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Open Access 11-03-2025 | Astrocytoma | Research

Impact of alternating electric fields therapy for newly diagnosed WHO grade 4 astrocytoma on patient survival: a real-world propensity-score adjusted prospective multicenter study

Authors: Peter Y. M. Woo, Jenny K. S. Pu, Lai-Fung Li, Desiree K. K. Wong, Victor K. H. Hui, Danny T. M. Chan, Michael W. Y. Lee, Tony K. T. Chan, Jason M. K. Ho, Ka-Man Cheung, Teresa P. K. Tse, Sarah S. N. Lau, Joyce S. W. Chow, Natalie M. W. Ko, Herbert H. F. Loong, Aya El-Helali, Tai-Chung Lam, Fung-Ching Cheung, Wai-Sang Poon

Published in: Journal of Neuro-Oncology

Abstract

Purpose

Alternating electric fields (AEF) therapy in addition to temozolomide chemoradiotherapy (TMZ CRT) is increasingly being recommended as first-line treatment for patients with newly-diagnosed WHO grade 4 astrocytoma. However, few have validated this treatment with real-world evidence.

Methods

Consecutive adult patients with newly-diagnosed WHO grade 4 astrocytoma treated with adjuvant TMZ CRT across all neuro-oncology centers in Hong Kong were reviewed. Identified from a territory-wide prospective glioma registry, propensity-score matching (1:2) was performed to match patients that either received TMZ CRT with AEF or TMZ CRT alone. Matching was according to age, Karnofsky performance status, IDH-1 mutation, pMGMT methylation and extent of resection. The primary endpoint was overall survival (OS). Secondary endpoints were the incidence of AEF-associated adverse effects and mean monthly treatment compliance.

Results

141 patients were reviewed, of whom 47 patients received AEF with TMZ CRT and 94 had CRT alone. Multivariate Cox proportional hazards analysis revealed that patients with pMGMT-methylated tumors (mOS: 30.8 months vs. 16.7 months [95% CI: 1.9–4.7] and those that received AEF (mOS: 22.8 vs. 14.3 months [95% CI: 1.9–4.7]) had longer OS. AEF therapy patients had a mOS benefit of 8.5 months. The mean monthly treatment compliance was 74 ± 12%. A compliance threshold of 60% conferred a survival benefit of 4.1 months (mOS: 21.5 months vs. 17.4 months [95% CI: 0.10–0.96]). The only identified AEF-associated adverse reaction was scalp dermatitis that occured in 77% (36/47) of patients.

Conclusion

This post-approval study offers real-world evidence in support of the use of AEF therapy as first-line treatment.

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Title: Impact of alternating electric fields therapy for newly diagnosed WHO grade 4 astrocytoma on patient survival: a real-world propensity-score adjusted prospective multicenter study
Authors: Peter Y. M. Woo
Jenny K. S. Pu
Lai-Fung Li
Desiree K. K. Wong
Victor K. H. Hui
Danny T. M. Chan
Michael W. Y. Lee
Tony K. T. Chan
Jason M. K. Ho
Ka-Man Cheung
Teresa P. K. Tse
Sarah S. N. Lau
Joyce S. W. Chow
Natalie M. W. Ko
Herbert H. F. Loong
Aya El-Helali
Tai-Chung Lam
Fung-Ching Cheung
Wai-Sang Poon
Publication date: 11-03-2025
Publisher: Springer US
Keywords: Astrocytoma
Astrocytoma
Astrocytoma
Glioblastoma
Glioblastoma
Glioblastoma
Published in: Journal of Neuro-Oncology
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-025-04985-3

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