Perspective on the EF-14 trial and its implications for the role of tumor-treating fields in the management of glioblastoma

Tumor-treating fields (TTFields) is a novel treatment modality that has been recently approved for the treatment of patients with both newly diagnosed and recurrent glioblastoma multiforme (GBM). This approach comprises of a portable device delivering low intensity and intermediate frequency alternating electric fields aiming at selectively inhibiting cellular proliferation of neoplastic cells. Promising findings of recent large scale multinational clinical trials have indicated that TTFields have a favorable safety profile without causing significant adverse effects on patients. One of these trials reported that GBM patients treated with TTFields had significantly prolonged overall and progression free survival (PFS) compared to patients receiving standard chemotherapy. Moreover, improved quality of life with better cognitive and emotional functions was observed in TTFields treated cohorts of patients. Conventional MR imaging using modified RANO criteria is currently considered as the standard protocol for assessing disease progression and treatment response in patients with GBM. Using physiological and metabolic MR imaging, we recently reported our experience with evaluating treatment response to TTFields in newly diagnosed GBM. We believe that additional studies evaluating the treatment response of TTFields will have a profound impact on the clinical use of this novel and effective treatment modality for GBM patients.