Talk:Alternating electric field therapy

I object to the tenor of the article

One of the more promising avenues of cancer therapy that even the article here, couched in over-cautious wording, is AT LEAST as effective as standard cancer care. Even the negative side-effects are over-stated, comparing a topical rash to devastating nausea and the destruction of healthy fast cell regeneration.

Cautiousness is one thing, but unfounded under-current denigration is another. — Preceding unsigned comment added by Garyonthenet (talk • contribs) 14:09, 11 May 2014 (UTC)

I would like to add a refference link

http://annonc.oxfordjournals.org/content/21/suppl_8/viii122.full.pdf+html

I would like to add this link to the references. Then After that maybe add a bit of wording to the phase two lung cancer clinicals being completed as well as a nod to the pilot study of the effectiveness of their TTT on breast cancer.

So thts my intent once I think of how to say it right and proper.

Feel free to speak up before I commit. 1zeroate (talk) 05:12, 15 December 2013 (UTC)

My apoligies there Alexbrn I was gonna fix that there stray linkage after a bit more learningI thought more references were better though even if not quite corrently placed they still cite the edits I made regarding this modality being past it's clinical trials for the brain cancer and on into new research trials in lung and breast cancer.I suppose Ill wait here for someone to do it the right way or learn more about the right way and do it myself in the DIY can do attitude of wiki.

Adding link to Novocure

I added a link to the Novocure site. http://www.novocure.com/ The link was removed with the following comment: " Please do not add inappropriate external links to Wikipedia, as you did to Tumor Treating Fields with this edit. Wikipedia is not a collection of links, nor should it be used for advertising or promotion. Inappropriate links may include, but are not limited to, links to personal websites, links to websites with which you are affiliated, and links that attract visitors to a website or promote a product. See the external links guideline and spam guideline for further explanations. Because Wikipedia uses the nofollow attribute value, its external links are disregarded by most search engines. If you feel the link should be added to the article, please discuss it on the article's talk page rather than re-adding it. Thank you. Jim1138 (talk) 06:11, 9 February 2014 (UTC) "

I've looked at the external links guidelines. They appear to SUPPORT adding a link to Novocure. Such as: http://en.wikipedia.org/wiki/Wikipedia:External_links "What can normally be linked Wikipedia articles about any organization, person, website, or other entity should link to the subject's official site, if any. See Official links below."

This article is not TITLED "Novocure" but it is about TTF which are directly described as relating to Novocure.

Jim1138 could you kindly cite what guideline you think this link violates? — Preceding unsigned comment added by 66.245.21.131 (talk) 17:01, 9 February 2014 (UTC)

As already stated, policy appears to support link to official site of Novocure. No response to above comments. I'm adding the link (again). If you remove it, please cite guideline that applies and please respond to comments above about why this link is relevant and appropriate. 66.245.21.131 (talk) 21:36, 4 March 2014 (UTC)

The company is already linked in the references. Adding an external too seems a bit spammy. Alexbrn ^{talk|contribs|COI} 05:30, 5 March 2014 (UTC)

Adding link to TED talk by Anthony Holland

I added a link to Anthony Holland's TED talk about TTF http://www.youtube.com/watch?v=1w0_kazbb_U The title of his talk is "shattering cancer with resonant frequencies" This link was delete by an automated BOT. Why is this link not allowed? 1. There's a link to another youtube TED talk on this page already 2. TED apparently uses youtube as its distribution channel -- I've been unable to find any other copy of this talk. — Preceding unsigned comment added by 66.245.21.131 (talk) 17:11, 9 February 2014 (UTC)

Has it got anything to do with Tumor Treating Fields? Alexbrn ^{talk|contribs|COI} 17:26, 9 February 2014 (UTC)

Well, I thinkt so, but let me hum a few bars here. The TED talk, as I said, is titled "shattering cancer with resonant frequencies". So, on topic. The video shows various organisms being destroyed/reduced/modified by use of frequencies. Holland uses a similar technology to Novocure (the same frequency range, but with a tube emitting the frequencies rather than electrodes). So, different company, using same range of frequencies. Oh, and Holland's company (Novobiotronics) calls the frequencies something other than TTF I think. But again, same frequencies, and they are doing testing against cancer and also some viruses/bacteria.

Another point is that I believe there was a wiki page about (this) Anthony Holland which was recently eliminated in favor of just having the TTF page. I don't know how to find deleted pages in wikipedia so I can't go look at it. But I think some of the idea was to combine these frequency treatments.

So, the reference is relevant, but it's about Novobiotronics' work, which is not currently cited on the page. I hadn't realized that there's nothing about Novobiotronics there currently. Best solution would be to add a sentence about Novobiotronics and also the TED talk.

66.245.21.131 (talk) 07:16, 10 February 2014 (UTC)

No comments on this for about 3 or 4 weeks. Following up on my last comment "best solution would be to add a sentence about Novobiotronics and also the TED talk". The sentence I propose is: "Another company doing similar work with frequencies is Novobiotronics, which calls its therapy "frequency-specific Plasma Emmission Field Treatment", rather than TTF." And then in the external links, I propose adding a link to both the novobiotronices website and the TED talk http://www.youtube.com/watch?v=1w0_kazbb_U 66.245.21.131 (talk) 00:16, 5 March 2014 (UTC)

Correction needed to how TTF works

The following information in the article is incorrect:

" The process works by using what's known in the medical community as angiogenesis inhibitor therapy, which involves preventing the formation of new blood vessels (preventing angiogenesis) in particular areas of the body and thereby ending the growth of cancerous tumors that require new blood vessels to expand. Thus, the field therapy represents what the scientific literature, such as an article in Discovery Medicine, has called an "outside-the-box" and "novel" method of fighting difficult cancers such as brain tumors, particularly those known as glioblastoma multiforme (GBM) tumors.[1][2]"

2 references are listed.

Reference 1 is about GBM tumors and use of monoclonal antibodies. I see no mention of TTF or how it works.

Reference 2 says (in part): "An outside-the-box approach to therapy of GBM in the recurrent setting is utilization of medium frequency electrical fields. The novel device known as NovoTTF-100A (Novocure, New Hampshire, USA) — was introduced to therapy of malignant glioma in 2011. Tumor treating fields (TTFs) work by arresting dividing cells in mitosis. "

According to Novocure http://www.novocure.com/ttf_therapy.php?ID=16 "These results demonstrate both disruption of cancer cell division up to complete cessation of the process, as well as complete destruction of the dividing cancer cells."

I suggest 1) deleting reference 1 and 2) adding reference I just cited and 3) changing the text to the following:

" The process works by interfering with cancer cells during division, resulting in both inability to of cancer cells to replicate, and destruction of the cancer cell attempting to divide. TTF therapy represents what the scientific literature, such as an article in Discovery Medicine, has called an "outside-the-box" and "novel" method of fighting difficult cancers such as brain tumors, particularly those known as glioblastoma multiforme (GBM) tumors." — Preceding unsigned comment added by 66.245.21.131 (talk) 17:43, 9 February 2014 (UTC)

I just made the change to the text (including "the proposed method of action...."), and references as noted above. I don't know how to edit the references properly. So now there are 2 references to http://www.discoverymedicine.com/Maciej-M-Mrugala/2013/04/25/advances-and-challenges-in-the-treatment-of-glioblastoma-a-clinicians-perspective/ This should be just one reference of course. I'm sorry, but I don't know how to fix this. 66.245.21.131 (talk) 22:37, 11 February 2014 (UTC)

We can say (carefully) how it is said to work; there's no good evidence yet that it really does. I wouldn't want to quote Novocure on this unless their claims were covered by good secondary sources.Alexbrn ^{talk|contribs|COI} 17:47, 9 February 2014 (UTC)

ha - well have you looked at what it says now? (I copied the first few words and corrected the part that was in error about the mechanism....) "The process works by using what's known in the medical community as"..... apparently that was acceptable. Seriously though, I'd be fine with changing it to quote what the article (ref 2) says rather than quoting Novocure. But, um, actually the article (ref 2) says "TTFs work by..." so that doesn't get rid of the idea that they actually work. Also, unfortunately, that's not a very complete explanation of the mechanism. Since the point is to outline HOW TTFs operate how about "TTFs are THOUGHT to work by...." The point here is to explain the mechanism.

"TTFs are thought to work by interfering with cancer cells during division [2], resulting in both inability to of cancer cells to replicate, and destruction of the cancer cell attempting to divide.[ref novocure] TTF therapy represents what the scientific literature, such as an article in Discovery Medicine, has called an "outside-the-box" and "novel" method of fighting difficult cancers such as brain tumors, particularly those known as glioblastoma multiforme (GBM) tumors. [2]"

"Thought to work" implies they work but we don't know why; "Said to work" would be more neutral (or some formulation that avoids saying "work" at all, like "the proposed mechanism of action is ..."). Perhaps we should align our headings with those suggested in MOS:MED ? Alexbrn ^{talk|contribs|COI} 07:10, 10 February 2014 (UTC)

Regarding wording: "proposed mechanism of action" is fine.

Regarding aligning headings with MOS:MED:

1. I didn't find what you are referring to. If you want to pursue this idea, please spell it out or at least cite the part you are referring to. (May be obvious to people more familiar with these guidelines, but I'm not and didn't find something that sounded like suggested headings. Quite possibly my error, but please help me out with this.)

2. there's a proposal to combine this article with another, so it may not be the best use of effort to change headings (since I presume they would need to change again).

If you have no further issues, I'll update the article to correct the misinformation about mechanism. 66.245.21.131 (talk) 07:32, 11 February 2014 (UTC)

See MOS:MED#Drugs.2C_medications_and_devices for some suggested heading. Alexbrn ^{talk|contribs|COI} 07:46, 11 February 2014 (UTC)

Well, THIS bit of data should be "Mechanism of action" but if I give it a heading, it seems I'll need to give everything after if some heading (otherwise all the rest would be part of "Mechanism of action") and I'm not so keen on trying to fit all the rest of the article under headings. If you want to give it a go....... 66.245.21.131 (talk) 15:49, 11 February 2014 (UTC)

I've just updated the text (including "the proposed mechanism of action....") and including references noted already. Unfortunately I don't know how to edit the references properly. There are now 2 references for http://www.discoverymedicine.com/Maciej-M-Mrugala/2013/04/25/advances-and-challenges-in-the-treatment-of-glioblastoma-a-clinicians-perspective/ -- of course there should just be one. I don't know how to fix this. Can someone repair this? Thanks.

66.245.21.131 (talk) 22:37, 11 February 2014 (UTC)

Spanish links

Why is the second reference in Spanish. I thought this was the English Wikipedia?65.93.14.96 (talk) 14:58, 9 March 2014 (UTC)

see WP:RSUE. Alexbrn ^{talk|contribs|COI} 15:16, 9 March 2014 (UTC)

Adverse effects

‎CoffeeWithMarkets has been aggressively[1] adding information about adverse effects into the article, apparently not noticing that we already say, simply, "The adverse effects of TTF were rashes caused by electrode use; in comparison standard chemotherapy caused digestive and blood problems". So the article now has variations of this three times, which seems excessive for a short piece. The useless text (see WP:MEDSECTIONS) "The review recommended more studies to be undertaken ..." has also been added. Alexbrn ^{talk|contribs|COI} 08:11, 2 April 2014 (UTC)

Early termination of phase III study

Alexbrn felt that my mention of this fails Wikipedia:MEDRS - having reviewed this guideline, I can see how discussion of specific figures (e.g. survival data) that have been presented only in abstract form might be inappropriate. However, I feel strongly that the early termination is unusual and significant enough to merit mentioning in the article, since it is consistent with prior data on recurrent GBM, but conveys that there is now objective evidence the approach may be of use in untreated GBM as well. I don't see that as inconsistent with Wikipedia:MEDRS. Early termination of a registered phase III clinical trial due to demonstration of efficacy is a) an objectively verifiable event for which popular press reports are sufficient and b) the result of action by an independent panel of medical experts who reviewed the data and decided that continuing to withhold the intervention from the control group would be unethical. Omitting any mention of this unusual and significant event (while including rather subjective criticism of the FDA approval process, for example), seems inappropriate. I'd suggest restoring mention as follows:

"Preliminary results of a Novocure-sponsored clinical trial of TTF in patients with newly diagnosed glioblastoma were reported at a meeting of the Society for Neuro-Oncology in November, 2014. The trial was terminated early by the independent data monitoring committee, following interim analysis which showed a modest but significant benefit in median survival for patients treated with TTF plus conventional therapy versus patients treated with conventional therapy alone.[2]" Rustavo^{Talk/Contribs} 20:56, 15 November 2014 (UTC)

I favour waiting until this is picked up by a high-quality MEDRS especially since (as the NYT article mentions) this treatment is controversial. Alexbrn ^{talk|contribs|COI} 04:41, 16 November 2014 (UTC)

If the results are as impressive as report makes it out to be, then MEDRS sources should follow suit shortly. Since we are not a newspaper, we can wait for said sources. Yobol (talk) 14:02, 16 November 2014 (UTC)

OK, how about simply adding the following to end of the paragraph about approval for recurrent GBM: "Preliminary clinical trial results have suggested that TTF may also be useful for treatment of newly diagnosed GBM." - citations to NYT article and [3]. This is a slightly different patient population than the FDA-approved indication - it is not some wacky & unsubstantiated concept. It may be months or even > a year until the trial is published and then described in a systematic review (greater than the life expectancy of some of the article's readers, sadly - as per WP:MEDRS - "Wikipedia's articles, while not intended to provide medical advice, are nonetheless an important and widely used source of health information"). In the meantime, if we are to apply your standards in their strictest form, I think we would be obligated to remove all of the subjective commentary which does not come from MEDRS sources, such as the description of "controversy" around the FDA approval. In its current form, the article is weirdly unbalanced and does not (to quote WP:MEDRS) "accurately reflect current medical knowlege."

Alternately, we can explain the controversy (with non-MEDRS sources), and also at least briefly allude to the new trial findings (which the co-chair of the Society for Neuro-oncology Conference described with the words "A new standard of care has been established for GBM patients"[4]). Some judgement is required in application of all wikipedia guidelines, and in this case I don't think we are serving readers well by pretending the newly dx GBM clinical trial does not exist until it is described in a tertiary source. I vote to include both the "controversy" and new trial results, but we cannot logically keep one and not the other. Rustavo^{Talk/Contribs}

Requested Move

Tumor Treating Fields → Alternating electric field therapy (oncology) – I've been reviewing a number of sources in preparation for an update to this page, and I've noticed that many independent english-language clinical review / guideline organizations (e.g. NCCN and UpToDate) seem to prefer the term "alternating electric field therapy" to refer to this technology in a generic sense. The term "tumor treating fields" was coined by Novocare researchers, and "NovoTTF" is the original, trademarked name for their device. It's not clear to me whether other companies that might produce devices in the future working on similar principles would be legally able to call them "tumor treating fields". "Tumor treating fields" is also a bit suboptimal from the standpoint of WP:POVTITLE, since it implies that the technology is efficacious in "treating tumors", while there is still substantial controversy among experts on this point. Finally, I think using a name that refers to the overall therapy, rather than intangible "fields" will lead to less awkward writing (such as the unwieldy first sentence "Tumor Treating Fields (sometimes abbreviated as TTF) is a neologism used to describe a type of electromagnetic field therapy using low-intensity electrical fields. --Relisted. Andrewa (talk) 16:45, 15 December 2014 (UTC) Rustavo^{Talk/Contribs} 23:00, 7 December 2014 (UTC)

There is no article named Alternating electric field therapy, so I'd suggest removing the disambiguator from the proposal. Dekimasuよ! 00:52, 8 December 2014 (UTC)

Electrotherapy, Electromagnetic therapy (alternative medicine), and Pulsed electromagnetic field therapy are all different pages with similar-sounding names - there is also a disambiguation-like page Electromagnetic field therapy. This page should probably also be linked from Electromagnetic field therapy. I think the "(oncology)" is helpful, to avoid content ending up in this page which would more appropriately be in one of those other pages, although a disambiguation line at the top of the article could also be useful. Rustavo^{Talk/Contribs} 04:30, 8 December 2014 (UTC)

Agree with Dekimasu, per WP:TITLE if there isn't a need for a parenthetical disambiguator there should not be one in the title. Generally also Support the title move to Alternating electric field therapy, if we have a general concept instead of a product name it's better to use the general name, like (for example) Glyphosate instead of the title Roundup (the weed-killer product). Handle the content with hat note, and a clear definition of the term and statement of scope in the opening sentence of the article. Zad68 04:48, 8 December 2014 (UTC)

It would be great to avoid pointing to sign-up pages, though the hosts may have done things so this is inevitable. On TTF, you've convinced me: on the principle that we prefer generic terminology to brand names I'd support the move. Alexbrn ^{talk|contribs|COI} 20:13, 26 December 2014 (UTC)

• Relisting comment: We should do something about this, quite a lot in fact... for a start the lead currently starts Tumor Treating Fields (sometimes abbreviated as TTF) is a neologism... (my emphasis) which is just plain wrong... the article topic is the therapy, not the term. But are any of the other terms attested? Relisting to see whether we can come up with a name for the therapy backed up by refs. Failing that, as the article is primarily about a device on which we have no other article, manufactured by a company on which we have no other article, probably move to one of those assuming we can establish notability for one or the other or both. And if not, probably delete. Andrewa (talk) 16:45, 15 December 2014 (UTC)

"Alternating electric field therapy" has zero hits on PUBMED; "Tumor treating fields" has 16. This rather rules out the proposed move. Alexbrn ^{talk|contribs|COI} 17:17, 15 December 2014 (UTC)

It certainly provides a case to answer, but not necessarily an unanswerable one. PubMed is free; Exactly what was your search? Are the hits relevant? Andrewa (talk) 20:17, 24 December 2014 (UTC)

I quoted the terms used to search. Alexbrn ^{talk|contribs|COI} 20:21, 24 December 2014 (UTC)

Yes, and from bitter experience that's no substitute for a link. Also a link is far easier to use of course. Just a suggestion, the easier you make it for people to examine your evidence, the more notice will be taken of it. Andrewa (talk) 19:37, 26 December 2014 (UTC)

Folks, the two primary research articles that described this technology (both referenced on the current page) are titled "Disruption of Cancer Cell Replication by Alternating Electric Fields" (Cancer Research, 2004) and "Alternating electric fields arrest cell proliferation in animal tumor models and human brain tumors" (PNAS 2007). As I clearly stated in my original requested move, major independent clinical review organizations refer to the technology as "Alternating electric field therapy" (NCCN) or "Alternating electric fields" (UpToDate). My feeling is that because the company that sponsored the original research and produced the devices has used both "Alternating electric fields" and "tumor treating fields", but independent review organizations seem to prefer the more generic "alternating electric field therapy" or a variant, the latter should be used for the title of the page.

In response to Alexbrn, Pubmed does not handle quoted phrase searches well, unless that exact phrase has been designated as a keyword in the publication - since Novocure and its affiliated scientists prefer the term "tumor treating fields", they probably haven't been designating the generic term as such. A Google Scholar search for "Alternating Electric Field Therapy" turns up three relevant 2014 articles, plus a 2013 published version of the NCCN guidelines referenced above, all of which use this exact phrase to refer to this technology. I stand by my recommendation to move the page to "Alternating electric field therapy." Rustavo^{Talk/Contribs} 18:09, 26 December 2014 (UTC)

I have no objection to a move it's if well-supported by sources, but it just seems not to be right now. BTW, the source used to support the new term in the lede points to a login page. Alexbrn ^{talk|contribs|COI} 19:20, 26 December 2014 (UTC)

Which one? NCCN requires a free registration to view its content - it takes 2 minutes. The two journal articles (current refs 2 and 3) require a subscription to read full text, but you can read the abstracts via the link. UpToDate unfortunately requires a subscription, but this is available through most major medical centers and medical libraries. I'm not sure what your remaining objection is to the move. Perhaps you could engage with the arguments of the prior discussion (TTF = Novocure-preferred name, more frequent usage in research publications, which have been largely sponsored by Novocure vs. AEFT = more generic name preferred in recent independent expert reviews). Rustavo^{Talk/Contribs} 19:59, 26 December 2014 (UTC)

Per prior discussion, I've changed the proposed move to remove the parenthetical disambiguator (i.e. "Alternating electric field therapy", not "Alternating electric field therapy (oncology)"), and added a hatnote to the current article Rustavo^{Talk/Contribs} 16:39, 27 December 2014 (UTC)