Teaching pack: Devices & Physical Therapies

Tumour treating fields (Optune, now approved in pancreatic cancer), hyperthermia, HIFU, histotripsy, photodynamic and photoimmunotherapy, electroporation, and intraoperative devices.

• Electrochemotherapy: Brief electric pulses applied to a tumour open pores in cell membranes so that a tiny dose of bleomycin or cisplatin floods in; used for skin metastases and, increasingly, for deep tumours.
• Focused ultrasound & histotripsy: Destroying tumours from outside the body with tightly focused sound waves, using either heat or microscopic bubbles.
• Focused-ultrasound blood-brain barrier opening: Sound waves plus microbubbles briefly open the brain's protective barrier so chemotherapy or antibodies can get to the tumour.
• Hyperthermia: Hyperthermia heats tumours to 40-43 °C to make radiation and chemotherapy work better.
• Infusion pumps, ports, and ambulatory chemotherapy devices: Infusion devices are the implanted ports, smart pumps, and take-home pumps that deliver chemotherapy safely, including 46-hour infusions patients carry home.
• Intratumoural gene electrotransfer (IL-12 plasmid): Injecting the gene for a powerful immune cytokine into a tumour and using an electric pulse to push it into the cells, so the cytokine is made locally rather than flooding the body.
• Intravesical therapy (BCG, chemotherapy, devices, gene and viral therapy): Treating early bladder cancer by putting the drug straight into the bladder through a catheter, so the whole body is spared.
• Irreversible electroporation (NanoKnife): Irreversible electroporation uses short high-voltage pulses that punch permanent holes in tumour cells while sparing nearby vessels and ducts.
• Magnetic nanoparticle hyperthermia: Magnetic nanoparticle hyperthermia injects iron-oxide nanoparticles into a tumour and heats them from outside with an alternating magnetic field.
• Percutaneous hepatic perfusion (chemosaturation): Isolating the liver's circulation with catheters and balloons so that high-dose melphalan can be pumped through it and filtered out before it reaches the rest of the body; approved in 2023 for eye melanoma that has spread to the liver.

• PANOVA-3 (phase 3, n=571): Overall survival: 16.2 months vs 14.2 months, HR 0.82
• EF-14 (phase 3, n=695): Progression-free survival: 6.7 months vs 4 months, HR 0.63
• STELLAR (phase 2, n=80): Overall survival (single arm vs historical): 18.2 months vs 12.1 months

1. What was the first approval in nearly thirty years specific to locally advanced pancreatic cancer?
   Answer

   Optune Pax (tumour treating fields) with gemcitabine/nab-paclitaxel, approved Q1 2026 on PANOVA-3.
2. What is tumour treating fields and which cancers is it approved for?
   Answer

   Wearable electrode arrays delivering alternating electric fields that disrupt cell division; approved for glioblastoma, mesothelioma, NSCLC after platinum, and (2026) locally advanced pancreatic cancer.