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Treatment with Tumor-Treating Fields Therapy and Pulse Dose Bevacizumab in Patients with Bevacizumab-Refractory Recurrent Glioblastoma: A Case Series.

Al's Comment:

 I do not think this was the best way to set up the study.  The better way of doing it would have been to start Optune a few weeks  after radiation is over, and perhaps try Avastin in a pulse dosing form  - either as newly diagnosed at the same time you start the optune, or at the time of recurrence.  Withholding Optune from a newly diagnosed patient for the purpose of entering a trial like this sounds unethical to me.

It shows a lack of understanding of how Optune works. It is a slow, gentle treatment. The time to start it is not when you have a recurrence as it needs a few months to kick in.  The effect of slowing tumor growth starts immediately but it takes time before the tumor starts to shrink.   The trial using it for newly diagnosed patients did much better than the one that started at recurrence.

Having said that, the results show that Optune does help when used this way, but I would like to see more trials using it the correct way. For those that missed out on the opportunity to use it when newly diagnosed, this shows that it is worth trying at the time of recurrence.

Posted on: 02/21/2016

Case Rep Neurol. 2016 Jan 8;8(1):1-9. doi: 10.1159/000442196.
Treatment with Tumor-Treating Fields Therapy and Pulse Dose Bevacizumab in Patients with Bevacizumab-Refractory Recurrent Glioblastoma: A Case Series.
Ansstas G1, Tran DD1.
Author information:
1Neuro-Oncology Program, Division of Oncology, Washington University, School of Medicine, St. Louis, Mo., USA.
Patients with bevacizumab-refractory recurrent glioblastoma multiforme (GBM) have a poor prognosis. We propose that instead of continuing on bevacizumab, patients should switch to treatment with Optune™, a novel antimitotic Tumor-Treating Fields (TTFields) therapy approved in the United States for newly diagnosed and recurrent GBM. This would reserve bevacizumab for subsequent disease progression. In this case series, we describe 8 patients with recurrent GBM who had disease progression on bevacizumab, discontinued bevacizumab treatment, and were treated with TTFields therapy alone. After subsequent radiographic or clinical progression, 5 patients were rechallenged with bevacizumab in a 'pulse dose' fashion, an approach not previously described. Following treatment with TTFields therapy, median overall survival (OS) was 216 days (7.2 months). Median OS from last dose of initial bevacizumab was 237 days (7.9 months), twice that of historical controls for bevacizumab failures, and median OS from the first dose of bevacizumab rechallenge was 172 days (5.7 months). TTFields therapy was well tolerated, with a mean adherence rate of 74.2% (range, 48.2-92.9%). These results support the use of TTFields therapy with pulse dose bevacizumab as an option in patients with refractory GBM. 


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