of skin reaction to the electrodes. There are a number of ways in which TTFields could be further evaluated, for example, in combination with chemotherapy, as a maintenance treatment, or as a salvage therapy if radiotherapy or surgery is not possible. While more clinical data are clearly needed, TTFields is an emerging and promising novel treatment concept.
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The phase I/II trial results compared well to matched historical controls.
“both of which compared well to matched historical controls.”
A phase I/II trial showed preliminary efficacy and safety of combining TTFields therapy with pemetrexed in patients with stage IIIB/IV NSCLC following failure of standard first-line therapy.
“recent phase I/II trial showed, for the first time, preliminary efficacy and safety of combining TTFields therapy with pemetrexed in patients with stage IIIB/IV NSCLC following failure of standard first-line therapy.11”
In the phase I/II trial of TTFields plus pemetrexed in stage IIIB/IV NSCLC after first-line failure, median progression-free survival was 22 weeks.
“This study demonstrated a median progression-free survival (PFS) of 22 weeks”
These results support the clinical activity of TTFields therapy when added to chemotherapy in advanced NSCLC, without incremental toxicity.
“These results support the clinical activity of TTFields therapy when added to chemotherapy in advanced NSCLC, without incremental toxicity.”
In that phase I/II trial, median overall survival was 13.8 months.
“Median overall survival was 13.8 months”
In that phase I/II trial, 1-year survival was 57%.
“and 1-year survival was 57%”
In that phase I/II trial, in-field progression-free survival was 28 weeks.
“and an encouraging in-field PFS (measured at the site where TTFields were delivered to the lungs and liver) of 28 weeks.”
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Zhang, X., Yarema, K. J., & Xu, A. (2017) · Springer eBooks · doi:10.1007/978-981-10-3579-1_2 · Cited by 2 · see citing works
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Liquid Metal Enabled Electrobiology: A Generalized Easy Going Way to Tackle Disease ChallengesPreprint
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- Authors
- Pless, M., & Weinberg, U.
- Affiliations
- Kantonsspital Winterthur (CH)
- Venue
- Expert Opinion on Investigational Drugs
- Publisher
- Informa UK Limited
- Published
- 2011-05-09
- Volume
- 20
- Issue
- 8
- Pages
- 1099-1106
- ISSN
- 1354-3784 (ISSN-L)
- 1744-7658
- OpenAlex
- W2056890176
- Cited by
- 78
- References
- 30
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 2 · 2023: 6 · 2022: 9 · 2021: 6 · 2020: 1 · 2019: 9 · 2018: 9 · 2017: 5 · 2016: 8 · 2015: 2 · 2014: 9 · 2013: 4 · 2012: 2
- FWCI
- 0.58
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Expert Opinion on Investigational Drugs (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Biophysics › Electromagnetic Fields and Biological Effects
- Health Sciences › Medicine › Genetics › Glioma Diagnosis and Treatment
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Biotechnology › Microbial Inactivation Methods
- Keywords
- tumor treating fields, glioblastoma, non-small cell lung cancer, pemetrexed, apoptosis, mitosis inhibition, local tumor control, combination chemotherapy, overall survival, quality of life, maintenance therapy, salvage therapy
- MeSH terms
- Animals, Clinical Trials as Topic, Electrodes, Electromagnetic Fields, Electric Stimulation Therapy, Humans, Neoplasms
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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