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Tumor-Treating Fields for Lung Cancer?
Tumor-treating fields for lung cancer is an FDA-approved therapy. According to the research excerpted below, overall survival is extended when TTF therapy is combined with standard therapies, such as immunotherapy.
I am a long-term survivor of an incurable blood cancer called multiple myeloma. Painful experience has taught me that conventional therapies for aggressive cancers like myeloma and lung cancer can be limited.
So the research documenting how combining TTF with immunotherapy caught my eye. Furthermore, consider enhancing your gut microbiome in preparation for immunotherapy.
Research shows that enhancing the gut microbiome can enhance the efficacy of immunotherapy.
Tumour Treating Fields therapy extends OS for mNSCLC after plantinum failure
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David Emerson
- Cancer Survivor
- Cancer Coach
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Researchers have found that exposing some types of cancer cells to alternating electric fields, also known as tumor treating fields (or TTFields), can interfere with the cells’ ability to grow and spread.
A wearable device known as Optune Lua is a TTFields treatment that creates such electric fields. It is an option to help treat some people with non-small cell lung cancer (NSCLC).
When might TTFields be used to treat NSCLC?
Optune Lua can be used along with either an immune checkpoint inhibitor or with the chemotherapydrug docetaxel to treat some people with metastatic NSCLC that has grown during or after treatment with chemotherapy.
How is TTFields therapy given?
For this treatment, the chest and/or back is shaved (if needed), and pads containing sets of electrodes are placed on the skin, usually 2 on the chest and 2 on the back.
The electrodes are attached to a battery pack (kept in a backpack) and are worn for most of the day – typically at least 18 hours. They create mild electric currents that are thought to affect cancer cells more than normal cells.
Possible side effects of TTFields therapy
Side effects of the device are usually limited to the electrode sites. They can include:
- Skin irritation
- Allergic reactions
- Local warmth and tingling sensations
- Muscle twitching
- Infections
- Breakdown of the skin (ulcers)
Tumor Treating Fields therapy with standard systemic therapy versus standard systemic therapy alone in metastatic non-small-cell lung cancer following progression on or after platinum-based therapy (LUNAR): a randomised, open-label, pivotal phase 3 study
Summary
Background
Tumor Treating Fields (TTFields) are electric fields that disrupt processes critical for cancer cell survival, leading to immunogenic cell death and enhanced antitumour immune response. In preclinical models of non-small-cell lung cancer, TTFields amplified the effects of chemotherapy and immune checkpoint inhibitors. We report primary results from a pivotal study of TTFields therapy in metastatic non-small-cell lung cancer.
Methods
This randomised, open-label, pivotal phase 3 study recruited patients at 130 sites in 19 countries. Participants were aged 22 years or older with metastatic non-small-cell lung cancer progressing on or after platinum-based therapy, with squamous or non-squamous histology and ECOG performance status of 2 or less. Previous platinum-based therapy was required, but no restriction was placed on the number or type of previous lines of systemic therapy. Participants were randomly assigned (1:1) to TTFields therapy and standard systemic therapy (investigator’s choice of immune checkpoint inhibitor [nivolumab, pembrolizumab, or atezolizumab] or docetaxel) or standard therapy alone…
TTFields therapy (150 kHz) was delivered continuously to the thoracic region with the recommendation to achieve an average of at least 18 h/day device usage. The primary endpoint was overall survival in the intention-to-treat population. The safety population included all patients who received any study therapy and were analysed according to the actual treatment received. The study is registered with ClinicalTrials.gov, NCT02973789.
Findings
Between Feb 13, 2017, and Nov 19, 2021, 276 patients were enrolled and randomly assigned to receive TTFields therapy with standard therapy (n=137) or standard therapy alone (n=139). The median age was 64 years (IQR 59–70), 178 (64%) were male and 98 (36%) were female, 156 (57%) had non-squamous non-small-cell lung cancer, and 87 (32%) had received a previous immune checkpoint inhibitor.
Median follow-up was 10·6 months (IQR 6·1–33·7) for patients receiving TTFields therapy with standard therapy, and 9·5 months (0·1–32·1) for patients receiving standard therapy.
Overall survival was significantly longer with TTFields therapy and standard therapy than with standard therapy alone (median 13·2 months [95% CI 10·3–15·5] vs 9·9 months [8·1–11·5]; hazard ratio [HR] 0·74 [95% CI 0·56–0·98]; p=0·035).
In the safety population (n=267), serious adverse events of any cause were reported in 70 (53%) of 133 patients receiving TTFields therapy plus standard therapy and 51 (38%) of 134 patients receiving standard therapy alone.
The most frequent grade 3–4 adverse events were leukopenia (37 [14%] of 267), pneumonia (28 [10%]), and anaemia (21 [8%]). TTFields therapy-related adverse events were reported in 95 (71%) of 133 patients; these were mostly (81 [85%]) grade 1–2 skin and subcutaneous tissue disorders. There were three deaths related to standard therapy (two due to infections and one due to pulmonary haemorrhage) and no deaths related to TTFields therapy.
Interpretation
TTFields therapy added to standard therapy significantly improved overall survival compared with standard therapy alone in metastatic non-small-cell lung cancer after progression on platinum-based therapy without exacerbating systemic toxicities. These data suggest that TTFields therapy is efficacious in metastatic non-small-cell lung cancer and should be considered as a treatment option to manage the disease in this setting.
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