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Complete radiological response following subtotal resection in three glioblastoma patients under treatment with Tumor Treating Fields.

Al's Comment:

 This is a relatively small trial but shows a huge effect supporting the use of Optune for Glioblastoma.  

In the big EF-14 phase 3 trial for newly diagnosed glioblastoma, the trial was stopped at the first interim analysis because it was obvious the Optune arm was doing so much better than the control group that it was unethical to continue withholding Optune from newly diagnosed patients.    The people running this study did not do that - they allowed it to go on for 5 years - knowing that they were withholding the best treatment.  Doesn't sound fair to me.


Posted on: 01/04/2020

  Oncol Lett. 2020 Jan;19(1):557-561. doi: 10.3892/ol.2019.11110. Epub 2019 Nov 19.
Complete radiological response following subtotal resection in three glioblastoma patients under treatment with Tumor Treating Fields.
Kessler AF1, Linsenmann T1, Westermaier T1, Wolber W1, Weiland J1, Monoranu CM2, Breun M1, Hagemann C1, Ernestus RI1, Löhr M 1.
 
Author information:
1. Department of Neurosurgery, University Hospital of Würzburg, Würzburg 97080, Germany.
2. Department of Neuropathology, Institute of Pathology, University of Würzburg, Würzburg 97080, Germany.
Abstract
 
Glioblastoma multiforme (GBM) treatment consists of surgery, radiotherapy and chemotherapy with Temozolomide (TMZ). After subtotal resection (STR), residual tumors rarely undergo spontaneous regression. Overall survival (OS) and progression-free survival (PFS) are reduced when compared with gross total resection. There is evidence that adding Tumor Treating Fields (TTFields) to standard management may lead to a significant increase in PFS and OS. In 2015 and 2016, STR was performed in 27 patients with GBM. Of these, four subsequently received TTFields therapy in addition to chemotherapy. The present study presents a series of three patients with GBM (44-54 years; isocitrate dehydrogenase wild-type, methylated O6-methylguanine-DNA methyltransferase promoter) that were treated with radiochemotherapy and TTFields after STR. Therapy with TTFields started concomitantly to TMZ following radiotherapy and was maintained for 14, 24 and 37 months. TTFields were used as monotherapy in one case, as TMZ treatment had to be stopped due to toxicity for 1 month. In all patients, TTFields therapy was well tolerated at high compliance levels, resulting in complete response (CR) after 4, 5 and 7 months, respectively. Two patients remain tumor-free at 16 and 40 months after STR. One patient exhibited multifocal recurrence 11 months after the beginning of TTFields treatment but remains alive, presenting a mild neurological decline 24 months after starting TTFields. All three presented patients gave written informed consent for their data to be published. In conclusion, the current report detailed three patients with GBM who underwent STR and were subsequently treated with TMZ and TTFields. TTFields treatment was tolerated well and was applied accurately and with high compliance by these patients, which may have contributed to the complete response. Four of the 27 patients treated with STR received additional TTFields treatment. Three of these 4 showed a CR, while a CR was observed only 2 of the remaining 23 patients without TTFields. The current series supports the effects in clinical practice, as demonstrated in recent clinical trials. The results also demonstrated that adjuvant TTFields therapy can structurally affect residual tumors after STR.
 
Copyright © 2020, Spandidos Publications.

 


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