Brain tumor patients face rarely get access to effective new treatments for their disease. While surgical techniques have advanced and many promising treatment approaches make their way through clinical trials, the fact is that development of effective new treatments for brain tumors has been slower than for other common cancers. Yet one seemingly surprising source of hope for patients and neuro-oncologists is not a drug or a surgical technique at all, but rather a piece of electromagnetic headgear called Novocure Optune that the FDA has approved to slow tumor growth.
As patients and caregivers move through clinics and meet others in the brain cancer community, they are likely to encounter patients who have a set of nodes on their heads with wires leading off to a device at their waist. Some might guess this an alternative or unproven treatment employed by the desperate, but in fact the Optune device is increasingly seen as one of the most useful weapons mainstream neuro-oncologists have in their arsenal today.
So just what is this thing, and how does it work?
Dr. Eilon Kirson, chief scientist with the device’s manufacturer Novocure, explains that the device prevents cell division in an area of the by moving a steady current of electricity across it. Patients wear electrical nodes on the head as they go about their daily life. All the while, the device creates low-intensity, painless fields of electricity between the nodes. These fields work in two ways to keep cells (both tumor and non-tumor) from dividing. Since a tumor consists of uncontrolled cell division, this process interrupts tumor growth.
Unlike cells in other parts of the body, healthy brain cells don’t need to divide – they largely develop in the womb and remain through life. For this reason, the brain is an ideal environment for Optune’s tumor treating fields to be used against cancer.
“The survival benefit is very clear. 20 years ago, a negligible number made it to five-year survival. Today 13% make it to 5 years with temozolomide plus Optune,” Kirson said.
Today only four treatments are approved by the FDA for glioblastoma (GBM): surgery, radiation, chemotherapy, and Optune. Optune is the newest of these, winning approval for recurrent GBM in 2011 and newly diagnosed GBM in 2015. Clinical trials are underway for other types of brain tumor.
Yet despite its newness, a series of successful studies has in short order led to Optune being considered a frontline treatment for GBM.
“If you come into your doctor’s office and get the bad news from your doctor that you have glioblastoma, ideally your options would have Optune up there with surgery, radiation, TMZ (temozolomide). If I were a patient, I would expect my doctor to explain this to me: these are my four best options for being the 1 in 7 who lives beyond five years. I really think anyone who’s up to date on literature, who follows developments neuro-oncology would know about Optune,” Dr. Kirson said.
Living with Optune
Patients who use Optune do learn that the device is expected to become a part of their daily life. The treatment requires that they use the device as continuously as possible. They are expected to go about their business with the nodes attached and the device powered on – while eating, sleeping, etc. Nodes are conspicuous although they can be safely worn with a hat or other head covering. The rest of the device, which once required a large backpack to carry now weighs just over two pounds and fits in a pouch – nevertheless it is something patients must commit to bringing everywhere with them. Nodes remain on the head all the time, for several days at a time before being changed.
On the other hand, side effects are mild compared to radiation or chemotherapy, consisting mainly of skin irritation at the site of the nodes and headaches. According to Dr. Kirson, many patients found find there is empowerment in using the device – since they manage it at home themselves, wearing it helps them feel that they’re doing all they can to maintain their quality of life in the face of diagnosis.
“If you want to fight for survival and take that extra step to live longer, you should be adding Optune. That’s the main message the physician should be saying,” Dr. Kirson said.