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Treatment of Glioblastoma (GBM) with the Addition of Tumor-Treating Fields (TTF): A Review

Al's Comment:

This article intended to be a balanced article on the plusses and minuses of Optune.  Unfortunately it is loaded with errors and bias.  For example,

 

1. They say:   They did a survey between January 2015 and July 2015 and found only 41% of doctors had access to the device.  Optune was approved for newly diagnosed in July 2015.  So they did the survey before the device was available for newly diagnosed. (The recurrent data was not great). This article was published in 2019.  Optune is now available at just about every major medical center in the USA. Their website, optune.com says there are 700 certified treatment centers that offer Optune in the USA.  They should have repeated the survey but instead used an old one that made Optune look bad.

 

2. They harp on the fact that there was no sham device in the control group.  That would have been ridiculous.  Imagine having to shave your head twice a week and carry around the old version of the device (which was twice as heavy and bulky as the current version), and risk getting skin problems without a chance to benefit from it? I would not want to do that.  The endpoint was overall survival. Placebos cannot show such an increase in overall survival.  The Temodar studies did not use a placebo and nobody faulted the study for that. The Avastin trials did use a placebo but the placebo group did not do better than the treatment group (which means placebos do not help  glioblastomas). This is absolutely not an issue.

 

3. They say Optune is not covered by Medicare or many other insurance companies. The second part of that statement is not true.  Over 90% of non-medicare insurance companies pay for Optune. They go on to say Medicare has now agreed to reconsider coverage – which only happened a few weeks ago so there is no reason to be so far behind on the statistics. That statement was true in 2015 but not in 2019. Hopefully by the end of this year all insurances including Medicare will be paying for it.  In the meantime, Novocure has said they would not let a patient not get access to this treatment due to being unable to afford it. They very generously gave it for free or at a very reduced rate to those on Medicare or who did not have insurance that covered it. 

 

4. They keep talking about patients being reluctant to wear the device and shave their heads. This is too subjective. Of course patients would prefer not to shave heads or have to wear a device that constantly reminds them of the disease.   However, having to use a wheelchair, or being unable to speak, at a much sooner time are not great alternatives. It is a personal decision that the patient has to make.

 

5. Finally – they complain about the price. At least they do point out that other new treatments are way more expensive.  I doubt we will ever see a new brain tumor treatment priced less than Optune.  Optune is about half of the price of Avastin, and the trials showed a big increase in survival for Optune, and no increase in survival for Avastin (although they did show a nice improvement in progression free survival and patients feel better on it). I never heard the complaint that Avastin was too expensive.  Hopefully we will have a few new treatments approved in the next year or 2.  We have no idea what they will cost but to put it in perspective:  The cheapest gene therapy on the market (for other diseases) is $373,000 for the one treatment. Most expensive now is over $1 million for the one treatment. A new one that is under review might be $4 million for the 1 dose. As for vaccines, the only one approved in the USA (for prostate cancer) cost about $93,000 for a 6 week course of treatment.    The only way to bring these prices down to earth is a major change in regulatory policy – but that is for another day.

 


Posted on: 02/12/2019

Treatment of Glioblastoma (GBM) with the Addition of Tumor-Treating Fields (TTF): A Review

 


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