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Review
. 2023 Sep 4;57(3):279-291.
doi: 10.2478/raon-2023-0044. eCollection 2023 Sep 1.

A review of tumor treating fields (TTFields): advancements in clinical applications and mechanistic insights

Xing Li  1 , Kaida Liu  1 , Lidong Xing  1 , Boris Rubinsky  2
Affiliations
Review

A review of tumor treating fields (TTFields): advancements in clinical applications and mechanistic insights

Xing Li et al. Radiol Oncol. .

Abstract

Background: Tumor Treating Fields (TTFields) is a non-invasive modality for cancer treatment that utilizes a specific sinusoidal electric field ranging from 100 kHz to 300 kHz, with an intensity of 1 V/cm to 3 V/cm. Its purpose is to inhibit cancer cell proliferation and induce cell death. Despite promising outcomes from clinical trials, TTFields have received FDA approval for the treatment of glioblastoma multiforme (GBM) and malignant pleural mesothelioma (MPM). Nevertheless, global acceptance of TTFields remains limited. To enhance its clinical application in other types of cancer and gain a better understanding of its mechanisms of action, this review aims to summarize the current research status by examining existing literature on TTFields' clinical trials and mechanism studies.

Conclusions: Through this comprehensive review, we seek to stimulate novel ideas and provide physicians, patients, and researchers with a better comprehension of the development of TTFields and its potential applications in cancer treatment.

Keywords: clinical applications of TTFields; mechanisms of action of TTFields; tumor treating fields.

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Figures

FIGURE 1.
FIGURE 1.
The process of TTFields clinical trials on typical tumor types.
FIGURE 2.
FIGURE 2.
Clinical trials of TTFields treatment on glioblastoma multiforme (GBM) EF-11= controlled randomized phase III trial EF-11; EF-14 = phase III trial EF-14; OS = overall survival; PFS = progression-free survival; TMZ = temozolomide
FIGURE 3.
FIGURE 3.
Clinical trials of TTFields treatment on malignant pleural mesothelioma and non-small cell lung cancer (NSCLC). EF-15 phase I/II = clinical trial NCT00749346; LUNAR = clinical trial NCT02973789; OS = overall survival; PFS = progression-free survival; STELLAR = clinical trial NCT 02397928
FIGURE 4.
FIGURE 4.
Clinical trials of TTFields treatment on platinum-resistant ovarian cancer (PROC), pancreatic adenocarcinoma (PAC) and hepatocellular carcinoma (HCC). AEs = adverse events; INNOVATE = a phase I/II clinical trial (EF-22, NCT02244502) and a phase III randomized controlled clinical trial (EF-28, NCT03940196); OS = overall survival; QoL = quality of life (QoL); PANOVA = a phase I/II clinical trial (EF-20, NCT01971281) and a larger randomized clinical phase III (EF-27, NCT03377491); PFS = progression-free survival
FIGURE 5.
FIGURE 5.
Researches on potential mechanisms of TTFields action.
See this image and copyright information in PMC

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