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Electric cap can kill brain cancer cells

July 22, 2017

One of the few treatments shown to prolong the lives of patients with brain tumors like Sen. John McCain’s is a mesh-like cap that zaps the brain with a low-level electric field. But cancer doctors have been slow to embrace it, and few patients use it.

The medical device, known as Optune and made by Novocure, was shown in a large clinical trial to prolong survival when used by patients with newly diagnosed glioblastoma, the type of aggressive brain tumor just found in McCain. The Food and Drug Administration approved Optune for this use in 2015, making it the first treatment for newly diagnosed brain cancer to reach the market since 2005.

But Optune is controversial. The science behind the device is not well-understood. Some doctors have raised questions about the strength of the clinical data used to secure FDA approval. Patients have to wear the Optune cap over their shaved scalp for a minimum of 18 hours per day, while tethered to a portable battery pack and generator that produce a cancer-killing electric field.

“Some patients are willing to put up with this, and others prefer not to,” said Dr. David Reardon, clinical director at the Center for Neuro-Oncology at Dana-Farber Cancer Institute in Boston.

In a clinical trial of nearly 700 patients with newly diagnosed glioblastoma, the combination of Optune and the chemotherapy temozolomide demonstrated a median overall survival of 21 months compared with 16 months for patients treated with the drug alone.

Patients wore the device for two years, after which 41 percent were still alive compared with 31 percent of the patients receiving only chemotherapy. After five years of follow up, 13 percent of the Optune-treated patients were alive compared to 5 percent of patients treated with just chemotherapy.

“This is a modest benefit, not a home run,” said Reardon, although he added that support for Optune among doctors who treat glioblastoma has increased because the survival benefit attributed to the device has been maintained with longer follow-up.

“This is much more than a modest benefit, it’s a huge jump in two-year survival,” countered Dr. Suriya Jeyapalan, a medical neuro-oncologist at Tufts Medical Center in Boston. She participated in the Novocure clinical trial and now prescribes Optune to about half of her glioblastoma patients.

The business of Optune has been modest to date, but growing. At the end of 2016, U.K.-based Novocure reported just under 1,100 glioblastoma patients in the U.S. and Europe were being treated with Optune, up from 600 patients at the end of 2015.

Optune sales totaled $83 million in 2016, a 151 percent increase over 2015, the company reported. Optune costs $21,000 per month, covered by private insurance but not Medicaid, although Novocure is appealing that decision.

Should McCain consider treatment with Optune?

“Absolutely,” said Jeyapalan. “If he wants to maximize the quantity and quality of his life, there are only two things — Optune and temozolomide — that have proven to do that.”

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