Game changer for GBM

[Gfunk6]

http://jama.jamanetwork.com/article.aspx?articleid=2475463

New technology called Optune which uses alternating electrical arrays attached to scalp to interfere with mitosis. Sequenced with adjuvant temozolomide after CRT for GBM.

5 month OS benefit from 15 --> 20 months! This was a Phase III randomized trial and this therefore represents Category I evidence.

Rad Oncs can perform treatment planning for this platform. I'm proud to say that my practice was one of the early adopters.

---

Members don't see this ad.

 

[RadOncMegatron]

!

In reply to the the discussion and editorial, I doubt that the placebo effect could actually cause a 5 month OS benefit. If it does, please sign me up forsome sham TTF.

 

[seper]

looks pretty good, agree. I like TTF name, sounds very badass

 

[RadOncDoc21]

Could they fit any more authors on the manuscript??

 

[Mandelin Rain]

http://jama.jamanetwork.com/article.aspx?articleid=2475463

New technology called Optune which uses alternating electrical arrays attached to scalp to interfere with mitosis. Sequenced with adjuvant temozolomide after CRT for GBM.

5 month OS benefit from 15 --> 20 months! This was a Phase III randomized trial and this therefore represents Category I evidence.

Rad Oncs can perform treatment planning for this platform. I'm proud to say that my practice was one of the early adopters.

I'd like to here more about how rad oncs do the planning and how you got a program going. Is there a site with provider specific info.

 

[napoleondynamite]

I remember watching a TED talk about this 5 or 6 years ago. Cool that it has gained traction and shows promise!

GFunk, I am also very interested in how to get a program going and to hear more about the treatment planning process, etc.

 

[Gfunk6]

The treatment planning system is called NovoTAL.

See link for details: http://www.optune.com/HCP/therapy/novotal.aspx

You lease the system from Novocure and can perform clinical treatment planning (bill code 77299). You use the patient's latest MRI brain to create the array maps. Compared to typical radiation planning, it is a bit underwhelming and quite different.

 

[GammaKnifeAndChill]

How much does the NovoTAL system cost to lease?

 

[nkmiami]

have used it- company wants 10,000 month, device unwieldy, and patient has to shave head. Most patients have been declining it.

 

[Gfunk6]

How much does the NovoTAL system cost to lease?

$800 per year or $1500 for two years

 

[nkmiami]

sorry, 10,000 a month for the patient- insurance has really been giving us a hard time

 

[Gfunk6]

I have personally had the opposite experience. Between surgery and radiation most patients lose quite a bit of their hair anyway. Also toxicity is quite minimal with grade 1-2 dermatitis being the most common reaction. I do agree that it is a commitment, patients need a caregiver to help them and it is not for everyone. They recently released a 2nd generation unit which is far lighter and more compact.

I do agree that insurance has been an issue on occasion. However, Novocure is very aggressive about appealing denials and are usually successful when the request is put in the hands of a Neuro-Oncologist. Furthermore, they have a very generous assistance program and for my patients with limited income, they have eaten the costs.

 

[nkmiami]

Maybe, I am coming off too negatively. The data from 2 trials are compelling, and I have used it on 3 patients with no real side effects. I have just been surprised how many of my patients ( at least half) reject it because of hair and the device being cumbersome. Personally, I would think those are inconsequential concerns, but in my limited experience, my patients have real issues with them. I am a little put off by the company billing $10,000 a month, but still offer it to everyone. It wont surprise me if someone in Taiwan copies it and sells for 100$. Electronically, not that much complexity to it and I would guess that "dosimetry" has minor impact on the electrical field orientations, but I am not an engineer

 

[Gfunk6]

Interesting points raised. As physicians, I do agree that we do have to be mindful of cost of interventions. This is especially germane for out of pocket costs of individual patients but, as a whole, it applies to the effect of cost on society. Regarding Optune specifically, it is now NCCN Cat 2A for upfront treatment after chemoXRT so I do believe I am offering my patients the standard of care.

When (not if) Medicare switches to a case rate model in a few years, all expensive interventions will either become cheaper or be forced out.

 

[Lamount]

Gfunk: subjectively, how would you judge quality of life with Optune?

 

[medgator]

Considering the OS benefit and the lowered toxicity compared to chemo or avastin, is the cost really that ridiculous when it comes to gbm treatment?

 

[Krukenberg]

Honest question: why is this a treatment that falls under the rad onc scope of practice alone? I'm surprised neuro oncs aren't trying to get it on it.


Sent from my iPhone using SDN mobile app

 

[thaddeus]

There's actually already data regarding cost-effectiveness of Optune:

http://www.ncbi.nlm.nih.gov/pubmed/27177573

Money Quote: "The ICER of TTF therapy at first-line treatment is far beyond conventional thresholds due to the prohibitive announced cost of the device"

 

[medgator]

There's actually already data regarding cost-effectiveness of Optune:

http://www.ncbi.nlm.nih.gov/pubmed/27177573

Money Quote: "The ICER of TTF therapy at first-line treatment is far beyond conventional thresholds due to the prohibitive announced cost of the device"

Nice read. Will be interesting to see articles like that on Opdivo and Kytruda

 

[Gfunk6]

Gfunk: subjectively, how would you judge quality of life with Optune?

I would say it is decent. We use it quite a bit in our practice so patients frequently find camaraderie with other Optune patients in the waiting room. Also, there is an inherent bias for those who can use it in that they require a reliable partner (spouse/friend/relative) to assist with the device. People in that position tend to have a better QoL anyway.

Honest question: why is this a treatment that falls under the rad onc scope of practice alone? I'm surprised neuro oncs aren't trying to get it on it.

It doesn't. In fact I'm one of the few Rad Oncs who uses the device and planning system. The sizable majority are NOs + Neurosurgeons.

 

[RadRadRad]

I've used NovoTTF for 3 years. Initially offered as salvage treatment, typically after Avastin and now offer upfront to most patients not on trial. The data is compelling. The survival benefit from the Stupp NovoTTF upfront trial (EF14) is just as much (actually more) than the survival benefit of temodar added to radiation.

Call me a cynic but i think if the Avastin upfront trials (or any other chemo drug) showed this magnitude of benefit, it would be offered to everyone...which is kind of crazy because the toxicity of novoTTF is lower than chemo or targeted therapy.

The majority of my patients (particularly if younger) have had no problem wearing the NovoTTF when presented with the data. I've only had one patient decline it (>70 years old, didn't want to shave head...didn't push the issue).

Just had my first patient get the 2nd generation battery which will should be a benefit from QOL standpoint. Its about 50% of the size and weight of first generation battery

I do think the pricing is a little off...but not that different than avastin which has less impressive phase III data IMO

 

[RollTideRadOnc]

Considering acquiring this device for my practice.

Is the cost to lease the device truly that low? $800 for one year or $1500 for two, as GFunk states above? That's an incredible deal if it's the case. Is there a hidden cost (training, etc?).

 

[napoleondynamite]

Considering acquiring this device for my practice.

Is the cost to lease the device truly that low? $800 for one year or $1500 for two, as GFunk states above? That's an incredible deal if it's the case. Is there a hidden cost (training, etc?).

That's the price for Novotal (the planning system) not Optune. The company is setup like a durable medical equipment essential ly, which is kind of nice IMO. They handle the prior authorization & billing crud. You just manage the patient clinically.

Sent from my Pixel using SDN mobile