Tuesday, May 29, 2012

NovoTFF-100A; A Fancy Way of Saying Brain Tumor Treatment Made Easy

          The new novocure NovoTFF system was officially announced in a press release one year ago May 29, 2012; today, the therapy data collected over the last year will be announced at the annual Scientific Meeting of the American Society of Clinical Oncology (Sacramento Bee).  The system claims to be the future of tumor reduction treatment, and honestly, it does sound like quite the revolution.  The idea behind the system is much more treatment based than "curing" based.  The treatment "contains" the tumor by creating an electrical field at the site, preventing the cancerous cells from dividing, and therefore, the tumor from growing (Ostrovsky).  The draw to the device is the fact that it is supposed to be used throughout the patient's daily life and will not impede their normal activities.  
          Is this the end all cancer treatment program the the Novocure company claims it to be?  Does it merely extend the patient's life a little longer or does it actually allow for tumor and overall cancer reduction?  These are the questions I hope to explore and attempt to answer.
Overview of the Treatment/ Machine:

How the Treatment Works:
          The 100A unit, the first piece of technology built to embrace the Novocure style of treatment, targets  Glioblastoma Multiforme brain tumors in adult patients.  The unit works on the principles pioneered by ProfessorYoram Palti; a cell’s physical properties can serve as targets for an anti-cancer therapy.  TFF therapy takes advantage of the special characteristics, geometrical shape, and rate of dividing cancer cells, which make the cancerous cells susceptible to the "effects of alternating electric fields by altering the tumor cell polarity" (Novocure).  Each cell type has to receive a different frequency of electromagnetic impulse much like each tumor receives different treatment in a contour radiation treatment.  The magnetic field created is most efficient in attacking cancerous cells while they are going through the process of replication, mitosis, at both the prometaphase and the Telophase/Cytokenisis stages.  It does so by disallowing the mitotic spindle from properly forming during prometaphase, and then causing the cell to lyse during the Telpphase/Cytokenisis stage (Novocure).  The video below actually shows a tumor cell exploding due to an electric field manipulation of the site:

The Machine:
          The TFF 100A unit was designed to deliver non-invasive treatment, focused on anti-mitotic goals, that doesn't impede the patient's life.  The Novocure website is plastered with information about and examples of people in their clinical trials who did not have to alter their lifestyles to make progress in the fight against their cancer.  The machine consists of a six pound box and chords leading to insulated electromagnetic nodes placed at the site of the tumor, in this case on the head for treatment of Glioblastoma Multiforme brain tumors, as shown by the image on the right.  The compact device is meant to be used throughout the day, during normal life style activities (Novocure).

Clinical Trials: Does it Work?
          The device/treatment is being tested on lung cancer as well as both new cases and reoccurring cases of Glioblastoma Multiforme brain cancer; I chose to look at the trials that have been conducted on reoccurring brain cancer, as the testing is in much later stages than in the other two clinical trial sets.  The trial, titled "A prospective, randomized, open-label, phase III clinical trial of NovoTTF-100A versus best standard of care chemotherapy in patients with recurrent glioblastoma" was published in the Journal of Clinical Oncology and is easily found on the Novocure company website, which leads me to believe that the company truly believes in their product and that even before combing through their trial, I have come to think that their must be great data to support their treatment.
          The study was conducted as so;  Patients with reoccurring Glioblastoma were supplied a TFF 100A unit to be used twenty to twenty four hours a day, seven days a week, or given what each of their physicians were to judge as "Best Standard Chemotherapy".  The sample was size was not exactly extensive, at 237 patients, but it also seems large enough to be able to show significant results without creating much doubt due to sample size.  The results shown in the study seemed to favor the novocure system over the best standard chemotherapy in multiple ways.  The only place that the TFF100A unit was seen as inferior was during the comparison of treatment times.  The patients using the electromagnetic, non-invasive treatment, underwent the process for a mean time of 4.4 months, where as the patients receiving chemotherapy only had to go through the process for a mean time of 2.3 months(Stupp, Kanner, Engelhard, et al.).  Although the novocure system had to be used for a longer amount of time, patients reported having many fewer, and less severe side effects than those receiving chemotherapy, with the largest and most sever occurrence being a mild to moderate skin rash at the site of the electrodes, experienced by 17% of patients (Stupp, Kanner, Engelhard, et al.).  Most importantly, alongside being less aggressive and creating less side effects, the Novocure TFF-100A treatment system actually had a significantly larger  1-year survival rate of 23.6% vs. 20.8% seen in chemotherapy patients(Stupp, Kanner, Engelhard, et al.).  Although this seems to a small increase in rate, it is still a huge step forward as one has to keep in mind that these are all patients with reoccurring cancer, which is usually seen as a death sentence.  The new system has not only increased the rate of survival, but has done so while significantly lessening the side effects.  Thus far, the treatment has been successful.

          This new system of treatment may, in fact, just be the way of the future.  Although it is not the holy grail discovery of a permanent, all encompassing cure for cancer, it seems like a huge leap in the right direction.  It gives doctors and patients alike a fourth option to be used alongside the age old, original three methods of treatment;cutting, burning, and poisoning.  As a patient looking at the four options while sitting in the office of an oncologist, the combination of this new, novel treatment and surgery would be much more appetizing than the alternative pairings of surgery and chemo, or surgery and radiation.  Although much more work needs to be done in order to get these therapies available to the public, nuvocure seems confident that their technology will improve cancer treatment in not only brain cancer, but other types of tumor based cancers as well, including lung cancer in which human clinical trials have already begun.  It will be extremely interesting to see if, in the coming years, this style of treatment, or immunotherapies will be the way of the future in terms of increasing cancer survival rates and reducing overall side affects.


Novocure, . "Novocure™ to Present NovoTTF™ Therapy Data at the 2012 Annual Scientific Meeting of the American Society of Clinical Oncology". Sacramento Bee. 29 May 2012:Web. 29 May. 2012. <http://www.sacbee.com/2012/05/29/4522875/novocure-to-present-novottf-therapy.html>.

"Novocure." Novocure. Novocure, 10/May/2012. Web. 29 May 2012. <http://www.novocure.com>.

Ostrovsky, Gene. "NovoTTF-100A for Treatment of Brain Tumors Wins FDA Clearance." medGadget. 15 Apr 2011: n. page. Web. 29 May. 2012. 

Stupp, R., A. Kanner, H. Engelhard, et al. "A prospective, randomized, open-label, phase III clinical trial of NovoTTF-100A versus best standard of care chemotherapy in patients with recurrent glioblastoma.." American Society of Clinical Oncology. 28.18 (2010): n. page. Web. 29 May. 2012. <http://www.virtualtrials.com/pdf/novocure/2010ASCOAbstract.pdf>.