Top Line: We all know the concept of tumor-treating fields is just…weird, so it continues to test the waters for only the most intractable diseases.
The Study: The international phase 3 PANOVA-3 trial randomized 571 patients receiving upfront Gem/Abraxane for unresectable locally-advanced pancreatic cancer to +/- the addition of TTF until disease progression. Patients in the TTF arm were encouraged to use it at least 75% of the day, and median usage was 62%. Ultimately, the TTF arm saw a significant, albeit modest, improvement in median overall survival from 14 to 16 months. Also improved was the secondary endpoint of pain-free survival (defined as time until ≥20-point increase in patient-reported pain) from 9 to 15 months, interesting given no demonstrated improvement in local control. Is this practice-changing? Maybe, maybe not. In patients whose survival remains measured in months–not years– reasonably few may sign up to wear a device 18 hours per day, 7 days per week for their remaining days. And on top of that, three-quarters of patients in the TTF arm reported mild-moderate skin reaction. Nonetheless, the demonstrated efficacy in at least a small subset of patients leaves the incorporation of TTF into the evolving landscape of both local (oh, hey, ablative radiation) and systemic (e.g., mFOLFIRINOX and/or KRAS inhibitors) therapies an open intriguing question.
TBL: The addition of TTF prolonged median survival by 2 months for patients receiving Gem/Abraxane for unresectable pancreatic cancer. | Babiker, J Clin Oncol 2025
The Study: The international phase 3 PANOVA-3 trial randomized 571 patients receiving upfront Gem/Abraxane for unresectable locally-advanced pancreatic cancer to +/- the addition of TTF until disease progression. Patients in the TTF arm were encouraged to use it at least 75% of the day, and median usage was 62%. Ultimately, the TTF arm saw a significant, albeit modest, improvement in median overall survival from 14 to 16 months. Also improved was the secondary endpoint of pain-free survival (defined as time until ≥20-point increase in patient-reported pain) from 9 to 15 months, interesting given no demonstrated improvement in local control. Is this practice-changing? Maybe, maybe not. In patients whose survival remains measured in months–not years– reasonably few may sign up to wear a device 18 hours per day, 7 days per week for their remaining days. And on top of that, three-quarters of patients in the TTF arm reported mild-moderate skin reaction. Nonetheless, the demonstrated efficacy in at least a small subset of patients leaves the incorporation of TTF into the evolving landscape of both local (oh, hey, ablative radiation) and systemic (e.g., mFOLFIRINOX and/or KRAS inhibitors) therapies an open intriguing question.
TBL: The addition of TTF prolonged median survival by 2 months for patients receiving Gem/Abraxane for unresectable pancreatic cancer. | Babiker, J Clin Oncol 2025