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TEDMED 2011

Bill Doyle: Treating cancer with electric fields

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Surgery, chemotherapy and radiation are the best-known methods for treating cancer. At TEDMED, Bill Doyle presents a new approach, called Tumor Treating Fields, which uses electric fields to interrupt cancer cell division. Still in its infancy -- and approved for only certain types of cancer -- the treatment comes with one big benefit: quality of life.

- Engineer
With his company Novocure, Bill Doyle works to bring breakthrough medical technologies to doctors and patients. Full bio

Everybody in our society's life is touched by cancer --
00:15
if not personally,
00:18
then through a loved one, a family member,
00:20
colleague, friend.
00:23
And once our lives are touched by cancer,
00:25
we quickly learn
00:28
that there are basically
00:30
three weapons, or three tools, that are available
00:32
to fight the disease:
00:35
surgery, radiation and chemotherapy.
00:38
And once we get involved
00:41
in the therapeutic decisions,
00:44
again either personally
00:47
or with our loved ones and family members,
00:49
we also very quickly learn
00:52
the benefits, the trade-offs and the limitations
00:55
of these tools.
00:58
I'm very thankful to Jay and to Mark
01:00
and the TEDMED team
01:02
for inviting me today
01:04
to describe a fourth tool, a new tool,
01:06
that we call Tumor Treating Fields.
01:09
Tumor Treating Fields
01:12
were invented by Dr. Yoram Palti,
01:14
professor emeritus at the Technion in Israel.
01:17
And they use low-intensity
01:20
electric fields
01:22
to fight cancer.
01:24
To understand how Tumor Treating Fields work,
01:26
we first need to understand
01:29
what are electric fields.
01:31
Let me first address
01:33
a few popular misconceptions.
01:36
First of all, electric fields
01:39
are not an electric current
01:41
that is coursing through the tissue.
01:43
Electric fields
01:46
are not ionizing radiation,
01:48
like X-rays or proton beams,
01:50
that bombard tissue
01:52
to disrupt DNA.
01:54
And electric fields
01:56
are not magnetism.
01:58
What electric fields are
02:00
are a field of forces.
02:02
And these forces
02:05
act on, attract, bodies
02:07
that have an electrical charge.
02:10
The best way to visualize an electric field
02:13
is to think of gravity.
02:15
Gravity is also a field of forces
02:17
that act on masses.
02:20
We can all picture astronauts in space.
02:22
They float freely in three dimensions
02:25
without any forces acting on them.
02:27
But as that space shuttle
02:29
returns to Earth,
02:32
and as the astronauts enter the Earth's gravitational field,
02:34
they begin to see the effects of gravity.
02:37
They begin to be attracted towards Earth.
02:40
And as they land,
02:42
they're fully aligned in the gravitational field.
02:44
We're, of course, all stuck in the Earth's gravitational field right now.
02:46
That's why you're all in your chairs.
02:49
And that's why we have to use our muscle energy
02:52
to stand up, to walk around
02:54
and to lift things.
02:56
In cancer,
02:59
cells rapidly divide
03:01
and lead to uncontrolled tumor growth.
03:03
We can think of a cell
03:06
from an electrical perspective
03:09
as if it's a mini space station.
03:11
And in that space station
03:14
we have the genetic material, the chromosomes,
03:16
within a nucleus.
03:19
And out in the cytoplasmic soup
03:21
we have special proteins
03:23
that are required for cell division
03:25
that float freely in this soup
03:27
in three dimensions.
03:29
Importantly, those special proteins
03:31
are among the most highly charged objects
03:34
in our body.
03:37
As cell division begins
03:39
the nucleus disintegrates,
03:41
the chromosomes line up
03:43
in the middle of the cell
03:45
and those special proteins
03:47
undergo a three-dimensional sequence
03:49
whereby they attach
03:53
and they literally click into place end-on-end
03:55
to form chains.
03:58
These chains
04:00
then progress and attach
04:02
to the genetic material
04:04
and pull the genetic material
04:07
from one cell into two cells.
04:09
And this is exactly how
04:11
one cancer cell becomes two cancer cells,
04:13
two cancer cells become four cancer cells,
04:15
and we have ultimately
04:17
uncontrolled tumor growth.
04:19
Tumor Treating Fields
04:22
use externally placed transducers
04:25
attached to a field generator
04:29
to create an artificial electric field
04:32
on that space station.
04:36
And when that cellular space station
04:39
is within the electric field,
04:42
it acts on those highly charged proteins
04:44
and aligns them.
04:48
And it prevents them from forming those chains,
04:50
those mitotic spindles,
04:53
that are necessary to pull the genetic material
04:55
into the daughter cells.
04:58
What we see is that the cells will attempt to divide
05:00
for several hours.
05:03
And they will either enter into
05:05
this so-called cellular suicide,
05:08
programmed cell death,
05:10
or they will form unhealthy daughter cells
05:12
and enter into apoptosis
05:15
once they have divided.
05:18
And we can observe this.
05:20
What I'm going to show you next
05:22
are two in vitro experiments.
05:24
This is cultures, identical cultures,
05:26
of cervical cancer cells.
05:29
And we've stained these cultures
05:31
with a green florescent dye
05:33
so that we can look at these proteins
05:35
that form these chains.
05:38
The first clip shows
05:40
a normal cell division
05:42
without the Tumor Treating Fields.
05:45
What we see
05:48
are, first of all, a very active culture,
05:50
a lot of divisions,
05:52
and then very clear nuclei
05:54
once the cells have separated.
05:56
And we can see them dividing throughout.
05:58
When we apply the fields --
06:00
again, in the identical time-scale
06:02
to the identical culture --
06:04
you're going to see something different.
06:06
The cells round up for division,
06:08
but they're very static in that position.
06:10
We'll see two cells
06:13
in the upper part of the screen
06:15
attempting to divide.
06:20
The one within the circle manages.
06:22
But see how much of the protein
06:24
is still throughout the nucleus,
06:26
even in the dividing cell.
06:28
The one up there can't divide at all.
06:30
And then this bubbling, this membrane bubbling,
06:32
is the hallmark
06:35
of apoptosis in this cell.
06:37
Formation of healthy mitotic spindles
06:40
is necessary for division
06:44
in all cell types.
06:47
We've applied Tumor Treating Fields
06:49
to over 20 different cancers in the lab,
06:51
and we see this effect
06:54
in all of them.
06:56
Now importantly,
06:59
these Tumor Treating Fields have no effect
07:01
on normal undividing cells.
07:04
10 years ago,
07:06
Dr. Palti founded a company called Novocure
07:08
to develop his discovery
07:11
into a practical therapy for patients.
07:14
In that time, Novocure's developed two systems --
07:17
one system for cancers in the head
07:21
and another system for cancers in the trunk of the body.
07:24
The first cancer that we have focused on
07:27
is the deadly brain cancer, GBM.
07:30
GBM affects about 10,000 people
07:33
in the U.S. each year.
07:36
It's a death sentence.
07:39
The expected five year survival
07:41
is less than five percent.
07:43
And the typical patient
07:45
with optimal therapy
07:47
survives just a little over a year,
07:49
and only about seven months
07:52
from the time that the cancer is first treated
07:54
and then comes back and starts growing again.
07:57
Novocure conducted
08:02
its first phase three randomized trial
08:04
in patients with recurrent GBM.
08:06
So these are patients
08:08
who had received surgery,
08:10
high dose radiation to the head
08:14
and first-line chemotherapy,
08:16
and that had failed and their tumors had grown back.
08:18
We divided the patients into two groups.
08:21
The first group received second-line chemotherapy,
08:24
which is expected to double the life expectancy,
08:27
versus no treatment at all.
08:30
And then the second group
08:32
received only Tumor Treating Field therapy.
08:34
What we saw in that trial
08:37
is that that the life expectancies of both groups --
08:39
so the chemotherapy treated group
08:42
and the Tumor Treating Field group --
08:44
was the same.
08:46
But importantly,
08:48
the Tumor Treating Field group
08:50
suffered none of the side effects
08:53
typical of chemotherapy patients.
08:56
They had no pain,
08:59
suffered none of the infections.
09:01
They had no nausea, diarrhea,
09:04
constipation, fatigue
09:07
that would be expected.
09:10
Based on this trial,
09:12
in April of this year,
09:14
the FDA approved Tumor Treating Fields
09:16
for the treatment of patients
09:19
with recurrent GBM.
09:21
Importantly, it was the first time ever
09:24
that the FDA included
09:27
in their approval of an oncology treatment
09:29
a quality of life claim.
09:32
So I'm going to show you now
09:36
one of the patients
09:39
from this trial.
09:41
Robert Dill-Bundi
09:44
is a famous Swiss cycling champion.
09:46
He won the gold medal in Moscow
09:48
in the 4,000 meter pursuit.
09:50
And five years ago,
09:53
Robert was diagnosed with GBM.
09:56
He received the standard treatments.
09:59
He received surgery.
10:01
He received high dose radiation to the head.
10:04
And he received first-line chemotherapy.
10:07
A year after this treatment --
10:10
in fact, this is his baseline MRI.
10:12
You can see that the black regions
10:15
in the upper right quadrant
10:18
are the areas where he had surgery.
10:20
And a year after that treatment,
10:22
his tumor grew back with a vengeance.
10:24
That cloudy white mass that you see
10:27
is the recurrence of the tumor.
10:30
At this point, he was told by his doctors
10:33
that he had about 3 months to live.
10:36
He entered our trial.
10:39
And here we can see him getting the therapy.
10:41
First of all, these electrodes are noninvasive.
10:44
They're attached to the skin
10:47
in the area of the tumor.
10:49
Here you can see
10:51
that a technician is placing them on there much like bandages.
10:53
The patients learn to do this themselves
10:56
And then the patients
10:59
can undergo all the activities of their daily life.
11:02
There's none of the tiredness.
11:05
There's none of what is called the "chemo head."
11:07
There's no sensation.
11:10
It doesn't interfere
11:12
with computers or electrical equipment.
11:14
And the therapy is delivered continuously
11:17
at home,
11:19
without having to go into the hospital
11:21
either periodically or continually.
11:23
These are Robert's MRIs,
11:26
again, under only TTField treatment.
11:29
This is a therapy that takes time to work.
11:32
It's a medical device;
11:35
it works when it's on.
11:37
But what we can see is, by month six,
11:39
the tumor has responded
11:41
and it's begun to melt away.
11:44
It's still there.
11:47
By month 12,
11:49
we could argue whether
11:51
there's a little bit of material around the edges,
11:53
but it's essentially completely gone.
11:55
It's now five years
11:58
since Robert's diagnosis,
12:00
and he's alive,
12:02
but importantly, he's healthy
12:05
and he's at work.
12:07
I'm going to let him, in this very short clip,
12:09
describe his impressions of the therapy
12:11
in his own words.
12:13
(Video) Robert Dill-Bundi: My quality of life,
12:15
I rate what I have today
12:17
a bit different than what most people would assume.
12:19
I am the happiest, the happiest person in the world.
12:23
And every single morning I appreciate life.
12:28
Every night I fall asleep very well,
12:32
and I am, I repeat,
12:35
the happiest man in the world,
12:38
and I'm thankful I am alive.
12:40
BD: Novocure's also working on lung cancer
12:45
as the second target.
12:48
We've run a phase two trial
12:50
in Switzerland
12:52
on, again, recurrent patients --
12:54
patients who have received standard therapy
12:56
and whose cancer has come back.
12:59
I'm going to show you another clip
13:02
of a woman named Lydia.
13:04
Lydia's a 66 year-old farmer
13:06
in Switzerland.
13:08
She was diagnosed with lung cancer
13:10
five years ago.
13:12
She underwent four different regimes of chemotherapy
13:14
over two years,
13:17
none of which had an effect.
13:19
Her cancer continued to grow.
13:21
Three years ago,
13:23
she entered the Novocure lung cancer trial.
13:25
You can see, in her case,
13:29
she's wearing her transducer arrays,
13:31
one of the front of her chest, one on the back,
13:33
and then the second pair side-to-side over the liver.
13:36
You can see the Tumor Treating Field field generator,
13:39
but importantly you can also see that she is living her life.
13:42
She is managing her farm.
13:45
She's interacting with her kids and her grand kids.
13:47
And when we talked to her,
13:50
she said that when she was undergoing chemotherapy,
13:53
she had to go to the hospital every month for her infusions.
13:55
Her whole family suffered
13:58
as her side effect profile came and went.
14:00
Now she can run
14:02
all of the activities of her farm.
14:04
It's only the beginning.
14:07
(Applause)
14:09
In the lab, we've observed tremendous synergies
14:16
between chemotherapy and Tumor Treating Fields.
14:20
There's research underway now at Harvard Medical School
14:23
to pick the optimum pairs
14:26
to maximize that benefit.
14:28
We also believe that Tumor Treating Fields will work with radiation
14:30
and interrupt the self-repair mechanisms that we have.
14:33
There's now a new research project underway
14:37
at the Karolinska in Sweden
14:39
to prove that hypothesis.
14:41
We have more trials planned
14:43
for lung cancer,
14:45
pancreatic cancer, ovarian cancer
14:47
and breast cancer.
14:49
And I firmly believe
14:51
that in the next 10 years
14:53
Tumor Treating Fields
14:55
will be a weapon available to doctors and patients
14:57
for all of these most-difficult-to-treat solid tumors.
15:00
I'm also very hopeful
15:06
that in the next decades,
15:08
we will make big strides
15:10
on reducing that death rate
15:12
that has been so challenging in this disease.
15:15
Thank you.
15:18
(Applause)
15:20

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About the Speaker:

Bill Doyle - Engineer
With his company Novocure, Bill Doyle works to bring breakthrough medical technologies to doctors and patients.

Why you should listen

Bill Doyle is the executive chair of Novocure, a company commercializing a new therapeutic modality for solid tumors using low-intensity electric fields. Recently, Novocure received FDA approval for its first indication, recurrent Glioblastoma Multiforme (GBM), the most virulent form of brain cancer; it is now conducting additional clinical trials.

In 2002, Doyle co-founded medical device venture firm WFD Ventures, which provides financing and business-building expertise to medical device companies with the potential to make a major impact on patient care, working with entrepreneurs, doctors and scientists to improve medical outcomes and maximize the potential of their innovations.

A graduate of MIT, Doyle stablished the MIT FIRST Scholarship for FIRST Robotics Competition participants admitted to MIT.

Watch Jay Walker's onstage Q&A with Bill Doyle >>

More profile about the speaker
Bill Doyle | Speaker | TED.com