Tumor Treating Fields in the Management of Patients with Malignant Gliomas
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Neuro-oncology (GJ Lesser, Section Editor)
Tumor Treating Fields in the Management of Patients with Malignant Gliomas Ashley P. Ghiaseddin, MD* David Shin, MD Kaitlyn Melnick, MD David D. Tran, MD, PhD* Address * Lillian S. Wells Department of Neurosurgery, University of Florida College of Medicine, 1505 SW Archer Road, Gainesville, FL, 32608, USA Email: [email protected] Email: [email protected]
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Neuro-oncology Keywords Tumor treating fields I CNS tumors I Malignant glioma I Glioblastoma I Alternating electric fields I Optune®
Opinion statement Malignant gliomas remain a challenging cancer to treat due to limitations in both therapeutic and efficacious options. Tumor treating fields (TTFields) have emerged as a novel, locoregional, antineoplastic treatment modality with favorable efficacy and safety being demonstrated in the most aggressive type of malignant gliomas, glioblastoma (GBM). In 2 large randomized, controlled phase 3 trials, the addition of TTFields was associated with increased overall survival when combined with adjuvant temozolomide (TMZ) chemotherapy in patients with newly diagnosed GBM (ndGBM) and comparable overall survival compared with standard chemotherapy in patients with recurrent GBM (rGBM). TTFields target cancer cells by several mechanisms of action (MoA) including suppression of proliferation, migration and invasion, disruption of DNA repair and angiogenesis, antimitotic effects, and induction of apoptosis and immunogenic cell death. Having several MoAs makes TTFields an attractive modality to combine with standard, salvage, and novel treatment regimens (e.g., radiotherapy, chemotherapy, and immunotherapy). Treatment within the field of malignant gliomas is evolving to emphasize combinatorial approaches that work synergistically to improve patient outcomes. Here, we review the current use of TTFields in GBM, discuss MOA and treatment delivery, and consider the potential for its wider adoption in other gliomas.
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Curr. Treat. Options in Oncol.
(2020) 21:76
Introduction DPrimary central nervous system (CNS) cancers account for 1.6% of cancers diagnosed each year worldwide, with gliomas being the most common histological type [1, 2]. The incidence of gliomas, primary brain tumors originating from glial or neuronal precursor cells, increases with age, with highest rates in those 75 years and older [3]. High-grade, malignant gliomas represent 35–45% of primary brain tumors and include glioblastoma (GBM), anaplastic astrocytoma, and anaplastic oligodendroglioma [4]. GBM, constituting 60–70% of malignant gliomas, is a highly aggressive, WHO grade IV glioma with a dismal 5-year survival rate of 6.8% [4–6]. Due to its aggressive and diffusely infiltrative nature, recurrence is common, often leading to rapid tumor spread to other brain regions [6], while the blood-brain barrier (BBB) typically limits metastatic spread beyond
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