Expert guidance on prophylaxis and treatment of dermatologic adverse events with Tumor Treating Fields (TTFields) therapy in the thoracic region

Our plain-English summary of Expert guidance on prophylaxis and treatment of dermatologic adverse events with Tumor Treating Fields (TTFields) therapy in the thoracic region, by M.J. Anadkat, M. Lacouture, A. Friedman, et al (Frontiers in Oncology, 2022).

The study

• Authors: M.J. Anadkat, M. Lacouture, A. Friedman, Z.D. Horne, J. Jung, B. Kaffenberger, S. Kalmadi, L. Ovington, R. Kotecha, H.I. Abdullah, F. Grosso
• Journal: Frontiers in Oncology
• Published: 2022;12:975473
• Type of article: Review
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Tumor Treating Fields (TTFields) are electric fields, delivered via wearable arrays placed on or near the tumor site, that exert physical forces to disrupt cellular processes critical for cancer cell viability and tumor progression. As a first-in-class treatment, TTFields therapy is approved for use in newly diagnosed glioblastoma, recurrent glioblastoma, and pleural mesothelioma. Additionally, TTFields therapy is being investigated in non-small cell lung cancer (NSCLC), brain metastases from NSCLC, pancreatic cancer, ovarian cancer, hepatocellular carcinoma, and gastric adenocarcinoma. Because TTFields therapy is well tolerated and delivery is locoregional, there is low risk of additive systemic adverse events (AEs) when used with other cancer treatment modalities. The most common AE associated with TTFields therapy is mild-to-moderate skin events, which can be treated with topical agents and may be managed without significant treatment interruptions. Currently, there are no guidelines for oncologists regarding the management of TTFields therapy-related skin AEs in the thoracic region, applicable for patients with pleural mesothelioma or NSCLC. This publication aims to provide guidance on preventing, minimizing, and managing dermatologic AEs in the thoracic region to help improve patient quality of life and reduce treatment interruptions that may impact outcomes with TTFields therapy.

Copyright © 2023 Anadkat, Lacouture, Friedman, Horne, Jung, Kaffenberger, Kalmadi, Ovington, Kotecha, Abdullah and Grosso.

In plain English

This article was a review giving expert guidance on preventing and managing chest skin side effects of Tumor Treating Fields (TTFields) therapy, a treatment approved for adults with unresectable pleural mesothelioma and still being investigated for non-small cell lung cancer. TTFields are electric fields delivered through arrays stuck to the skin. The article did not study new patients and did not study asbestos exposure. The authors said their guidance rested on their clinical experience and consensus, not on controlled study data. They listed contact dermatitis, itching (pruritus), excessive sweating (hyperhidrosis), pressure necrosis and skin erosions as the most common skin problems. A table adapted from earlier trials showed that in the STELLAR study, 57 of 80 patients with pleural mesothelioma (71%) had skin side effects, and 4 (5%) had severe (grade 3) ones. The authors noted that pilot studies had found no correlation between select risk factors and these skin problems. Their recommendations included changing arrays every 3 to 4 days, trimming hair with an electric razor, and avoiding ointments and petroleum-based products. The authors concluded these measures may prevent treatment interruptions.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Review presenting expert guidance based on the authors' clinical experience and consensus
• Who was studied: No new patients were studied. The guidance is aimed at patients receiving TTFields therapy in the thoracic (chest) region. This includes adults with unresectable pleural mesothelioma, for which the therapy is approved, and patients with non-small cell lung cancer (NSCLC), for which it was still being investigated.
• Exposure: Tumor Treating Fields therapy: electric fields delivered through arrays placed on the skin. The therapy is approved for adult patients with unresectable pleural mesothelioma at 150 kHz. Asbestos exposure was not studied.
• Main results:
  • The authors named contact dermatitis, pruritus, hyperhidrosis, pressure necrosis and skin erosions as the most common TTFields-related skin adverse events.
  • A table adapted from earlier trials reported that in the STELLAR study (pleural mesothelioma), 57 of 80 patients (71%) had skin adverse events of any grade and 4 (5%) had grade 3 skin adverse events.
  • The same table reported that in the EF-15 study (NSCLC), 18 of 42 patients (43%) had skin adverse events of any grade and 1 (2%) had grade 3 skin adverse events.
  • The authors noted that analysis of pilot studies had not identified any correlation between select risk factors and TTFields-related skin adverse events.
  • The authors stated that safety outcomes generally show a higher incidence of skin adverse events when arrays are placed on the thoracic region than on the scalp.
  • The authors' guidance was to change arrays every 3 to 4 days.
  • The authors' guidance was to trim hair very short with an electric razor rather than shave closely, epilate or wax.
  • The authors' guidance was to avoid ointments and petroleum-based products because they show high levels of impedance.
• The authors' conclusion: The authors concluded that proactive skin-care measures and awareness strategies may prevent treatment interruptions and support optimal use of TTFields therapy.
• Limitations the authors state:
  • The guidance is not supported by data from controlled clinical studies.
  • The effect of calcineurin inhibitors on electrical impedance has not been specifically tested.
  • It is not known whether aluminum zirconium antiperspirants contribute to electrical impedance.

Topics

Medical terms in this study, explained in our Lexicon: Tumor Treating Fields (TTFields), Pleural Mesothelioma, Non-Small Cell Lung Cancer, Ovarian Cancer, Carcinoma, Adenocarcinoma, Quality of Life.

Related studies

• Prevention and Management of Dermatologic Adverse Events Associated With Tumor Treating Fields in Patients With Glioblastoma — M.E. Lacouture, M.J. Anadkat, et al. (2020)
• The safety profile of Tumor Treating Fields (TTFields) therapy in glioblastoma patients with ventriculoperitoneal shunts — N.A. Oberheim-Bush, W. Shi, et al. (2022)
• Tumor Treating Fields (TTFields) Therapy in Unresectable Pleural Mesothelioma: Overview of Efficacy, Safety, and Future Outlook — G.L. Ceresoli, L. Gianoncelli (2025)
• Treatment with tumor-treating fields (TTFields) suppresses intercellular tunneling nanotube formation in vitro and upregulates immuno-oncologic biomarkers in vivo in malignant mesothelioma — A. Sarkari, S. Korenfeld, et al. (2023)
• Tumor Treating Fields (TTFields) Hinder Cancer Cell Motility through Regulation of Microtubule and Acting Dynamics — T. Voloshin, R.S. Schneiderman, et al. (2020)
• The schemes, mechanisms and molecular pathway changes of Tumor Treating Fields (TTFields) alone or in combination with radiotherapy and chemotherapy — G. Tanzhu, L. Chen, et al. (2022)

Browse more research in Frontiers in Oncology, or return to medical research.