HRQoL Data Add Support For TTFields In Glioblastoma Patients

The addition of tumour-treating fields therapy to temozolomide extends deterioration-free survival in newly diagnosed glioblastoma patients without a major impact on health-related quality of life

medwireNews: Glioblastoma patients undergoing temozolomide therapy after radiochemotherapy derive a significant benefit in deterioration-free survival from the use of tumour-treating fields (TTFields) therapy at little cost to their health-related quality of life (HRQoL), suggest further findings from the EF-14 trial.

The study’s final progression-free survival results   showed a significant gain for patients who received 6–12 cycles of maintenance temozolomide plus low-intensity 200 kHz frequency alternating electric fields therapy applied for at least 18 hours per day versus temozolomide alone.

The secondary analysis, now published in JAMA Oncology, found that the only significant HRQoL difference between the temozolomide plus TTFields and the temozolomide alone treatment groups was itchy skin, which the investigators explain is “a direct and expected consequence of the placement of the transducer rays on the patients’ scalp.”

Specifically, TTFields-treated patients experienced a significant and clinically relevant greater worsening of this symptom at 3, 6 and 9 months than those given temozolomide only, although there was no difference at 12 months.

Use of TTFields was also associated with significantly longer deterioration-free survival than temozolomide alone in terms of global health (4.8 vs 3.3 months), and physical (5.1 vs 3.7 months) and emotional functioning (5.3 vs 3.9 months). This was also true for pain (5.6 vs 3.6 months) and leg weakness (5.6 vs 3.9 months) and the researchers believe these outcomes are “likely related to improved progression-free survival.”

Martin Taphoorn, from Haaglanden Medical Center in The Hague, the Netherlands, and co-authors therefore conclude: “When considering the net clinical benefit, improved survival without a negative influence on health-related quality of life supports the addition of tumor-treating fields to standard treatment in patients with glioblastoma.” 

Lia Halasz (University of Washington, Seattle, USA) and Timur Mitin (Oregon Health and Sciences University, Portland, USA) describe the apparent absence of HRQoL burden from the continuous wearing of the transducers and carriage of the heavy battery pack as “comforting” but note the trial participants were a highly selected group of motivated patients who may not be representative of the general glioblastoma patient population. 

“Many do not want the physical and visual cues that may remind them of their life-altering, life-limiting diagnosis”, they write in an accompanying comment, comparing the potential for distress from the TTFields equipment to that of alopecia in breast cancer patients. 

“Yet, in order for TTFields to gain popularity, it is not enough for patients alone to become more accepting; physicians will also need to be open to novel treatments”, the commentators observe. 

“It is somewhat incongruous that we are so concerned about a therapy that has few adverse effects when many of our newly approved active cancer molecules are associated with reduced patient safety even if they improve overall survival or HRQoL.” 

Lia Halasz and Timur Mitin conclude: “Overall, these new data on HRQoL, coupled with the overall survival results of EF-14, strengthen the inclusion of TTFields as an important treatment for our patients with [glioblastoma] if they are willing to wear the device.” 

References

Taphoorn MJB, Dirven L, Kanner AA, et al. Influence of treatment with tumor-treating fields on health-related quality of life of patients with newly diagnosed glioblastoma. A secondary analysis of a randomized clinical trial.JAMA Oncol; Advance online publication 1 February 2018 . doi:10.1001/jamaoncol.2017.5082

Halasz LM, Mitin T. Tumor-treating fields. Answering the concern about quality of life. JAMA Oncol; Advance online publication 1 February 2018 . doi:10.1001/jamaoncol.2017.5062

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