Recent FDA Approval an Exciting Step for Mesothelioma Treatment

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The recent approval by the U.S. Food and Drug Administration of NovoTTF-100L — what people will know as Tumor Treating Fields — for mesothelioma has been in the making for quite some time.

I’m already familiar with this treatment approach. I was part of a mesothelioma advisory group which included about 10 doctors around the United States. We provided expert opinions that were reviewed by the company before this therapy was launched.

What’s interesting is that it’s very different from any other modality or any other mesothelioma treatment in general.

It’s a completely novel approach, different from chemotherapy, different from radiation or surgery and different from the immunotherapy that is grabbing all the headlines right now.

Low-Voltage Electrical Field

Not only is Tumor Treating Fields novel, it will be used for a lot of different cancers, not just mesothelioma.

It involves a low-voltage electrical field, distributed with pads placed on the body. It already is being used effectively with brain cancer.

With mesothelioma, the pads are placed on the front or the back of the chest, distributing the electrical current.

The electric current is designed to disrupt the inner components of a cell when it divides. It impedes the way the cell does its division, which should inhibit tumor growth.

Any cell that is dividing quickly — or growing quickly and dividing — will be disrupted by the electrical current.

The good thing is that it fights these rapidly dividing cancer cells. The downside is that normal cells are going to be disrupted, too.

Side Effects Should Be Manageable

There may be some side effects for healthy, rapidly dividing cells, particularly of the gastrointestinal tract, or other intestinal cells that are quick dividers.

But in the brain or the chest, where there are no fast dividing cells, the therapy will preferentially target and disrupt the division of fast-growing cancer cells such as mesothelioma.

This is exciting for mesothelioma because there haven’t been many new therapy developments.

Tumor Treating Fields certainly isn’t a cure. There is no long-term track record to show.

We don’t have any robust scientific data yet that shows it is better than current standard therapy. We are not at that point.

A Much-Needed Second-Line Treatment

Yes, it’s preliminary, but it also is innovative, exciting and safe. It is proven to have some beneficial effects.

At this point, I don’t think it’s going to replace standard of care, but what it can be is an adjunct — an addition.

It could be seen as second-line treatment if standard of care fails. It’s not going to be the first go-to treatment, but an addition to chemotherapy or surgery for patients who have tumor progression.

Distribution Will Take Commitment

The distribution is somewhat cumbersome. There is a large battery pack that is needed, which you have to carry around to make it work properly.

They are large pads going directly on the skin. You have to shave, and you have to change the pads every two to three days. To be effective, the machine has to deliver the electrical field for as long as possible. They recommend having it on 18 to 20 hours a day.

The treatment is generally well-tolerated, although there may be a few skin burns or rashes on the body.

Yes, it’s still in its infancy, and there are still questions out there.

But with an aggressive cancer such as mesothelioma, which has no definitive cure and very few options, this is innovative and something to get excited about.

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Thoracic Surgeon & Contributing Writer

Dr. Fontaine is a thoracic surgeon who joined the Moffitt Cancer Center in 2011 and quickly moved into a leadership role as the director of the Mesothelioma Research and Treatment Center. He also holds an appointment as an associate professor of surgery at the Morsani College of Medicine at the University of South Florida.

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