Bill Doyle: Treating cancer with electric fields

Everybody in our society's life is touched by cancer --

if not personally,

then through a loved one, a family member,

colleague, friend.

And once our lives are touched by cancer,

we quickly learn

that there are basically

three weapons, or three tools, that are available

to fight the disease:

surgery, radiation and chemotherapy.

And once we get involved

in the therapeutic decisions,

again either personally

or with our loved ones and family members,

we also very quickly learn

the benefits, the trade-offs and the limitations

of these tools.

I'm very thankful to Jay and to Mark

and the TEDMED team

for inviting me today

to describe a fourth tool, a new tool,

that we call Tumor Treating Fields.

Tumor Treating Fields

were invented by Dr. Yoram Palti,

professor emeritus at the Technion in Israel.

And they use low-intensity

electric fields

to fight cancer.

To understand how Tumor Treating Fields work,

we first need to understand

what are electric fields.

Let me first address

a few popular misconceptions.

First of all, electric fields

are not an electric current

that is coursing through the tissue.

Electric fields

are not ionizing radiation,

like X-rays or proton beams,

that bombard tissue

to disrupt DNA.

And electric fields

are not magnetism.

What electric fields are

are a field of forces.

And these forces

act on, attract, bodies

that have an electrical charge.

The best way to visualize an electric field

is to think of gravity.

Gravity is also a field of forces

that act on masses.

We can all picture astronauts in space.

They float freely in three dimensions

without any forces acting on them.

But as that space shuttle

returns to Earth,

and as the astronauts enter the Earth's gravitational field,

they begin to see the effects of gravity.

They begin to be attracted towards Earth.

And as they land,

they're fully aligned in the gravitational field.

We're, of course, all stuck in the Earth's gravitational field right now.

That's why you're all in your chairs.

And that's why we have to use our muscle energy

to stand up, to walk around

and to lift things.

In cancer,

cells rapidly divide

and lead to uncontrolled tumor growth.

We can think of a cell

from an electrical perspective

as if it's a mini space station.

And in that space station

we have the genetic material, the chromosomes,

within a nucleus.

And out in the cytoplasmic soup

we have special proteins

that are required for cell division

that float freely in this soup

in three dimensions.

Importantly, those special proteins

are among the most highly charged objects

in our body.

As cell division begins

the nucleus disintegrates,

the chromosomes line up

in the middle of the cell

and those special proteins

undergo a three-dimensional sequence

whereby they attach

and they literally click into place end-on-end

to form chains.

These chains

then progress and attach

to the genetic material

and pull the genetic material

from one cell into two cells.

And this is exactly how

one cancer cell becomes two cancer cells,

two cancer cells become four cancer cells,

and we have ultimately

uncontrolled tumor growth.

Tumor Treating Fields

use externally placed transducers

attached to a field generator

to create an artificial electric field

on that space station.

And when that cellular space station

is within the electric field,

it acts on those highly charged proteins

and aligns them.

And it prevents them from forming those chains,

those mitotic spindles,

that are necessary to pull the genetic material

into the daughter cells.

What we see is that the cells will attempt to divide

for several hours.

And they will either enter into

this so-called cellular suicide,

programmed cell death,

or they will form unhealthy daughter cells

and enter into apoptosis

once they have divided.

And we can observe this.

What I'm going to show you next

are two in vitro experiments.

This is cultures, identical cultures,

of cervical cancer cells.

And we've stained these cultures

with a green florescent dye

so that we can look at these proteins

that form these chains.

The first clip shows

a normal cell division

without the Tumor Treating Fields.

What we see

are, first of all, a very active culture,

a lot of divisions,

and then very clear nuclei

once the cells have separated.

And we can see them dividing throughout.

When we apply the fields --

again, in the identical time-scale

to the identical culture --

you're going to see something different.

The cells round up for division,

but they're very static in that position.

We'll see two cells

in the upper part of the screen

attempting to divide.

The one within the circle manages.

But see how much of the protein

is still throughout the nucleus,

even in the dividing cell.

The one up there can't divide at all.

And then this bubbling, this membrane bubbling,

is the hallmark

of apoptosis in this cell.

Formation of healthy mitotic spindles

is necessary for division

in all cell types.

We've applied Tumor Treating Fields

to over 20 different cancers in the lab,

and we see this effect

in all of them.

Now importantly,

these Tumor Treating Fields have no effect

on normal undividing cells.

10 years ago,

Dr. Palti founded a company called Novocure

to develop his discovery

into a practical therapy for patients.

In that time, Novocure's developed two systems --

one system for cancers in the head

and another system for cancers in the trunk of the body.

The first cancer that we have focused on

is the deadly brain cancer, GBM.

GBM affects about 10,000 people

in the U.S. each year.

It's a death sentence.

The expected five year survival

is less than five percent.

And the typical patient

with optimal therapy

survives just a little over a year,

and only about seven months

from the time that the cancer is first treated

and then comes back and starts growing again.

Novocure conducted

its first phase three randomized trial

in patients with recurrent GBM.

So these are patients

who had received surgery,

high dose radiation to the head

and first-line chemotherapy,

and that had failed and their tumors had grown back.

We divided the patients into two groups.

The first group received second-line chemotherapy,

which is expected to double the life expectancy,

versus no treatment at all.

And then the second group

received only Tumor Treating Field therapy.

What we saw in that trial

is that that the life expectancies of both groups --

so the chemotherapy treated group

and the Tumor Treating Field group --

was the same.

But importantly,

the Tumor Treating Field group

suffered none of the side effects

typical of chemotherapy patients.

They had no pain,

suffered none of the infections.

They had no nausea, diarrhea,

constipation, fatigue

that would be expected.

Based on this trial,

in April of this year,

the FDA approved Tumor Treating Fields

for the treatment of patients

with recurrent GBM.

Importantly, it was the first time ever

that the FDA included

in their approval of an oncology treatment

a quality of life claim.

So I'm going to show you now

one of the patients

from this trial.

Robert Dill-Bundi

is a famous Swiss cycling champion.

He won the gold medal in Moscow

in the 4,000 meter pursuit.

And five years ago,

Robert was diagnosed with GBM.

He received the standard treatments.

He received surgery.

He received high dose radiation to the head.

And he received first-line chemotherapy.

A year after this treatment --

in fact, this is his baseline MRI.

You can see that the black regions

in the upper right quadrant

are the areas where he had surgery.

And a year after that treatment,

his tumor grew back with a vengeance.

That cloudy white mass that you see

is the recurrence of the tumor.

At this point, he was told by his doctors

that he had about 3 months to live.

He entered our trial.

And here we can see him getting the therapy.

First of all, these electrodes are noninvasive.

They're attached to the skin

in the area of the tumor.

Here you can see

that a technician is placing them on there much like bandages.

The patients learn to do this themselves

And then the patients

can undergo all the activities of their daily life.

There's none of the tiredness.

There's none of what is called the "chemo head."

There's no sensation.

It doesn't interfere

with computers or electrical equipment.

And the therapy is delivered continuously

at home,

without having to go into the hospital

either periodically or continually.

These are Robert's MRIs,

again, under only TTField treatment.

This is a therapy that takes time to work.

It's a medical device;

it works when it's on.

But what we can see is, by month six,

the tumor has responded

and it's begun to melt away.

It's still there.

By month 12,

we could argue whether

there's a little bit of material around the edges,

but it's essentially completely gone.

It's now five years

since Robert's diagnosis,

and he's alive,

but importantly, he's healthy

and he's at work.

I'm going to let him, in this very short clip,

describe his impressions of the therapy

in his own words.

(Video) Robert Dill-Bundi: My quality of life,

I rate what I have today

a bit different than what most people would assume.

I am the happiest, the happiest person in the world.

And every single morning I appreciate life.

Every night I fall asleep very well,

and I am, I repeat,

the happiest man in the world,

and I'm thankful I am alive.

BD: Novocure's also working on lung cancer

as the second target.

We've run a phase two trial

in Switzerland

on, again, recurrent patients --

patients who have received standard therapy

and whose cancer has come back.

I'm going to show you another clip

of a woman named Lydia.

Lydia's a 66 year-old farmer

in Switzerland.

She was diagnosed with lung cancer

five years ago.

She underwent four different regimes of chemotherapy

over two years,

none of which had an effect.

Her cancer continued to grow.

Three years ago,

she entered the Novocure lung cancer trial.

You can see, in her case,

she's wearing her transducer arrays,

one of the front of her chest, one on the back,

and then the second pair side-to-side over the liver.

You can see the Tumor Treating Field field generator,

but importantly you can also see that she is living her life.

She is managing her farm.

She's interacting with her kids and her grand kids.

And when we talked to her,

she said that when she was undergoing chemotherapy,

she had to go to the hospital every month for her infusions.

Her whole family suffered

as her side effect profile came and went.

Now she can run

all of the activities of her farm.

It's only the beginning.

(Applause)

In the lab, we've observed tremendous synergies

between chemotherapy and Tumor Treating Fields.

There's research underway now at Harvard Medical School

to pick the optimum pairs

to maximize that benefit.

We also believe that Tumor Treating Fields will work with radiation

and interrupt the self-repair mechanisms that we have.

There's now a new research project underway

at the Karolinska in Sweden

to prove that hypothesis.

We have more trials planned

for lung cancer,

pancreatic cancer, ovarian cancer

and breast cancer.

And I firmly believe

that in the next 10 years

Tumor Treating Fields

will be a weapon available to doctors and patients

for all of these most-difficult-to-treat solid tumors.

I'm also very hopeful

that in the next decades,

we will make big strides

on reducing that death rate

that has been so challenging in this disease.

Thank you.

(Applause)