Is There a Role for Tumor Treatment Fields in Advanced NSCLC?

Corey Langer, MD, Director of Thoracic Oncology, Abramson Cancer Center, Hospital of the University of Pennsylvania, provides an overview on the potential role tumor treatment (TT) fields could have in the treatment of advanced non-small cell lung cancer (NSCLC), a topic he presented at the virtual 2022 Great Debates & Updates in Lung Cancers meeting.

In his presentation, Dr Langer discussed the latest breakthroughs and current research on TTFields in advanced NSCLC, with a focus on new FDA approvals and the major progression-free and overall survival advantages this approach has provided in other indications.

Transcript:

Hi, I'm Corey Langer, I'm the Director of Thoracic Oncology at the Abramson Cancer Center, University of Pennsylvania, and I had the privilege of co-chairing the recent Great Debates & Updates in Lung Cancer, the end of August with Eddie Garon from Los Angeles. I discussed a specifically unique approach or strategy to lung cancer, and this is tumor treatment field. It's certainly not mainstream.

Tumor treatment fields, or TTFields, involve the application of electrodes through a transducer with alternating current, essentially being transmitted to structures underneath those transducers. And this approach is FDA-approved now in primary glioblastoma multiforme, where the combination of tumor treatment fields plus standard radiation and temozolomide actually led to a major progression-free and overall survival advantage compared to conventional radiation and chemotherapy, about a 6 or 7 month advantage.

This approach also has an FDA approval in malignant pleural mesothelioma, where the combination with the pemetrexed and cisplatin led to a median survival about 18 months. That was based on phase 2 data. Approval for a device of this sort is not as rigid or rigorous as it is for new cytotoxics or targeted therapy; it can be based on phase 2 data.

This has opened the door to looking at this approach in other malignancies, including lung cancer. There's an ongoing trial called the LUNAR Trial, in the second-line setting, comparing standard second-line treatment, be it docetaxel or checkpoint inhibitor, with or without tumor treatment fields, with roughly 300 patients or so accrued to that effort.

The last accrual was in November of 2021 so we're waiting the results. A phase 3 effort and other efforts as well, looking at this in combination with pembrolizumab in treatment-naïve individuals with advanced non-small cell lung cancerand high PD-L1 levels. Again, metastatic, but intrathoracic-only disease. If the TTFields are going to work, they will basically work in proximity to the tumor.

These transducers are a bit inconvenient. They need to be worn generally a minimum of 16 to 18 hours a day, which could be cumbersome. There must be an outlet, or at least some sort of battery source to enable these to work. The only downside is the logistics of the application. Beyond that there doesn't appear to be any added toxicity. Maybe some skin rash or irritation underneath the electrodes, but by and large, a very well tolerated approach.

And the jury of course, is out in lung cancer, we're awaiting both phase 2 and phase 3 data, but this is an interesting strategy that can potentially be added to our more standard traditional therapeutic armamentarium, whether it's chemotherapy or immunotherapy.

Source:

Langer, C. Is There a Role For TTFields in Advanced NSCLC? Presented at: Great Debates & Updates in Lung Cancers. Aug 24-26, 2022. Virtual.