TTFields therapy: a new treatment modality for metastatic NSCLC

Tumour treating fields (TTFields) therapy is a non-invasive, locally, and continuously delivered cancer treatment. Adding TTFields therapy to second-line standard-of-care in patients with metastatic non-small cell lung cancer (NSCLC) improved overall survival in the phase 3 LUNAR study.

Despite recent advances, metastatic NSCLC remains largely incurable. Platinum-based chemotherapy with immune checkpoint inhibitors (ICI) is the standard first-line therapy, but 5-year survival is only 9%, highlighting the need for new effective treatments [1].

TTFields therapy is a locally delivered cancer treatment modality using electric fields. TTFields therapy has an anti-mitotic effect by inducing immunogenic cell death and enhancing antitumour immune responses [2]. Prof. Ticiana Leal (Emory University, GA, USA) presented the result of the phase 3 LUNAR trial (NCT02973789), which evaluated the safety and efficacy of TTFields therapy in patients with metastatic NSCLC who progressed on or after first-line platinum-based therapy [3].

The study randomised 276 participants 1:1 to receive standard-of-care (investigator’s choice of ICI or docetaxel) or standard-of-care plus TTFields therapy. TTFields therapy was continuously delivered by a portable device. The primary endpoint of the study was overall survival (OS); key secondary endpoints were OS in the standard-of-care subgroups (ICI-treated vs docetaxel-treated).

TTFields therapy significantly improved median OS compared with standard-of-care only (13.2 vs 9.9 months; HR 0.74; P=0.035). OS benefit with TTFields therapy over standard-of-care was most prominent in ICI-treated patients (18.5 vs 10.8 months; HR 0.63; P=0.030). In the docetaxel-treated patients, OS benefit was not significantly different (11.1 vs 8.9 months; HR 0.87). Progression-free survival did not differ between both treatment arms.

The most frequent TTFields treatment-related adverse event was grade 1–2 dermatitis (41%). Treatment-related adverse events leading to discontinuation of treatment were observed in 36% of patients in the TTFields therapy arm versus 20% in the standard-of-care arm.

“LUNAR met its primary endpoint with a statistically and clinically significant improvement in median OS with TTFields therapy added to standard-of-care, in particular in patients treated with ICI,” concluded Prof. Leal. “Therefore, TTFields therapy could be considered as part of second-line standard-of-care for metastatic NSCLC.”

1. Lung Cancer–Non-Small Cell: Statistics. Accessed on 4 July 2023 from: https://www.cancer.net/cancer-types/lung-cancer-non-small-cell/statistics.
2. Barsheshet Y, et al. Int J Mol Sci. 2022;23:14073.
3. Leal T, et al. Tumor Treating Fields (TTFields) therapy with standard of care (SOC) in metastatic non-small cell lung cancer (mNSCLC) following platinum failure: Randomized, phase 3 LUNAR study. Abstract LBA9005, ASCO Annual Meeting 2023, 2–6 June, Chicago, USA.

 

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Posted on 2 August 202315 February 2024