Tumor treating field therapy in non-MGMT-Methylated newly diagnosed glioblastoma: is there a role for temozolomide?

A Research Highlight of a recently published paper: “The effects of tumor treating fields (and temozolomide in MGMT expressing and non-expressing patient-derived glioblastoma cells” (J Clin Neurosci 2017; 36:120-124) is presented. Introductory background on alternating tumor treating field (TTFields) therapy, an FDA approved therapy for newly diagnosed glioblastoma, is reviewed in the context of standard temozolomide (TMZ) chemotherapy. The highlighted paper evaluated the potential interactions of TMZ and TTFields in vitro , as this could not be readily accomplished clinically. The authors reported a clinical model using 2 different sets of patient-derived GBM stem-like cells (GSCs) including MGMT-expressing (TMZ resistant) GSC and non-MGMT-expressing (TMZ sensitive) GSC. The results demonstrated no interactions, and the inability of TTFields to overcome TMZ resistance. The significant clinical implications of these results, and the rationale for exploring other innovative treatment strategies in combination with TTFields are discussed.