By Aleksandar Jankov, M.D. | Photography courtesy of Aleksandar Jankov, M.D.
New treatment option gives hope to brain cancer patients.
In late 2017, Senator John McCain of Arizona announced the grave news of his brain cancer diagnosis. Specifically, he was diagnosed with stage IV glioblastoma, the same brain cancer that stole the young life of Vice President Joe Biden’s son, Beau Biden, in 2015 at age 46.
As a medical oncologist with Baptist Cancer Center in Memphis, Tenn., I treat patients with glioblastoma multiforme, also called GBM for short. While rare, it is, however, the most common type of primary brain cancer in adults with more than 12,500 new cases diagnosed each year in the United States. Personally, my own family was affected by this disease when my aunt died of GBM in 1975.
Even now decades later, we’re faced with the same fatal prognosis – but with a glimmer of new hope. Until 2017, the standard of care involved surgery, chemotherapy and radiation – a similar regimen for many cancers. On April 2, 2017, however, the final results of a pivotal trial study called EF-14 showed clear benefits. Subsequently, the FDA added a treatment called Tumor Treating Fields (TTF), a fourth modality, and more importantly, defined a new standard of care on the same day at the American Association of Cancer Research conference.
TTF is employed specifically in combination with standard chemotherapy, temozolomide (TMZ), and in newly-diagnosed and recurrent cases of GBM.
A new novel treatment involving electrodes called Optune®, a wearable, portable medical device, is classified as durable medical equipment by the FDA. Optune works by creating low-intensity electric fields – called Tumor Treating Fields (TTFields) – which potentially slow or stop cell division leading to cell death. Because TTFields do not enter the bloodstream like a drug, they do not significantly increase TMZ-related side effects for newly diagnosed patients. In clinical trials the most common side effects were scalp irritation from device use and headaches.
The procedure is relatively straight forward. Optune patients wear electrodes on the skull and carry a portable battery pack that weighs less than three pounds. Studies so far indicate that 18 hours per day produces the best results. Studies aren’t complete yet on whether or not wearing it longer has better outcomes; however, we know with certainty that wearing it less than 18 hours isn’t optimal treatment.
Optune is approved for patients 22 years or older. For newly diagnosed patients, Optune is used with the chemotherapy temozolomide after surgery and radiation with TMZ. For patients with tumor recurrence, it can be used alone when surgery and radiation treatment options have been exhausted. In a clinical trial, adding Optune to TMZ was proven to delay GBM tumor growth and extend survival in newly diagnosed patients compared with TMZ alone.
The April 2017 news comes following the findings of a randomized, multi-center, phase III clinical trial which showed impressive results. Approximately half of the people who used Optune with TMZ were alive at two years or longer, compared to 32 percent who were on TMZ alone. In a long-term follow-up of 695 people in the same study, the median survival and median progression-free survival were consistent. Survival at five years was 13 percent for Optune plus TMZ versus five percent for TMZ alone.
Along with Semmes Murphey colleagues, I participated in certification training and now evaluate patients who are potential candidates for Optune.
How does it work exactly? First, I meet with patients to determine if they are a candidate for Optune treatment. The process involves no surgery or hospitalization, and the treatment is administered in a clinic setting. We begin by uploading the MRI images for mapping a patient’s skull to help ensure the proper placement of the electrodes. We place the electrodes and train the patient on how to handle the equipment at home but with our medical supervision.
The success of the treatment in part depends on patient’s motivation to wear the electrodes and willingness to learn how to handle the device. In order to get to the 18-hour mark per day, I encourage wearing it at night while asleep and around the house. This way, patients can enjoy six hours per day daily without the device – to go shopping, have dinner with their families or hit the gym. Unlike chemotherapy, the follow-up is much easier since there is no blood work to monitor. The Optune company sends us a report detailing the patient’s use history so patients can avoid extra office visits, and it also provides close oversight from a nurse.
It is important to raise awareness about Optune and to let Mid-South patients who are diagnosed with GBM know that another local treatment option exists. While this procedure isn’t a cure, we do know it potentially extends life, and more importantly, gives our patients at Baptist Cancer Center a hopeful treatment option.