Management of tumor treating fields (TTFields) therapy-related skin adverse events in pleural mesothelioma: A single center experience of TTFields therapy concomitant with chemotherapy.

Authors

null

Federica Grosso

Mesothelioma Unit, SS Antonio e Biagio e Cesare Arrigo, Alessandria, AL, Italy

Federica Grosso , Sara Delfanti , Giulia Gallizzi , Francesca Marengo , Iacopo Megna , Carlotta Bertolina , Giovanni Luca Ceresoli

Organizations

Mesothelioma Unit, SS Antonio e Biagio e Cesare Arrigo, Alessandria, AL, Italy, Mesothelioma Unit, SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy, Oncology Unit, S Spirito Hospital, Azienda Sanitaria Locale Alessandria, Alessandria, Italy, Clinical Trial Center, Research and Innovation Department, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy

Research Funding

Pharmaceutical/Biotech Company
Novocure

Background: Tumor Treating Fields (TTFields) therapy is a noninvasive, locoregional modality comprised of electric fields which disrupt critical cellular processes necessary for cancer cell viability and tumor progression. TTFields therapy is FDA approved and CE-marked for glioblastoma, and pleural mesothelioma. Approval for the latter was based on results from the phase 2 STELLAR study (EF-23, NCT02397928), in which the median OS was 18.2 months (95% CI 12.1–25.8) and median PFS was 7.6 months (95% CI 6.7–8.6). As the electrical fields are delivered non-invasively via skin-adhered arrays, the most common adverse events (AEs) are mild-moderate skin reactions which can be effectively managed with appropriate prophylaxis and timely intervention. Here we report a single-center experience of treating and managing TTFields therapy-related AEs in the STELLAR study, based on a center-specific protocol. Methods: The STELLAR study was a multicenter, single-arm, non-randomized, phase 2 study, whereby patients received TTFields therapy (150 kHz, 18 h/day) concomitant with pemetrexed (500 mg/m2) and platinum-based chemotherapy (75 mg/m2). TTFields-therapy AEs were managed and treated using a center-specific protocol (Table). Results: In this single center, 23 patients were treated using the predefined protocol to prevent skin AEs; all were included in the safety analysis. n = 15 (65%) reported a mild-moderate skin AE (n = 12 [52%] medical device site reaction [skin AE], n = 1 [4%] had mild-moderate rash, rash erythematous and skin irritation) in the single center, vs n = 54 (68%) in the overall STELLAR population. n = 2 (9%) in the single site had a severe medical device site reaction, which was comparable with the overall STELLAR study population. Conclusions: A predefined multidisciplinary approach was successful to help prevent mild-moderate skin AEs. Timely and appropriate management of mild/moderate skin AEs can prevent exacerbations. Skin management may support usage, thus optimizing outcomes for patients. Guidelines on preventing skin AEs when using TTFields therapy are available and should be incorporated in a clinical setting. Clinical trial information: NCT02397928.

RoleStep
Patient· Remove torso hair
Patient/clinician· Monitor skin closely; send pictures after array removal
Patient· Clean the skin when changing arrays, apply zinc-based cream
Patient/caregiver/palliative care nurse· Thoroughly wash hands before array removal/replacement
· Gently remove arrays (aided by caregiver after initial nurse) using medical adhesive removal spray
Patient· Allow 6 h between array removal/replacement
Patient· Shift arrays placement per suggested layout; during placement of new array, alternate layout by ~2 cm from prior site-of-contact
Patient· Remove arrays before scheduled visits to check skin status with dermatologist

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Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Publication Only: Lung Cancer—Non-Small Cell Local-Regional/Small Cell/Other Thoracic Cancers

Track

Lung Cancer

Sub Track

Mesothelioma

Clinical Trial Registration Number

NCT02397928

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr e20542)

DOI

10.1200/JCO.2023.41.16_suppl.e20542

Abstract #

e20542

Abstract Disclosures