Mrugala Maciej M, Engelhard Herbert H, Dinh Tran David, Kew Yvonne, Cavaliere Robert, Villano John L, Annenelie Bota Daniela, Rudnick Jeremy, Love Sumrall Ashley, Zhu Jay-Jiguang, Butowski Nicholas
University of Washington, Seattle, WA
University of Illinois Hospital and Health Sciences System, Chicago, IL.
Semin Oncol. 2014 Oct;41 Suppl 6:S4-S13. doi: 10.1053/j.seminoncol.2014.09.010. Epub 2014 Sep 16.
Recurrent glioblastoma multiforme (GBM) is a highly aggressive cancer with poor prognosis, and an overall survival of 6 to 7 months with optimal therapies. The NovoTTF-100A™ System is a novel antimitotic cancer therapy recently approved for the treatment of recurrent GBM, based on phase III (EF-11) trial results. The Patient Registry Dataset (PRiDe) is a post-marketing registry of all recurrent GBM patients who received NovoTTF Therapy in a real-world, clinical practice setting in the United States between 2011 and 2013. Data were collected from all adult patients with recurrent GBM who began commercial NovoTTF Therapy in the United States between October 2011 and November 2013. All patients provided written consent before treatment was started. Overall survival (OS) curves were constructed for PRiDe using the Kaplan-Meier method. Median OS in PRiDe was compared for patients stratified by average daily compliance (≥75% v<75% per day) and other prognostic variables. Adverse events were also evaluated. Data from 457 recurrent GBM patients who received NovoTTF Therapy in 91 US cancer centers were analyzed. More patients in PRiDe than the EF-11 trial received NovoTTF Therapy for first recurrence (33% v 9%) and had received prior bevacizumab therapy (55.1% v 19%). Median OS was significantly longer with NovoTTF Therapy in clinical practice (PRiDe data set) than in the EF-11 trial (9.6 v 6.6 months; HR, 0.66; 95% CI, 0.05 to 0.86, P = .0003). One- and 2-year OS rates were more than double for NovoTTF Therapy patients in PRiDe than in the EF-11 trial (1-year: 44% v 20%; 2-year: 30% v 9%). First and second versus third and subsequent recurrences, high Karnofsky performance status (KPS), and no prior bevacizumab use were favorable prognostic factors. No unexpected adverse events were detected in PRiDe. As in the EF-11 trial, the most frequent adverse events were mild to moderate skin reactions associated with application of the NovoTTF Therapy transducer arrays. Results from PRiDe, together with those previously reported in the EF-11 trial, indicate that NovoTTF Therapy offers clinical benefit to patients with recurrent GBM. NovoTTF Therapy has high patient tolerability and favorable safety profile in the real-world, clinical practice setting.
复发性多形性胶质母细胞瘤(GBM)是一种侵袭性很强、预后很差的癌症,采用最佳治疗方法时总体生存期为6至7个月。NovoTTF-100A™系统是一种新型抗有丝分裂癌症治疗方法,基于III期(EF-11)试验结果,最近被批准用于治疗复发性GBM。患者注册数据集(PRiDe)是一个上市后注册库,收录了2011年至2013年在美国现实临床实践环境中接受NovoTTF治疗的所有复发性GBM患者的数据。数据收集自2011年10月至2013年11月在美国开始接受商业化NovoTTF治疗的所有成年复发性GBM患者。所有患者在开始治疗前均提供了书面同意书。使用Kaplan-Meier方法为PRiDe构建总生存期(OS)曲线。对按平均每日依从性(≥75%对<75%/天)和其他预后变量分层的患者的PRiDe中位OS进行了比较。还对不良事件进行了评估。分析了在美国91个癌症中心接受NovoTTF治疗的457例复发性GBM患者的数据。PRiDe中因首次复发接受NovoTTF治疗的患者比EF-11试验中的患者更多(33%对9%),且之前接受过贝伐单抗治疗的患者更多(55.1%对19%)。在临床实践(PRiDe数据集)中,NovoTTF治疗的中位OS明显长于EF-11试验(9.6对6.6个月;风险比,0.66;95%置信区间,0.05至0.86,P = 0.0003)。PRiDe中接受NovoTTF治疗的患者的1年和2年OS率比EF-11试验中的患者高出一倍多(1年:44%对20%;2年:30%对9%)。首次和第二次复发与第三次及后续复发相比、高卡诺夫斯基功能状态(KPS)以及之前未使用过贝伐单抗是有利的预后因素。在PRiDe中未检测到意外不良事件。与EF-11试验一样,最常见的不良事件是与应用NovoTTF治疗换能器阵列相关的轻至中度皮肤反应。PRiDe的结果以及之前在EF-11试验中报告的结果表明,NovoTTF治疗为复发性GBM患者带来了临床益处。在现实临床实践环境中,NovoTTF治疗具有较高的患者耐受性和良好的安全性。