Recurrent GBM

Recurrent GBM Study Design

In recurrent GBM,

The efficacy and safety of Optune Gio monotherapy were compared with physician’s choice of chemotherapy.

EF-11 phase 3 pivotal trial—Optune Gio vs physician’s choice of chemotherapy, including bevacizumab28

Flowchart showing randomization of 237 recurrent GBM patients to Optune Gio monotherapy or chemotherapy.

Approximately 20% of patients in each EF-11 treatment arm had failed a prior bevacizumab-containing regimen28

 

Key efficacy endpoints1,28

  • Primary endpoint
    • OS
  • Secondary endpoints
    • PFS
    • 1-year survival
    • PFS6
    • Median time to progression
    • Radiological response rates
    • QoL

 

Key Inclusion Criteria1, 28

  • Not a candidate for further radiotherapy or additional resection of residual tumor

 

Key inclusion criteria1,3

  • Underwent maximal debulking surgery and radiotherapy concomitant with TMZ
  • KPS ≥70

 

Key exclusion criteria1

  • Progressive disease per Macdonald criteria, following concomitant chemoradiation
  • Implanted electronic medical devices
  • Significant comorbidities at baseline that would prevent maintenance TMZ treatment
  • Infratentorial tumor(s)

EF-11: Key baseline characteristics, intent to treat (ITT) population1,28

Patient characteristics comparison table for Optune Gio versus chemotherapy, including age, gender, and prior therapy.

Single agent or combination regimens29

Chemotherapy regimen table showing distribution of drugs used in study, including bevacizumab and irinotecan.

Recurrent GBM Efficacy

In recurrent GBM,

EF-11 was a randomized trial that showed Optune Gio monotherapy demonstrated efficacy comparable to that of chemotherapy28*

Curve graph comparing the median overall survival of patients using Optune Gio versus chemotherapy at 6 and 6.6 months.

Median OS was similar at 6.6 months with Optune Gio monotherapy and 6.0 months with physician’s choice of chemotherapy*

Twice as many patients responded to Optune Gio vs physician’s choice of chemotherapy30

Comparison table of response rates for Optune Gio versus chemotherapy, including complete and partial responses, and median time to response.

OS correlated with treatment usage in a subgroup analysis of patients treated with Optune Gio31†

Bar chart comparing median overall survival for patients using Optune Gio more than 18 hours versus less than 18 hours per day.
  • OS was significantly higher in patients who received Optune Gio for ≥18 hours per day (n=92) vs those who received therapy for <18 hours per day (n=28), 7.7 months vs 4.5 months, respectively31
  • Median usage was 86% (range 41%-98%) of the time in each treatment month, translating into a mean use of 20.6 hours per day28

Recurrent GBM Quality of Life

In recurrent GBM,

Optune Gio monotherapy demonstrated quality of life results comparable to that of chemotherapy*

Quality of Life: Overall Results28

Bar chart comparing baseline to 3-month change in functioning scores for Optune Gio versus chemotherapy, highlighting improvements in cognitive, emotional, and physical functioning.
  • No clinically meaningful differences were found in global health and social functioning28
  • Data collected by EORTC QLQ-C30 questionnaire28

Fewer treatment-related adverse events occurred in patients treated with Optune Gio1

Quality of life: Common cancer treatment-related adverse events28

Bar chart of symptom score changes from baseline to 3 months, comparing Optune Gio with chemotherapy, showing improvement in constipation and diarrhea with Optune Gio.
  • Optune Gio monotherapy was associated with more favorable changes in patient-reported symptoms28
  • Data collected by EORTC QLQ-C30 questionnaire28

Recurrent GBM Safety

In recurrent GBM,

Patients on Optune Gio experienced fewer systemic AEs than patients on chemotherapy alone1,28

Comparison table of adverse event incidence for Optune Gio versus chemotherapy, covering hematologic and gastrointestinal disorders.
  • The most common (≥10%) AEs seen with Optune Gio monotherapy were medical device site reaction and headache32
  • The following AEs were considered related to Optune Gio: medical device site reaction, headache, malaise, muscle twitching, fall, and skin ulcer28
  • In EF-11, 16% of patients experienced a grade 1/2 medical device site reaction28
  • Mild-to-moderate skin irritation, the most common device-related side effect with Optune Gio, was typically manageable, reversible, and did not result in treatment discontinuation28

Improved safety vs chemotherapy

  • Significantly fewer of the systemic AEs associated with chemotherapy, including gastrointestinal side effects, hematological side effects, and infections, were observed with Optune Gio1

*Therapy options were the physician’s best choice for chemotherapy. The best available therapy was prescribed according to local practice and depending on prior treatment exposure.28

 

From a post hoc analysis

 

CT, computed tomography; GBM, glioblastoma; KPS, Karnofsky Performance Score; MRI, magnetic resonance imaging; OS, overall survival; PFS, progression-free survival; PFS6, progression-free survival at 6 months; QoL, quality of life; BCNU, carmustine; CCNU, lomustine; PCV, procarbazine, lomustine (CCNU), and vincristine; OS, overall survival; EORTC QLQ-C30, European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30; AEs, adverse events.

 

 

Indications For Use

Optune Gio® is intended as a treatment for adult patients (22 years of age or older) with histologically confirmed glioblastoma multiforme (GBM).

 

Optune Gio with temozolomide is indicated for the treatment of adult patients with newly diagnosed, supratentorial glioblastoma following maximal debulking surgery, and completion of radiation therapy together with concomitant standard of care chemotherapy.

 

For the treatment of recurrent GBM, Optune Gio is indicated following histologically or radiologically confirmed recurrence in the supratentorial region of the brain after receiving chemotherapy. The device is intended to be used as a monotherapy and is intended as an alternative to standard medical therapy for GBM after surgical and radiation options have been exhausted.
 

Important Safety Information

Contraindications

Do not use Optune Gio in patients with an active implanted medical device, a skull defect (such as, missing bone with no replacement), or bullet fragments. Use of Optune Gio together with implanted electronic devices has not been tested and may theoretically lead to malfunctioning of the implanted device. Use of Optune Gio together with skull defects or bullet fragments has not been tested and may possibly lead to tissue damage or render Optune Gio ineffective.

 

Do not use Optune Gio in patients that are known to be sensitive to conductive hydrogels. In this case, skin contact with the gel used with Optune Gio may commonly cause increased redness and itching, and rarely may even lead to severe allergic reactions such as shock and respiratory failure.

 

Warnings and precautions

Optune Gio can only be prescribed by a healthcare provider that has completed the required certification training provided by Novocure (the device manufacturer).

 

Do not prescribe Optune Gio for patients that are pregnant, you think might be pregnant or are trying to get pregnant, as the safety and effectiveness of Optune Gio in these populations have not been established.

 

The most common (≥10%) adverse events involving Optune Gio in combination with temozolomide were thrombocytopenia, nausea, constipation, vomiting, fatigue, medical device site reaction, headache, convulsions, and depression.

 

The most common (≥10%) adverse events seen with Optune Gio monotherapy were medical device site reaction and headache.
The following adverse reactions were considered related to Optune Gio when used as monotherapy: medical device site reaction, headache, malaise, muscle twitching, fall, and skin ulcer.

 

Use of Optune Gio in patients with an inactive implanted medical device in the brain has not been studied for safety and effectiveness, and use of Optune Gio in these patients could lead to tissue damage or lower the chance of Optune Gio being effective.

 

If the patient has an underlying serious skin condition on the scalp, evaluate whether this may prevent or temporarily interfere with Optune Gio treatment.

Please click here to see the Optune Gio® Instructions For Use for complete information regarding the device’s indications, contraindications, warnings, and precautions.

 

References

1. Optune Gio. Instructions For Use. Novocure; 2023. 2. Taphoorn MJB, Dirven L, Kanner AA, et al. Influence of treatment with tumor-treating fields on health-related quality of life of patients with newly diagnosed glioblastoma: a secondary analysis of a randomized clinical trial. JAMA Oncol. 2018;4(4):495-504. doi:10.1001/jamaoncol.2017.5082 3. Stupp R, Taillibert S, Kanner A, et al. Effect of tumor-treating fields plus maintenance temozolomide vs maintenance temozolomide alone on survival in patients with glioblastoma: a randomized clinical trial. JAMA. 2017;318(23):2306-2316. doi:10.1001/ jama.2017.18718 4. Novocure Data on File US-DOF-0035. 5. Novocure Data on File US-DOF-0038. 6. Stupp R, Idbaih A, Steinberg DM, et al. Prospective, multi-center phase III trial of tumor treating fields together with temozolomide compared to temozolomide alone in newly diagnosed glioblastoma. Presented at: 2017 Annual Meeting of the American Association for Cancer Research; April 1-5, 2017; Washington, DC. Oral presentation LBA AACR CT007. 7. Stupp R, Mason WP, van den Bent MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352(10):987-996. doi:10.1056/NEJMoa043330 8. Sulman EP, Ismaila N, Armstrong TS, et al. Radiation therapy for glioblastoma: American Society of Clinical Oncology Clinical Practice Guideline endorsement of the American Society for Radiation Oncology Guideline. J Clin Oncol. 2017;35(3):361-369. doi:10.1200/JCO.2016.70.7562 9. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Central Nervous System Cancers. V.3.2024. © National Comprehensive Cancer Network, Inc. 2024. All rights reserved. Accessed November 27, 2024. To view the most recent and complete version of the guideline, go online to NCCN.org. 10. Kinzel A, Ambrogi M, Varshaver M, Kirson ED. Tumor treating fields for glioblastoma treatment: patient satisfaction and compliance with the second-generation Optune® system. Clin Med Insights Oncol. 2019:13: 1179554918825449. doi:10.1177/1179554918825449 11. Novocure Data on File US-DOF-0049. 12. Optune. Patient Information and Operation Manual for Glioblastoma Multiforme. Novocure; 2023. 13. Karanam NK, Story MD. An overview of potential novel mechanisms of action underlying tumor treating fields-induced cancer cell death and their clinical implications. Int J Radiat Biol. 2021;97(8):1044-1054. doi:10.1080/09553002.2020.1837984 14. Ahmad MA, Al Natour Z, Mustafa F, Rizvi TA. Electrical characterization of normal and cancer cells. IEEE Access. 2018;6:25979-25986. doi:10.1109/ACCESS.2018.2830883 15. Kirson ED, Gurvich Z, Schneiderman R, et al. Disruption of cancer cell replication by alternating electric fields. Cancer Res. 2004;64(9):3288-3295. doi:10.1158/0008-5472.can-04-0083 16. Gera N, Yang A, Holtzman TS, Lee SX, Wong ET, Swanson KD. Tumor treating fields perturb the localization of septins and cause aberrant mitotic exit. PLoS One. 2015;10(5):e0125269. doi:10.1371/journal.pone.0125269 17. Giladi M, Schneiderman RS, Voloshin T, et al. Mitotic spindle disruption by alternating electric fields leads to improper chromosome segregation and mitotic catastrophe in cancer cells. Sci Rep. 2015;5:18046. doi:10.1038/srep18046 18. Novocure Data on File US-DOF-0052. 19. Vanderbeek AM, Rahman R, Fell G, et al. The clinical trials landscape for glioblastoma: is it adequate to develop new treatments? Neuro Oncol. 2018;20(8):1034-1043. doi:10.1093/neuonc/noy027 20. Stupp R, Taillibert S, Kanner A, et al. Effect of tumor-treating fields plus maintenance temozolomide vs maintenance temozolomide alone on survival in patients with glioblastoma: a randomized clinical trial. Supplement 1. Trial protocol and statistical analysis plan. JAMA. 2017;318(23):2306-2316. Accessed January 9, 2025. https://jamanetwork.com/journals/jama/fullarticle/2666504 21. Toms SA, Kim CY, Nicholas G, Ram Z. Increased compliance with tumor treating fields therapy is prognostic for improved survival in the treatment of glioblastoma: a subgroup analysis of the EF-14 phase III trial. J Neurooncol. 2019;141(2):467-473. doi:10.1007/s11060-018-03057-z 22. Ram Z, Kim CY, Hottinger AF, Idbaih A, Nicholas G, Zhu JJ. Efficacy and safety of Tumor Treating Fields (TTFields) in elderly patients with newly diagnosed glioblastoma: subgroup analysis of the phase 3 EF-14 clinical trial. Front Oncol. 2021;11:671972. doi:10.3389/fonc.2021.671972 23. Taphoorn MJB, Dirven L, Kanner AA, et al. Influence of treatment with tumor-treating fields and health-related quality of life of patients with newly diagnosed glioblastoma: a secondary analysis of a randomized clinical trial. Supplementary online content. JAMA Oncol. 2018;4(4):495-504. Accessed January 9, 2025. https://jamanetwork.com/journals/jamaoncology/fullarticle/2670704 24. EORTC Quality of Life Group. EORTC QLQ-C30, Version 3.0. 1995. European Organisation for Research and Treatment of Cancer, Belgium. https://www.eortc.org/app/uploads/sites/2/2018/08/Specimen-QLQ-C30-English.pdf 25. Zhu JJ, Demireva P, Kanner AA, et al. Health-related quality of life, cognitive screening, and functional status in a randomized phase III trial (EF-14) of tumor treating fields with temozolomide compared to temozolomide alone in newly diagnosed glioblastoma. J Neurooncol. 2017;135(3):545-552. doi:10.1007/s11060-017-2601-y 26. Novocure Data on File OPT-103. 27. Lacouture ME, Anadkat MJ, Ballo MT, et al. Prevention and management of dermatologic adverse events associated with Tumor Treating Fields in patients with glioblastoma. Front Oncol. 2020;10:1045. doi:10.3389/fonc.2020.01045 28. Stupp R, Wong ET, Kanner AA, et al. NovoTTF-100A versus physician’s choice chemotherapy in recurrent glioblastoma: a randomised phase III trial of a novel treatment modality. Eur J Cancer. 2012;48(14):2192-2202. doi:10.1016/j.ejca.2012.04.011 29. Stupp R, Wong ET, Kanner AA, et al. NovoTTF-100A versus physician’s choice chemotherapy in recurrent glioblastoma: a randomised phase III trial of a novel treatment modality. Supplementary Table 1. Eur J Cancer. 2012;48(14):2192-2202. Accessed January 10, 2025. https://www.ejcancer.com/article/S0959-8049(12)00352-8/fulltext 30. Wong ET, Lok E, Swanson KD, et al. Response assessment of NovoTTF-100A versus best physician’s choice chemotherapy in recurrent glioblastoma. Cancer Med. 2014;3(3):592-602. doi:10.1002/cam4.210 31. Kanner AA, Wong ET, Villano JL, Ram Z; EF-11 Investigators. Post hoc analyses of intention-to-treat population in phase III comparison of NovoTTF-100A™ system versus best physician’s choice of chemotherapy. Semin Oncol. 2014;41(suppl 6):S25-S34. doi:10.1053/j. seminoncol.2014.09.008 32. Novocure Data on File OPT-109. 33. Ballo MT, Conlon P, Lavy-Shahaf G, Kinzel A, Vymazal J, Rulseh AM. Association of Tumor Treating Fields (TTFields) therapy with survival in newly diagnosed glioblastoma: a systematic review and meta-analysis. J Neurooncol. 2023;164(1):1-9. doi:10.1007/s11060-023-04348-w 34. Bähr O, Tabatabai G, Fietkau R, Goldbrunner R, Glas M. Tumor Treating Fields therapy in patients with newly diagnosed glioblastoma: long-term survival results from TTFields in Germany in Routine Clinical Care (TIGER) study. Poster presented at: American Society of Clinical Oncology; May 31–June 4, 2024; Chicago, IL. 35. Palmer JD, Chavez G, Furnback W, et al. Health-related quality of life for patients receiving tumor treating fields for glioblastoma. Front Oncol. 2021;11:772261. doi:10.3389/fonc.2021.772261

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US-OPG-00982 v1.0 July 2025

US-OPG-00982 v1.0 July 2025