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Case Reports
. 2014 Apr 5;6(1):109-15.
doi: 10.1159/000362264. eCollection 2014 Jan.

Resolution of cystic enhancement to add-on tumor treating electric fields for recurrent glioblastoma after incomplete response to bevacizumab

Grace Elzinga  1 , Eric T Wong  1
Affiliations
Case Reports

Resolution of cystic enhancement to add-on tumor treating electric fields for recurrent glioblastoma after incomplete response to bevacizumab

Grace Elzinga et al. Case Rep Neurol. .

Abstract

The NovoTTF-100A device emits alternating tumor treating electric fields (TTFields) that interfere with cytokinesis and chromosome segregation during mitosis. Because it has a similar efficacy to cytotoxic chemotherapy, the device has been approved by the United States Food and Drug Administration for the treatment of recurrent glioblastoma. Although bevacizumab has been in use for recurrent glioblastoma, patients who experience incomplete or no response to bevacizumab may be predisposed to early bevacizumab treatment failure. However, the addition of TTFields therapy may augment the efficacy from bevacizumab. We report a patient with recurrent cystic glioblastoma who received add-on TTFields therapy due to an incomplete response to single-agent bevacizumab. After 6 cycles of therapy, a resolution of cystic enhancement was noted, together with reduction of the tumor cyst and resolution of most of the cerebral edema in the surrounding brain. However, the patient also suffered from relapsed disease at locations distant from the original glioblastoma and the corresponding radiation fields received at initial diagnosis. We conclude that combination TTFields and bevacizumab therapy is safe and may be efficacious for patients with recurrent glioblastoma. A further study would be needed to determine the relapse pattern and the distribution of the electric fields in the brain.

Keywords: Alternating electric fields; Glioblastoma; Response.

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Figures

Fig. 1
Fig. 1
Response characteristics from combination TTFields and bevacizumab therapy. At the time of first recurrence, the tumor cyst measured 3.4 × 4.4 cm on gadolinium-enhanced T1-weighted (a) and FLAIR (b) images. After 2 cycles of bevacizumab, there was a partial decrease in the size of the cystic tumor to 1.9 × 3.6 cm as seen on gadolinium-enhanced T1-weighted images (c) and a partial resolution of the edema as detected on FLAIR (d) images. After 6 cycles of combination TTFields and bevacizumab therapy, there was a further decrease of the cystic tumor to 1.7 × 3.1 cm, or 65% reduction, as seen on gadolinium-enhanced T1-weighted images (e) and a resolution of edema as detected on FLAIR (f) images.
Fig. 2
Fig. 2
Foci of relapsed disease outside of the previously irradiated glioblastoma. Gadolinium enhancement was detected in the internal capsule (a) and medial left frontal brain (b) after 6 cycles of TTFields and bevacizumab therapy.
See this image and copyright information in PMC

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