PANOVA-3 Supports Tumor Treating Fields in Locally Advanced Pancreatic Cancer

Clinical Summary: 

• Design/Population: The international, phase 3 PANOVA-3 trial enrolled more than 500 patients with locally advanced pancreatic cancer who were randomized to receive standard gemcitabine plus nab-paclitaxel with or without tumor treating fields (TTFields).
• Key Outcomes: The addition of TTFields significantly improved overall survival and delayed systemic disease progression compared with chemotherapy alone. Treatment was also associated with improvements in multiple quality-of-life measures, including delayed pain progression, while maintaining a manageable safety profile characterized primarily by low-grade skin toxicity.
• Clinical Relevance: These findings supported FDA approval of TTFields for locally advanced pancreatic cancer and establish a new treatment option that may improve both survival and quality of life in this setting.

Vincent Picozzi, MD, Virginia Mason Medical Center, Seattle, Washington, discusses results from the phase 3 PANOVA-3 trial evaluating tumor treating fields (TTFields) in combination with gemcitabine and nab-paclitaxel for patients with locally advanced pancreatic cancer.

The study demonstrated significant improvements in survival and patient-reported outcomes with the addition of TTFields while maintaining an acceptable safety profile. Dr Picozzi also discusses the potential for TTFields to serve as a platform for future combination strategies with targeted therapies and immunotherapy as treatment approaches for pancreatic cancer continue to evolve.

Transcript:

My name is Dr Vince Picozzi, I'm a medical oncologist at the Virginia Mason Clinic in Seattle, Washington, and the director of the pancreatobiliary program here. It's my pleasure to visit with you for several moments about tumor-treating fields in pancreatic cancer. 

As you may be aware, the FDA just recently approved the use of this technology in locally advanced pancreatic cancer. The basis for this approval was the PANOVA-3 trial which was a large, multi-continental, multi-international, phase 3 trial of over 500 patients in which gemcitabine and [nab-paclitaxel], given in standard dose and schedule, were randomized either to the use of tumor-treating fields or not.

This trial produced a number of significant results, the first of which was a statistically significant survival advantage in favor of use of the device and interestingly, this survival advantage was associated with a delay in systemic disease progression. Secondly, there was a significant improvement in virtually all quality-of-life parameters as formally assessed by questionnaire, and most particularly a freedom from pain progression for over 7 months. 

In addition to improvements in both quality and quantity-of-life, things that are very significant to patients being treated with a disease that's generally not curable, the device also proved to be facile to use. Patients were able to use it on average for over 14 hours a day, and really, the only significant incremental side effect was skin toxicity, which did compromise use in about 7 or 8 percent of patients.

With that top-line information, the FDA did see fit to approve this device, something that I'm personally very excited about and plan to introduce in my practice immediately. I think the device can produce immediate advantages for patients in the study population identified both by PANOVA-3 and the FDA, but also I think the device and its use will provide a platform for further investigation and further therapeutic advance. 

The device is being tested in metastatic pancreatic cancer in conjunction with a checkpoint inhibitor and also offers potential synergy with a variety of agents being developed for pancreatic cancer including KRAS inhibitors, immunotherapy, and PARP inhibitors. I believe what we're seeing is just the beginning of the use of this device in pancreatic cancer and related diseases, with further expansive usage to come.

Source: 

Business Wire. US FDA Approves Novocure’s Optune Pax® for the Treatment of Locally Advanced Pancreatic Cancer. Accessed February 20, 2026. https://www.businesswire.com/news/home/20260211674921/en/U.S.-FDA-Approves-Novocures-Optune-Pax-for-the-Treatment-of-Locally-Advanced-Pancreatic-Cancer