Cancer Researcher Offer New Hope for Brain Tumor
Jim Black is fighting the meanest, most aggressive, most common kind of brain tumor in the United States: recurrent glioblastoma multiforme (GBM). In the United States, each year, approximately 10,000 patients are affected by GBM. Now, a novel investigational device – available only at clinical trial sites – is offering new hope to these patients.
The non-invasive procedure – called Tumor Treating Fields (TTF) – is delivered using a portable device – called the NovoTTF-100A System made by Novocure. The TTF procedure uses alternating electrical fields to disrupt the rapid cell division exhibited by cancer cells.
“Patients with recurrent GBM present a significant treatment challenge,” said Santosh Kesari, MD, PhD, director of Neuro-Oncology at UC San Diego Moores Cancer Center. “The initial clinical research for the approval trial demonstrated that, compared to patients who were treated with chemotherapy, patients treated with NovoTTF achieved comparable survival times, had fewer side effects, and reported improved quality of life.”
On average, a patient with GBM survives less than 15 months with optimal treatment and only three to five months without additional effective treatment. The TTF procedure may provide physicians with a fourth treatment option in addition to surgery, radiation therapy and chemotherapy.
TTFs inhibit tumor growth by causing cancerous cells to die. The TTF procedure is delivered using non-invasive, insulated transducer arrays (electrodes) that are placed directly on the skin in the region of the tumor. The hat-like collection of electrodes connects to a portable device which is slightly thicker than a laptop and weighs about six pounds. The device sends a low intensity, alternating electric field into the tumor which prevents the cells from dividing and spreading and causes cancer cells to die.
Glioblastoma multiforme (GBM) is one of the most aggressive primary brain tumors, with a grim prognosis despite maximal treatment. Advancements in the past decades have not significantly increased the overall survival of patients with this disease. The recurrence of GBM is inevitable, its management often unclear and case dependent. In this report, the authors summarize the current literature regarding the natural history, surveillance algorithms, and treatment options of recurrent GBM. Furthermore, they provide brief discussions regarding current novel efforts in basic and clinical research. They conclude that although recurrent GBM remains a fatal disease, the literature suggests that a subset of patients may benefit from maximal treatment efforts. Nevertheless, further research effort in all aspects of GBM diagnosis and treatment remains essential to improve the overall prognosis of this disease.
Introduction
Glioblastoma multiforme is a World Health Organization Grade IV tumor that represents 15 to 20% of all primary intracranial tumors. It is the most malignant astrocytic tumor, with histopathological features that include cellular polymorphism, brisk mitotic activity, microvascular proliferation, and necrosis. Despite advances in imaging techniques and multi-modal treatment options, the overall prognosis of patients with GBM remains grim. The median duration of patient survival is estimated to be between 12 and 18 months with maximal treatment, but those without any intervention die soon after diagnosis. To date, very few cases of curative outcome or long-term survival have been reported. In a large retrospective study, Scott, et al., estimated that 2.2% of the cohort survived for more than 2 years. Overall, the 5-year survival rate is less than 10%, with a final mortality rate of close to 100%.
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Lewis C. Hou, M.D.; Anand Veeravagu, B.S.; Andrew R. Hsu, B.S.; Victor C. K. Tse, M.D., Ph.D
The most commonly reported side effect from NovoTTF is a mild-to-moderate scalp rash, beneath the electrodes. The FDA-approved device is intended as an alternative to standard medical therapy for GBM after surgical and radiation options have been exhausted.
“When all other options have been exhausted, patients are willing to do just about anything to keep the tumor at bay,” said Kesari. “This device gives them an opportunity to fight back, to feel like they are taking an active, hands-on role in their own treatment, and provides tremendous hope.”
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Source: University of California, San Diego Health Sciences