Top Line: Impressive results with tumor-treating fields (TTF) for glioblastoma has been creating skeptics for nearly a decade.
The Study: The phase 3 LUNAR trial enrolled 276 patients across 19 countries with metastatic non-small cell lung cancer (NSCLC) refractory to platinum-based chemo receiving next-line therapy with immune checkpoint inhibition (ICI) or docetaxel at physician discretion and prospectively randomized to +/- the addition of TTF. The mets could be de novo or new since platinum chemo. The fields were placed on the thorax with a goal of 18 hours of daily usage, though this was achieved by less than a quarter of patients in the TTF arm. “Array layouts were determined by the investigator based on sex, disease burden, and patient body size” with shifts in placement every 3-4 days to reduce risk of skin irritation. The headline here is that the primary endpoint of overall survival was significantly prolonged from a median of 10 to 13 months with the addition of TTF in the intention-to-treat analysis, which appeared almost exclusively driven by the 8 month absolute survival advantage among the roughly half of patients (n=67) receiving ICI concurrent to TTF. The real head scratcher is the lack of detail regarding these patients’ thoracic versus extrathoracic tumor burdens considering these arrays are only treating the former—notwithstanding any potentiating effects on ICI as touched on by an accompanying editorial. Another is the lack of benefit in the secondary endpoints of progression-free survival (median of roughly 4 months either way) and response rate (17-20% either way).
TBL: In the LUNAR trial, the addition of tumor treating fields to standard therapy for metastatic NSCLC was associated with improved OS. | Leal, Lancet Oncol 2023 & Fennell, Lancent Oncol 2023
The Study: The phase 3 LUNAR trial enrolled 276 patients across 19 countries with metastatic non-small cell lung cancer (NSCLC) refractory to platinum-based chemo receiving next-line therapy with immune checkpoint inhibition (ICI) or docetaxel at physician discretion and prospectively randomized to +/- the addition of TTF. The mets could be de novo or new since platinum chemo. The fields were placed on the thorax with a goal of 18 hours of daily usage, though this was achieved by less than a quarter of patients in the TTF arm. “Array layouts were determined by the investigator based on sex, disease burden, and patient body size” with shifts in placement every 3-4 days to reduce risk of skin irritation. The headline here is that the primary endpoint of overall survival was significantly prolonged from a median of 10 to 13 months with the addition of TTF in the intention-to-treat analysis, which appeared almost exclusively driven by the 8 month absolute survival advantage among the roughly half of patients (n=67) receiving ICI concurrent to TTF. The real head scratcher is the lack of detail regarding these patients’ thoracic versus extrathoracic tumor burdens considering these arrays are only treating the former—notwithstanding any potentiating effects on ICI as touched on by an accompanying editorial. Another is the lack of benefit in the secondary endpoints of progression-free survival (median of roughly 4 months either way) and response rate (17-20% either way).
TBL: In the LUNAR trial, the addition of tumor treating fields to standard therapy for metastatic NSCLC was associated with improved OS. | Leal, Lancet Oncol 2023 & Fennell, Lancent Oncol 2023