Dr Picozzi on the Addition of TTFields to Gemcitabine and Nab-Paclitaxel in Locally Advanced PDAC

"The use of TTFields did produce a statistically significant improvement in overall survival over [chemotherapy alone]. This is important in that this is first positive trial ever in this stage of pancreatic cancer, and it also provides a foundation for additional therapy endeavors that leverage the use of TTFields."

Vincent Picozzi, MD, a medical oncologist at Virginia Mason Medical Center, discussed the clinical relevance of data from the phase 3 PANOVA-3 trial (NCT03377491) evaluating the addition of tumor-treating fields (TTFields) to gemcitabine and nab-paclitaxel (Abraxane) in patients with locally advanced pancreatic ductal adenocarcinoma (PDAC).

Results from PANOVA-3 presented at the 2025 ASCO Annual Meeting demonstrated that the TTFields regimen generated a statistically significant overall survival (OS) benefit over chemotherapy alone (HR, 0.82; 95% CI, 0.68-0.99; P = .039). Specifically, TTFields plus chemotherapy produced a median OS of 16.2 months (95% CI, 15.0-18.0) compared with 14.2 months (95% CI, 12.8-15.4) for chemotherapy alone. The 1-year OS rates were 68.1% (95% CI, 62.0%-73.5%) and 60.2% (95% CI, 54.2%-65.7%), respectively (P = .029).

This study represents the first positive phase 3 trial in the locally advanced PDAC patient population, Picozzi noted. He said that these data provide a foundation for further exploration of TTFields in PDAC and may inform future strategies incorporating the device into standard treatment paradigms.

PANOVA-3 enrolled patients with unresectable, locally advanced PDAC who had not received prior systemic therapy and were ineligible for immediate surgical resection or radiation. Participants were randomly assigned to receive either standard-of-care chemotherapy with gemcitabine and nab-paclitaxel alone or in combination with TTFields, which delivers low-intensity, alternating electric fields via a wearable device that disrupts mitotic activity in tumor cells.

In addition to OS outcomes, quality-of-life (QOL) metrics favored the TTFields arm. Improvements were observed in global health status and patient-reported pain measures, as well as prolonged time to deterioration in pain. Picozzi emphasized that in pancreatic cancer, where treatment options are limited and the symptom burden is high, QOL outcomes are particularly important and may be as clinically meaningful as traditional survival end points.