Emerging potential of tumor treating fields as a treatment modality for pancreatic cancer: a narrative review of therapeutic evolution

Background and Objective: Pancreatic ductal adenocarcinoma (PDAC) is poorly responsive to conventional treatment and therefore is among the deadliest cancers. Tumor treating fields (TTFields) delivers low-intensity electrical fields that alternate in direction and frequency to disrupt cell division in cancer cells and has emerged as a potentially effective therapy for PDAC. In this narrative review, we discuss the primary mechanisms of TTFields as well as emerging preclinical and clinical outcomes of this novel technology for PDAC. Methods: We performed a literature search on PubMed, Clinicaltrials.gov and Google Scholar using the terms "tumor treating fields" and "pancreatic ductal adenocarcinoma". We included studies, review articles and editorials published in English between 1st January 2000 and 5th January 2023. All papers reviewed and their key references are cross-checked to maintain a balanced and high-quality literature review on the subjects. Key Content and Findings: Preclinical studies have demonstrated anti-mitotic effects of TTFields on PDAC cell lines, and the safety of TTFields has been demonstrated in a phase II study. An ongoing phase III trial of chemotherapy +/− TTFields will hopefully provide valuable insights into whether TTFields should become a standard of care (SOC) for locally advanced unresectable pancreatic cancer. Thus, TTFields could represent a major breakthrough in the treatment of this highly malignant disease. Conclusions: Preliminary clinical findings suggest that TTFields could be a promising treatment option for patients with PDAC, given its favorable safety profile and potential for significant clinical benefit. However, further research is needed to determine the optimal treatment parameters and patient subgroups that may benefit the most from this therapy.