Tumor treating fields in glioblastoma: long-term treatment and high compliance as favorable prognostic factors

Junjie Wang; Quan Du; Jiarui Chen; Jianjian Liu; Zhaowen Gu; Xiaoyu Wang; Anke Zhang; Shiqi Gao; Anwen Shao; Jianmin Zhang; Yongjie Wang

doi:10.3389/fonc.2024.1345190

Tumor treating fields in glioblastoma: long-term treatment and high compliance as favorable prognostic factors

Front Oncol. 2024 Mar 20:14:1345190. doi: 10.3389/fonc.2024.1345190. eCollection 2024.

Authors

Junjie Wang^#^{1

2}, Quan Du^#^{1

3}, Jiarui Chen^{1

2}, Jianjian Liu^{1

2}, Zhaowen Gu^{1

2}, Xiaoyu Wang^{1

2}, Anke Zhang^{1

2}, Shiqi Gao^{1

2}, Anwen Shao^{1

2}, Jianmin Zhang^{1

2

4

5}, Yongjie Wang^{1

2}

Affiliations

¹ Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
² Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou, China.
³ Department of Neurosurgery, Hangzhou First People's Hospital, Hangzhou, China.
⁴ Brain Research Institute, Zhejiang University, Hangzhou, China.
⁵ Collaborative Innovation Center for Brain Science, Zhejiang University, Hangzhou, China.

^# Contributed equally.

Abstract

Introduction: Tumor treating fields (TTFields) have earned substantial attention in recent years as a novel therapeutic approach with the potential to improve the prognosis of glioblastoma (GBM) patients. However, the impact of TTFields remains a subject of ongoing debate. This study aimed to offer real-world evidence on TTFields therapy for GBM, and to investigate the clinical determinants affecting its efficacy.

Methods: We have reported a retrospective analysis of 81 newly diagnosed Chinese GBM patients who received TTFields/Stupp treatment in the Second Affiliated Hospital of Zhejiang University. Overall survival (OS) and progression-free survival (PFS) were analyzed using Kaplan-Meier method. Cox regression models with time-dependent covariates were utilized to address non-proportional hazards and to assess the influence of clinical variables on PFS and OS.

Results: The median PFS and OS following TTFields/STUPP treatment was 12.6 months (95% CI 11.0-14.1) and 21.3 months (95% CI 10.0-32.6) respectively. Long-term TTFields treatment (>2 months) exhibits significant improvements in PFS and OS compared to the short-term treatment group (≤2 months). Time-dependent covariate COX analysis revealed that longer TTFields treatment was correlated with enhanced PFS and OS for up to 12 and 13 months, respectively. Higher compliance to TTFields (≥ 0.8) significantly reduced the death risk (HR=0.297, 95%CI 0.108-0.819). Complete surgical resection and MGMT promoter methylation were associated with significantly lower risk of progression (HR=0.337, 95% CI 0.176-0.643; HR=0.156, 95% CI 0.065-0.378) and death (HR=0.276, 95% CI 0.105-0.727; HR=0.249, 95% CI 0.087-0.710).

Conclusion: The TTFields/Stupp treatment may prolong median OS and PFS in GBM patients, with long-term TTFields treatment, higher TTFields compliance, complete surgical resection, and MGMT promoter methylation significantly improving prognosis.

Keywords: brain tumor; glioblastoma; retrospective cohort; survival analysis; tumor treating fields.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research was funded by National Natural Science Foundation of China (81502139) and Medical Health Science and Technology Project of Zhejiang Province (2023RC174).