Tumor Treating Fields for Glioblastoma Therapy During the COVID-19 Pandemic

Na Tosha N Gatson; Jill Barnholtz-Sloan; Jan Drappatz; Roger Henriksson; Andreas F Hottinger; Piet Hinoul; Carol Kruchko; Vinay K Puduvalli; David D Tran; Eric T Wong; Martin Glas

doi:10.3389/fonc.2021.679702

Tumor Treating Fields for Glioblastoma Therapy During the COVID-19 Pandemic

Front Oncol. 2021 May 7:11:679702. doi: 10.3389/fonc.2021.679702. eCollection 2021.

Authors

Na Tosha N Gatson^{1

2}, Jill Barnholtz-Sloan³, Jan Drappatz⁴, Roger Henriksson⁵, Andreas F Hottinger⁶, Piet Hinoul⁷, Carol Kruchko⁸, Vinay K Puduvalli⁹, David D Tran¹⁰, Eric T Wong¹¹, Martin Glas¹²

Affiliations

¹ Division of Neuro-Oncology, Department of Neurology, Geisinger Health, Neuroscience & Cancer Institutes, Danville, PA & Geisinger Commonwealth School of Medicine, Scranton, PA, United States.
² Neuro-Oncology, Banner MD Anderson Cancer Center, Phoenix, AZ, United States.
³ Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine & Research and Education, University Hospitals of Cleveland, Cleveland, OH, United States.
⁴ Hillman Cancer Center, Department of Medicine and Neurology, University of Pittsburgh, Pittsburgh, PA, United States.
⁵ Department of Radiation Sciences & Oncology at the University of Ume, Ume, Sweden.
⁶ Departments of Clinical Neurosciences & Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
⁷ Global Medical Affairs, Novocure Inc., New York, NY, United States.
⁸ Central Brain Tumor Registry of the United States (CBTRUS), Hinsdale, IL, United States.
⁹ Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
¹⁰ Lillian S. Wells Department of Neurosurgery and Preston A. Wells, Jr. Brain Tumor Center at the McKnight Brain Institute of the University of Florida College of Medicine, Gainesville, FL, United States.
¹¹ Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
¹² Division of Clinical Neurooncology, Department of Neurology and German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, University Duisburg-Essen, Essen, Germany.

Abstract

Background: The COVID-19 pandemic has placed excessive strain on health care systems and is especially evident in treatment decision-making for cancer patients. Glioblastoma (GBM) patients are among the most vulnerable due to increased incidence in the elderly and the short survival time. A virtual meeting was convened on May 9, 2020 with a panel of neuro-oncology experts with experience using Tumor Treating Fields (TTFields). The objective was to assess the risk-to-benefit ratio and provide guidance for using TTFields in GBM during the COVID-19 pandemic.

Panel discussion: Topics discussed included support and delivery of TTFields during the COVID-19 pandemic, concomitant use of TTFields with chemotherapy, and any potential impact of TTFields on the immune system in an intrinsically immunosuppressed GBM population. Special consideration was given to TTFields' use in elderly patients and in combination with radiotherapy regimens. Finally, the panel discussed the need to better capture data on COVID-19positive brain tumor patients to analyze longitudinal outcomes and changes in treatment decision-making during the pandemic.

Expert opinion: TTFields is a portable home-use device which can be managed via telemedicine and safely used in GBM patients during the COVID-19 pandemic. TTFields has no known immunosuppressive effects which is important during a crisis where other treatment methods might be limited, especially for elderly patients with multiple co-morbidities. It is too early to estimate the full impact of COVID-19 on the global healthcare system and on patient outcomes and the panel strongly recommended collaboration with existing cancer COVID-19 registries to follow CNS tumor patients.

Keywords: COVID-19; elderly; glioblastoma; recurrent glioblastoma; tumor treating fields.