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Skin toxicities associated with tumor treating fields: case based review

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Abstract

The novel anti-mitotic based tumor treating fields (TTFields) is FDA approved for recurrent glioblastoma. Recently the phase III upfront trial combining the Novo TTF-100A device, called Optune, with temozolomide following concurrent radiation therapy and chemotherapy, demonstrated improvement in survival. Wider use of this novel therapy is expected. The most common adverse event is dermatologic, which dominates compared to the next most frequently observed adverse event of headaches, the incidence of which was even in both arms in the phase III registration trial for recurrent glioblastoma. Our case review outlines the presentation, treatment, and outcome of representative patients using TTFields. In summary, preventative strategies to inform and educate patients and operators can prevent many of these dermatological events. Skin toxicity in the setting of concurrent use of TTFields with other therapies such as bevacizumab is an unknown and will need to be closely followed.

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References

  1. Davies AM, Weinberg U, Palti Y (2013) Tumor treating fields: a new frontier in cancer therapy. Ann N Y Acad Sci 1291:86–95. doi:10.1111/nyas.12112

    Article  PubMed  Google Scholar 

  2. Stupp R, Taillibert S, Kanner AA, Kesari S, Steinberg DM, Toms SA, Taylor LP, Lieberman F, Silvani A, Fink KL, Barnett GH, Zhu JJ, Henson JW, Engelhard HH, Chen TC, Tran DD, Sroubek J, Tran ND, Hottinger AF, Landolfi J, Desai R, Caroli M, Kew Y, Honnorat J, Idbaih A, Kirson ED, Weinberg U, Palti Y, Hegi ME, Ram Z (2015) Maintenance therapy with tumor-treating fields plus temozolomide vs temozolomide alone for glioblastoma: a randomized clinical trial. JAMA 314:2535–2543. doi:10.1001/jama.2015.16669

    Article  CAS  PubMed  Google Scholar 

  3. Stupp R, Wong ET, Kanner AA, Steinberg D, Engelhard H, Heidecke V, Kirson ED, Taillibert S, Liebermann F, Dbaly V, Ram Z, Villano JL, Rainov N, Weinberg U, Schiff D, Kunschner L, Raizer J, Honnorat J, Sloan A, Malkin M, Landolfi JC, Payer F, Mehdorn M, Weil RJ, Pannullo SC, Westphal M, Smrcka M, Chin L, Kostron H, Hofer S, Bruce J, Cosgrove R, Paleologous N, Palti Y, Gutin PH (2012) NovoTTF-100A versus physician’s choice chemotherapy in recurrent glioblastoma: a randomised phase III trial of a novel treatment modality. Eur J Cancer 48:2192–2202. doi:10.1016/j.ejca.2012.04.011

    Article  PubMed  Google Scholar 

  4. Mrugala MM, Engelhard HH, Dinh Tran D, Kew Y, Cavaliere R, Villano JL, Annenelie Bota D, Rudnick J, Love Sumrall A, Zhu JJ, Butowski N (2014) Clinical practice experience with NovoTTF-100A system for glioblastoma: The Patient Registry Dataset (PRiDe). Semin Oncol 41(Suppl 6):S4-S13. doi:10.1053/j.seminoncol.2014.09.010

    PubMed  Google Scholar 

  5. Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA, Marosi C, Bogdahn U, Curschmann J, Janzer RC, Ludwin SK, Gorlia T, Allgeier A, Lacombe D, Cairncross JG, Eisenhauer E, Mirimanoff RO (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. New Engl J Med 352:987–996

    Article  CAS  PubMed  Google Scholar 

  6. Westbury C, Hines F, Hawkes E, Ashley S, Brada M (2000) Advice on hair and scalp care during cranial radiotherapy: a prospective randomized trial. Radiother Oncol 54:109–116

    Article  CAS  PubMed  Google Scholar 

  7. NovoTTF-100A With Bevacizumab (Avastin) in Patients with recurrent glioblastoma.ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT01894061?term=bevacizumab+and+novocure&rank=3. Accessed 21 May 2017

  8. Lacouture ME, Davis ME, Elzinga G, Butowski N, Tran D, Villano JL, DiMeglio L, Davies AM, Wong ET (2014) Characterization and management of dermatologic adverse events with the NovoTTF-100A System, a novel anti-mitotic electric field device for the treatment of recurrent glioblastoma. Semin Oncol 41(Suppl 4): S1–S14 doi:10.1053/j.seminoncol.2014.03.011

    Article  PubMed  Google Scholar 

  9. NCI Common Terminology Criteria for Adverse Events (CTCAE), Version 4.0. http://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_8.5x11.pdf

  10. Chen AP, Setser A, Anadkat MJ, Cotliar J, Olsen EA, Garden BC, Lacouture ME (2012) Grading dermatologic adverse events of cancer treatments: the common terminology criteria for adverse events version 4.0. J Am Acad Dermatol 67:1025–1039. doi:10.1016/j.jaad.2012.02.010

    Article  PubMed  Google Scholar 

  11. Grice EA, Segre JA (2011) The skin microbiome. Nat Rev Microbiol 9:244–253. doi:10.1038/nrmicro2537

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Post-approval Study of NovoTTF-100A in Recurrent GBM patients. ClinicalTrials.gov.https://clinicaltrials.gov/ct2/show/NCT01756729?term=ef+19&rank=1. Accessed May 21, 2017

  13. Voegeli D (2013) Moisture-associated skin damage: an overview for community nurses. Br J Community Nurs 18(6):10–12. doi:10.12968/bjcn.2013.18.Sup9.S6

    Google Scholar 

  14. Christopherson KM, Rotondo RL, Bradley JA, Pincus DW, Wynn TT, Fort JA, Morris CG, Mendenhall NP, Marcus RB Jr, Indelicato DJ (2014) Late toxicity following craniospinal radiation for early-stage medulloblastoma. Acta Oncol 53:471–480. doi:10.3109/0284186X.2013.862596

    Article  CAS  PubMed  Google Scholar 

  15. Rudolph R, Utley J, Woodward M, Hurn I (1981) The ultrastructure of chronic radiation damage in rat skin. Surg Gynecol Obstet 152:171–178

    CAS  PubMed  Google Scholar 

  16. Kirson ED, Schneiderman RS, Dbaly V, Tovarys F, Vymazal J, Itzhaki A, Mordechovich D, Gurvich Z, Shmueli E, Goldsher D, Wasserman Y, Palti Y (2009) Chemotherapeutic treatment efficacy and sensitivity are increased by adjuvant alternating electric fields (TTFields). BMC Med Phys 9:1. doi:10.1186/1756-6649-9-1

    Article  PubMed  PubMed Central  Google Scholar 

  17. Salzberg M, Kirson E, Palti Y, Rochlitz C (2008) A pilot study with very low-intensity, intermediate-frequency electric fields in patients with locally advanced and/or metastatic solid tumors. Onkologie 31:362–365. doi:10.1159/000137713

    Article  PubMed  Google Scholar 

  18. Pless M, Droege C, von Moos R, Salzberg M, Betticher D (2013) A phase I/II trial of Tumor Treating Fields (TTFields) therapy in combination with pemetrexed for advanced non-small cell lung cancer. Lung Cancer 81:445–450. doi:10.1016/j.lungcan.2013.06.025

    Article  PubMed  Google Scholar 

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Correspondence to John L. Villano.

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Lukas, R.V., Ratermann, K.L., Wong, E.T. et al. Skin toxicities associated with tumor treating fields: case based review. J Neurooncol 135, 593–599 (2017). https://doi.org/10.1007/s11060-017-2612-8

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  • DOI: https://doi.org/10.1007/s11060-017-2612-8

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