Effect of NovoTTF-100A Together With Temozolomide in Newly Diagnosed Glioblastoma Multiforme (GBM)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00916409
Recruitment Status : Completed
First Posted : June 9, 2009
Last Update Posted : April 10, 2017
Information provided by (Responsible Party):
NovoCure Ltd.

Brief Summary:
The study is a prospective, randomly controlled pivotal trial, designed to test the efficacy and safety of a medical device, the NovoTTF-100A, as an adjuvant to the best standard of care in the treatment of newly diagnosed GBM patients. The device is an experimental, portable, battery operated device for chronic administration of alternating electric fields (termed TTFields or TTF) to the region of the malignant tumor, by means of surface, insulated electrode arrays.

Condition or disease Intervention/treatment Phase
Glioblastoma Multiforme Device: NovoTTF-100A device Drug: Temozolomide Phase 3

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Detailed Description:


The effect of the electric fields generated by the NovoTTF-100A device (TTFields, TTF) has been tested in a large prospective, randomized trial, in recurrent GBM. The outcome of subjects treated with the NovoTTF-100A device was compared to those treated with an effective best standard of care chemotherapy (including bevacizumab). NovoTTF-100A subjects had comparable overall survival to subjects receiving the best available chemotherapy in the US today. Similar results showing comparability of NovoTTF-100A to BSC chemotherapy were seen in all secondary endpoints.

Recurrent GBM patients treated with the NovoTTF-100A device in this trial experienced fewer side effects in general, significantly fewer treatment related side effects, and significantly lower gastrointestinal, hematological and infectious adverse events compared to controls. The only device-related adverse events seen were a mild to moderate skin irritation beneath the device electrodes. Finally, quality of life measures were better in NovoTTF-100A subjects as a group when compared to subjects receiving effective best standard of care chemotherapy.

In a small scale pilot trial in newly diagnosed GBM patients, the treatment was well tolerated and suggested that NovoTTF-100A may improve time to disease progression and overall survival of newly diagnosed GBM patients. Although the number of patients in the pilot trial was small, The FDA has determined that the data gathered so far warrant testing of NovoTTF-100A treatment as a possible therapy for patients with newly diagnosed GBM.


All patients included in this trial are newly diagnosed GBM patients who underwent a biopsy or surgery (with or without Gliadel wafers), followed by radiation therapy in combination with Temozolomide chemotherapy. In addition, all patients must meet all eligibility criteria.

Eligible patients will be randomly assigned to one of two groups:

  1. Treatment with the NovoTTF-100A device in combination with Temozolomide chemotherapy.
  2. Treatment with Temozolomide alone, as the best known standard of care.

Patients will be randomized at a 2:1 ratio (2 of every three patients who participate in the trial will be treated with the NovoTTF-100A device). Baseline tests will be performed in patients enrolled in both arms, including specific genetic tests done using tumor samples obtained during their initial surgery. If assigned to the NovoTTF-100A in combination with Temozolomide group, the patients will be treated continuously with the device until second progression. They will also receive temozolomide and possibly a second line treatment that can be one of the following: re-operation, local radiotherapy (gamma-knife), a second line of chemotherapy or a combination of the above.

NovoTTF-100A treatment will consist of wearing four electrically insulated electrode arrays on the head. Electrode array placement will require shaving of the scalp before and frequently during the treatment. After an initial short visit to the clinic for training and monitoring, patients will be released to continue treatment at home where they can maintain their regular daily routine.

During the trial, regardless of which treatment group the patient was assigned to, he or she will need to return once every month to the clinic where an examination by a physician and a routine laboratory examinations will be done. These routine visits will continue for as long as the patient's disease is not progressing for the second time under the study treatment. If such occurs, patients will need to return once per month for two more months to the clinic for similar follow up examinations.

During the visits to the clinic patients will be examined physically and neurologically. Additionally, routine blood tests will be performed. A routine MRI of the head will be performed at baseline and every second month thereafter, until second progression. After this follow up plan, patients will be contacted once per month by telephone to answer basic questions about their health status.


Electric fields exert forces on electric charges similar to the way a magnet exerts forces on metallic particles within a magnetic field. These forces cause movement and rotation of electrically charged biological building blocks, much like the alignment of metallic particles seen along the lines of force radiating outwards from a magnet.

Electric fields can also cause muscles to twitch and if strong enough may heat tissues. TTFields are alternating electric fields of low intensity. This means that they change their direction repetitively many times a second. Since they change direction very rapidly (200 thousand times a second), they do not cause muscles to twitch, nor do they have any effects on other electrically activated tissues in the body (brain, nerves and heart). Since the intensities of TTFields in the body are very low, they do not cause heating.

The breakthrough finding made by NovoCure was that finely tuned alternating fields of very low intensity, now termed TTFields (Tumor Treating Fields), cause a significant slowing in the growth of cancer cells. Due to the unique geometric shape of cancer cells when they are multiplying, TTFields cause the building blocks of these cells to move and pile up in such a way that the cells physically explode. In addition, cancer cells also contain miniature building blocks which act as tiny motors in moving essential parts of the cells from place to place. TTFields cause these tiny motors to fall apart since they have a special type of electric charge.

As a result of these two effects, cancer tumor growth is slowed and can even reverse after continuous exposure to TTFields.

Other cells in the body (normal healthy tissues) are affected much less than cancer cells since they multiply at a much slower rate if at all. In addition TTFields can be directed to a certain part of the body, leaving sensitive areas out of their reach.

In conclusion, TTField hold the promise of serving as a brand new cancer treatment with very few side effects and promising affectivity in slowing or reversing this disease.

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 700 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Prospective, Multi-center Trial of NovoTTF-100A Together With Temozolomide Compared to Temozolomide Alone in Patients With Newly Diagnosed GBM.
Study Start Date : June 2009
Actual Primary Completion Date : December 2016
Actual Study Completion Date : March 2017

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: NovoTTF-100A device in combination with Temozolomide
patients will be treated continuously with the NovoTTF-100A device, in addition to Temozolomide. NovoTTF-100A treatment will consist of wearing four electrically insulated electrode arrays on the head. The treatment enables the patient to maintain regular daily routine.
Device: NovoTTF-100A device
patients will be treated continuously with the NovoTTF-100A device, in addition to Temozolomide. NovoTTF-100A treatment will consist of wearing four electrically insulated electrode arrays on the head. The treatment enables the patient to maintain regular daily routine.

Active Comparator: Temozolomide alone, as the best known standard of care
Patients will be treated with Temozolomide, as the best known standard of care for Glioblastoma Multiforme patients.
Drug: Temozolomide

maintenance Temozolomide will be administered according to the approved dosing scheme as follows: Maintenance Phase Cycle 1: Four weeks after completing the Temozolomide + Radiotherapy phase, Temozolomide is administered for an additional 6 cycles of maintenance treatment. Dosage in Cycle 1 (maintenance) is 150 mg/m2 once daily for 5 days followed by 23 days without treatment.

Cycles 2-6: At the start of Cycle 2, the dose is escalated to 200 mg/m2, if the CTC non-hematologic toxicity for Cycle 1 is Grade ≤2 (except for alopecia, nausea and vomiting), absolute neutrophil count (ANC) is ≥ 1.5 x 109/L, and the platelet count is ≥ 100 x 109/L. The dose remains at 200 mg/m2 per day for the first 5 days of each subsequent cycle except if toxicity occurs. If the dose was not escalated at Cycle 2, escalation should not be done in subsequent cycles.

Primary Outcome Measures :
  1. Progression Free Survival (PFS) time [ Time Frame: 5 years ]

Secondary Outcome Measures :
  1. Overall survival (OS) [ Time Frame: 5 years ]

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Pathological evidence of GBM using WHO classification criteria.
  2. > 18 years of age.
  3. Received maximal debulking surgery and radiotherapy concomitant with Temozolomide (45-70Gy):

    1. Patients may enroll in the study if received Gliadel wafers before entering the trial
    2. Any additional treatments received prior to enrollment will be considered an exclusion.
    3. Minimal dose for concomitant radiotherapy is 45 Gy
  4. Karnofsky scale ≥ 70
  5. Life expectancy at least 3 months
  6. Participants of childbearing age must use effective contraception.
  7. All patients must sign written informed consent.
  8. Treatment start date at least 4 weeks out from surgery.
  9. Treatment start date at least 4 weeks out but not more than 7 weeks from the later of last dose of concomitant Temozolomide or radiotherapy.

Exclusion Criteria:

  1. Progressive disease (according to MacDonald Criteria). If pseudoprogression is suspected, additional imaging studies must be performed to rule out true progression.
  2. Actively participating in another clinical treatment trial
  3. Pregnant
  4. Significant co-morbidities at baseline which would prevent maintenance Temozolomide treatment:

    1. Thrombocytopenia (platelet count < 100 x 103/μL)
    2. Neutropenia (absolute neutrophil count < 1.5 x 103/μL)
    3. CTC grade 4 non-hematological Toxicity (except for alopecia, nausea, vomiting)
    4. Significant liver function impairment - AST or ALT > 3 times the upper limit of normal
    5. Total bilirubin > upper limit of normal
    6. Significant renal impairment (serum creatinine > 1.7 mg/dL)
  5. Implanted pacemaker, programmable shunts, defibrillator, deep brain stimulator, other implanted electronic devices in the brain, or documented clinically significant arrhythmias.
  6. Infra-tentorial tumor
  7. Evidence of increased intracranial pressure (midline shift > 5mm, clinically significant papilledema, vomiting and nausea or reduced level of consciousness)
  8. History of hypersensitivity reaction to Temozolomide or a history of hypersensitivity to DTIC.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00916409

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United States, Alabama
University of Alabama at Birmingham
Birmingham, Alabama, United States, 35294-3410
United States, Arizona
Barrow Neurology Clinics
Phoenix, Arizona, United States, 85013
United States, California
City of Hope
Duarte, California, United States, 91010-3000
University of California San Diego Moores Cancer Center (UCSD)
La Jolla, California, United States, 92093
University of Southern California (USC)
Los Angeles, California, United States, 90033
United States, Colorado
University of Colorado Denver
Aurora, Colorado, United States, 80045
United States, Florida
UF Health Cancer Center at Orlando Health
Orlando, Florida, United States, 32806
H. Lee Moffitt Cancer Center & Research Institute
Tampa, Florida, United States, 33612
United States, Georgia
Emory University, Winship Cancer Institute
Atlanta, Georgia, United States, 30322
United States, Illinois
University of Illinois at Chicago (UIC)
Chicago, Illinois, United States, 60612
United States, Kentucky
University of Kentucky, Markey Cancer Center
Lexington, Kentucky, United States, 40536-0093
Norton Cancer Institute
Louisville, Kentucky, United States, 40202
United States, Maine
Maine Medical Center
Scarborough, Maine, United States, 04074
United States, Maryland
The Johns Hopkins Hospital
Baltimore, Maryland, United States, 21287
United States, Massachusetts
Tufts Medical Center
Boston, Massachusetts, United States, 02111
Beth Israel Deaconess Medical Center
Boston, Massachusetts, United States, 02215
Lahey Clinic Medical Center
Burlington, Massachusetts, United States, 01805
United States, Michigan
Henry Ford Health System
Detroit, Michigan, United States, 48202
United States, Missouri
Washington University School of Medicine, Division of Oncology
St. Louis, Missouri, United States, 63110
United States, New Jersey
New Jersey Neuroscience Center - JFK Medical Center
Edison, New Jersey, United States, 08818
John Theurer Cancer Center at Hackensack University Medical Center
Hackensack, New Jersey, United States, 07601
United States, New York
Weill Cornell Medical College
New York, New York, United States, 10021
Mount Sinai Medical Center, Department of Neurosurgery
New York, New York, United States, 10029
Columbia University Medical Center
New York, New York, United States, 10032
United States, North Carolina
University of North Carolina
Chapel Hill, North Carolina, United States, 27599
United States, Ohio
Cleveland Clinic Taussig Cancer Center
Cleveland, Ohio, United States, 44195
The Ohio State University Arthur G. James Cancer Hospital and Solove Research Institute
Columbus, Ohio, United States, 43210
United States, Pennsylvania
Geisinger Health System
Danville, Pennsylvania, United States, 17822
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States, 19104
Pennsylvania Hospital
Philadelphia, Pennsylvania, United States, 19104
University of Pittsburgh Medical Center (UPMC)
Pittsburgh, Pennsylvania, United States, 15232
United States, Texas
UT Southwestern Medical Center
Dallas, Texas, United States, 75235-8808
Dallas, Texas, United States, 75246
Methodist Hospital
Houston, Texas, United States, 77030
Methodist Neurological Institute
Houston, Texas, United States, 77030
The University of Texas Health Science Center at Houston (UTHSC)
Houston, Texas, United States, 77030
Scott and White Healthcare
Temple, Texas, United States, 76508
Memorial Hermann The Woodlands
The Woodlands, Texas, United States, 77380
United States, Virginia
University of Virginia Health System
Charlottesville, Virginia, United States, 22908
United States, Washington
Swedish Neuroscience Institute
Seattle, Washington, United States, 98122
University of Washington/Seattle Cancer Care Alliance
Seattle, Washington, United States, 98195
University Hospital Graz
Graz, Austria
Medical University of Vienna
Vienna, Austria
Vienna, Austria
Canada, Alberta
Tom Baker Cancer Center
Calgary, Alberta, Canada, T2N 4N2
Canada, Manitoba
CancerCare Manitoba
Winnipeg, Manitoba, Canada, R3E 0V9
Canada, Ontario
Juravinski Cancer Centre
Hamilton,, Ontario, Canada, L8V5C2
The Ottawa Hospital Cancer Centre
Ottawa, Ontario, Canada, K1H 8L6
Canada, Quebec
Notre-Dame Hospital (CHUM)
Montreal, Quebec, Canada, H2L 4 M1
Montreal Neurological Institute
Montreal, Quebec, Canada, H3A 2B4
McGill - Gerald Bronfman Centre for Clinical Research in Oncology -
Montreal, Quebec, Canada, H3T 1E2
(CHUS) Centre Hospitalier Universitaire de Sherbrooke, Service de Neurochirurgie
Sherbrooke, Quebec, Canada, J1H 5N4
Czech Republic
Na Homolce Hospital
Prague, Czech Republic
CHU Amiens Sud-Salouel
Amiens, France
CHU Angers
Angers, France
Hôpital Saint André Centre Hospitalier Universitaire (CHU) des Hôpitaux de Bordeaux
Bordeaux, France
Hospital of Neurology Pierre Wertheimer
Lyon, France
Group Hospitals Pitie-Salpetriere
Paris, France
Centre Hospitalo-Universitaire de Toulouse Purpan
Toulouse, France
University Medical Center Hamburg-Eppendorf
Hamburg, Germany
Medical University Heidelberg
Heidelberg, Germany
University Hospital of Schleswig-Holstein
Kiel, Germany
Tel Aviv Sourasky Medical Center
Tel Aviv, Israel
Az. Ospedaliero-Universitaria - Ospedali Riuniti
Ancona, Italy
Ospedale Lecco
Lecco, Italy
C. Besta Neurological Institute
Milan, Italy
Foundation Hospital Greater Policlinico
Milan, Italy
Istituti Fisioterapici Ospitalieri - Istituto Nazionale dei Tumori Regina Elena
Rome, Italy
Korea, Republic of
Asan Medical Center
Asan, Korea, Republic of
Yeungnam University Hospital
Daegu, Korea, Republic of
Chungnam National University Hospital (CNUH)
Daejeon, Korea, Republic of
Samsung Medical Center (SMC)
Seoul, Korea, Republic of
Seoul National University Bundang Hospital (SNUBH)
Seoul, Korea, Republic of
Seoul National University Hospital (SNUH)
Seoul, Korea, Republic of
The Catholic University of Korea, Seoul St. Mary's Hospital (CMC Seoul)
Seoul, Korea, Republic of
Yonsei University Severance Hospital (YUHS)
Seoul, Korea, Republic of
Ajou University Hospital (AUH)
Suwon, Korea, Republic of
Hospital Universitari Germans Trias i Pujol
Badalona, Spain
Hospital Clinic i Provincial de Barcelona
Barcelona, Spain
Hospital del Mar
Barcelona, Spain
Hospital Universitari de Bellvitge-ICO Duran i Reynals
Barcelona, Spain
Fundacion Jimenes Diaz
Madrid, Spain
Hospital 12 de Octubre, Servicio de Oncología Médica
Madrid, Spain
Hospital Clinico San Carlos
Madrid, Spain
Hospital Universitario Ramon y Cajal
Madrid, Spain
Clínica Universidad de Navarra
Pamplona, Spain
Karolinska Institute
Stockholm, Sweden
Centre Hospitalier Universitaire Vaudois (CHUV)
Lausanne, Switzerland
UniversitätsSpital Zürich
Zurich, Switzerland
Sponsors and Collaborators
NovoCure Ltd.
Study Director: Roger Stupp, MD University Hospital, Zürich
Study Director: Philip H. Gutin, MD Memorial Sloan Kettering Cancer Center
Study Director: Eric T. Wong, MD Beth Israel Deaconess Medical Center
Study Director: Herbert H. Engelhard, MD, PhD University of Illinois at Chicago
Study Director: Manfred Westphal, Prof. MD Universitätsklinikum Hamburg-Eppendorf

Additional Information:
Publications automatically indexed to this study by Identifier (NCT Number):

Responsible Party: NovoCure Ltd. Identifier: NCT00916409     History of Changes
Other Study ID Numbers: EF-14
First Posted: June 9, 2009    Key Record Dates
Last Update Posted: April 10, 2017
Last Verified: April 2017

Keywords provided by NovoCure Ltd.:
Glioblastoma Multiforme
Brain tumor
Minimal toxicity
Newly Diagnosed
Tumor Treating Fields

Additional relevant MeSH terms:
Neoplasms, Neuroepithelial
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms, Glandular and Epithelial
Neoplasms, Nerve Tissue
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents