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Neurological Rehabilitation

(Kiosk 4) Early Utilization of Tumor Treating Fields Therapy with Temozolomide and Radiation Therapy for Newly Diagnosed Glioblastoma: A Case Report

Thursday, November 16, 2023
12:45 PM – 2:15 PM CT

    Primary Author(s)

  • Sammy Wu, MD

    Resident
    New York Presbyterian Hospital (Columbia and Cornell) PM&R Program
    New York, New York

    • Co-Author(s)

  • AB

    Akinpelumi Beckley, MBA, MD

    Associate Program Director
    Columbia University Medical Center
    New York, New York

  • Raquel B. Orosa, Other

    Medical Student
    Western University of Health Sciences, College of Osteopathic Medicine of the Pacific
    San Jose, California

  • Bernardo Emanuel Gonzalez, MD

    Resident Physician
    Texas Tech University Health Sciences Center
    Amarillo, Texas

Case Diagnosis: A 71 year old female with newly diagnosed right frontotemporal glioblastoma (GBM) status-post surgical resection was enrolled onto the treatment arm (concomitant radiation therapy, temozolomide, and tumor treating fields therapy) of the EF-32 (TRIDENT) phase 3 randomized clinical trial with neuro-oncology.

Case Description or Program Description: She was later admitted to neurology for gait instability, bilateral lower extremity weakness, and subsequently admitted to acute inpatient rehabilitation.

Setting: Urban Academic Medical Center

Assessment/Results: She did not make functional progress as intended and was discharged to subacute rehabilitation with adjuvant TTFT and temozolomide. She was readmitted from subacute rehabilitation for altered mental status, found to have clinical progression of the glioblastoma, and was ultimately withdrawn from the trial and transitioned to hospice care.

Discussion (relevance): The current management for GBM is maximal safe surgical resection followed by concurrent chemoradiation with further maintenance therapy of temozolomide (TMZ) and tumor treating fields therapy (TTFT). TTFT has been shown to extend overall survival and progression-free survival for patients with newly diagnosed GBM. It is a non-invasive anticancer modality consisting of low-intensity, intermediate-frequency alternating electric fields to disrupt DNA repair, cellular replication and cancer cell proliferation by interfering with the mitotic apparatus. TTFT is delivered via cutaneous transducer arrays configured to provide optimal tumor-site coverage. The most common side effect of TTFT is scalp irritation, including dermatitis and hyperhidrosis.

Conclusions: Physiatrists should be aware of current treatment strategies under investigation for GBM. Research has shown that concurrent administration of TTFT and radiation therapy in treatment of GBM is both feasible and offers biologic synergy. Current work is underway to establish whether a clinical benefit exists for tri–modality therapy in newly diagnosed glioblastoma patients that is comparing chemoradiation with TTFT versus standard chemoradiation with a primary endpoint of median overall survival and secondary endpoints including median progression free survival and overall radiological response.