The Role of Tumor Treating Fields (TTFields) in the Management of High-Grade Gliomas

Abstract This paper explores the role of Tumor Treating Fields (TTFields) in managing high-grade gliomas, particularly glioblastoma multiforme (GBM), through non-invasive electric field-based therapy. It highlights how TTFields disrupt mitosis in rapidly dividing tumor cells by targeting key proteins, such as tubulin and septin, involved in spindle formation during cell division. The therapy selectively induces mitotic arrest and apoptosis, sparing non-dividing healthy cells, thus minimizing side effects. Preclinical evidence supports TTFields' efficacy in disrupting cancer cell division and enhancing the effects of chemotherapy, particularly temozolomide. The EF-14 trial established TTFields as a standard therapy for newly diagnosed GBM, showing significant improvements in overall and progression-free survival compared to chemotherapy alone. Real-world data from the PRiDe registry corroborate these findings, demonstrating similar survival benefits and a favorable safety profile. Challenges include patient compliance due to the device’s daily usage requirements and cost-related barriers. Ongoing research explores the combination of TTFields with immunotherapy, radiation, and novel therapeutic agents, as well as its potential applications in other solid tumors. Future studies may focus on improving patient adherence, expanding therapeutic combinations, and refining device technology for broader cancer treatment applicability. Keywords High-grade gliomas, Tumor Treating Fields, TTFields, glioblastoma, non-invasive therapy, electric fields, cancer treatment