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ttfields for lung cancer - is this actually something for meso or different?

Family · · 2,794 views
So my dad's oncologist at Northwestern mentioned tumor treating fields as a possibility and I got excited because I work in healthcare and I know ttfields is FDA approved for glioblastoma. But then I realized I have no idea if this is actually used for lung cancer or if it's just meso or what the deal is.

I know my dad's pleural meso is stage IV and we're palliative right now since October, but I want to understand every option on the table before we completely close the door on active treatment. His performance status isn't great but it's not zero either.

Does anyone here have experience with ttfields for lung cancer specifically, or is this something that's mainly being studied for meso? I've seen some research on it for mesothelioma but I'm getting conflicting information about whether it's the same application or if oncologists are just throwing it out there because they're looking at anything at this point.

Also if anyone knows whether insurance typically covers this I'd love to hear that too because the out of pocket piece matters for us right now.

15 Replies

Family
I'm sorry, I don't have direct experience with ttfields specifically but I've learned so much just from sitting in oncology appointments with my mom these past few months. What I can tell you is that Northwestern is a really solid center so if they're mentioning it, they probably have good reason.

From what I've picked up, ttfields got approved for glioblastoma first and now there's definitely research happening around other cancers including lung and meso. My mom's oncologist at Mayo Phoenix mentioned it once in passing but said it wasn't right for her particular situation, so I think it's really case by case depending on tumor location and type. The fact that your dad's doctor is bringing it up means they probably think his specific presentation might be a candidate, which is actually a good sign that they're still exploring things.

The insurance piece is real though. We spent like three weeks in September just trying to figure out what Mayo's novel treatments would actually cost us out of pocket before committing to anything. I'd honestly call the billing department at Northwestern directly and ask them to run it as a hypothetical before your dad has any more appointments about it. They can usually give you a ballpark at least.

I get wanting to understand every option before closing doors. That's been me this whole time, reading research papers at like 10pm when I should be grading papers instead. But also just being real with you, sometimes the exploring itself becomes its own kind of exhausting. Make sure your dad's feeling okay about the pace of all this too. My mom got tired of being "the case to solve" if that makes sense.
Medical ✓ Expert Response
Your dad's oncologist mentioning this actually makes a lot of sense given where the research is heading right now. TTFields works through electric fields that disrupt cell division, and yes it's the same device and same company (Novocure) for both applications, but the approvals and evidence base are genuinely different depending on the cancer type.

For pleural meso specifically, the STELLAR trial published in 2019 showed median overall survival around 18 months when TTFields was combined with standard chemo, which got a lot of attention because that's a meaningful number for stage IV disease. For non-small cell lung cancer there's also been real research, the LUNAR trial results came out in 2023 and showed survival benefit in second-line treatment. So this isn't your oncologist just throwing things at the wall. there's actual data here for both.

The insurance piece is genuinely complicated and I won't pretend otherwise. Coverage for meso indications has varied a lot, and the palliative context matters for how payers look at it. What I've seen families do is work directly with Novocure's patient support team because they have dedicated people who handle insurance appeals and sometimes bridge programs. That call is worth making before you assume it's out of reach.

Performance status is something his oncologist will weigh carefully, and you're right to flag it. But "not zero" does matter in these conversations. Keeping that door open with his care team, asking specifically about clinical trials for TTFields in meso right now, that's worth one more direct conversation.

If any of this is bringing up a lot emotionally for you as a family caregiver, please know that's something worth talking to someone about too. Being the healthcare-literate person in the family who's also grieving is its own particular weight.
3 found this helpful
Patient
TTfields is FDA approved for glioblastoma and some lung cancers but honestly the mesothelioma data is still pretty limited. I've been reading a lot of studies since my diagnosis in November and there's ongoing research specifically for pleural meso, but it's not standard of care yet like it is for certain lung cancer subtypes. Your dad's oncologist might be looking at it because there's some promising phase 2 data out there, but I'd want to know if that's based on his specific histology and stage.

The insurance piece is tricky. Coverage depends heavily on whether it's being used for an FDA-approved indication or if it's experimental for his particular diagnosis. I haven't pursued it myself because I'm already committed to the HIPEC surgery route, but I've seen people on here mention it gets denied initially and requires appeals. That's honestly exhausting when you're already dealing with stage IV.

What I'd push for is asking his oncologist specifically which studies support using it for pleural meso versus lung cancer, because they're not the same beast. Ask if it's based on published data or if they're recommending it off-label. Get the actual mechanism they think will help him. I keep a detailed journal of every treatment discussion and what the rationale is because once you start getting into palliative territory, you need to be crystal clear about what's actually evidence-based versus what's a Hail Mary. Northwestern is solid though, so there's probably real thinking behind it.
Family
Yeah that's what I'm trying to figure out. The oncologist mentioned it pretty casually and honestly I'm not sure if he's genuinely thinking it could help or just making sure we've looked at everything. My dad's got epithelioid histology which I know tends to respond better than biphasic, so maybe that's why it came up.

Did your team give you any sense of whether the lung cancer approvals would even apply to meso cases, or are they treating it as totally separate research tracks? I'm trying to decide if I should push back and ask more specific questions about the actual data for his particular situation.
Veteran
TTFields is approved for glioblastoma and some lung cancers but the evidence for meso is still pretty limited from what I've seen. Your dad's oncologist at Northwestern is solid though, they do good work up there.

I didn't go the TTFields route myself. Got the pleurectomy in August and we stuck with chemo protocol after that. My oncologist at the VA talked about it as an option but honestly the data wasn't there yet for stage II like mine was, and I wanted something with more track record. But stage IV is a different conversation and if Northwestern is bringing it up they've probably looked at his specific situation pretty carefully.

The insurance piece is real. We spent like two weeks in September just fighting with coverage on follow-up imaging before the surgery even happened. TTFields devices aren't cheap and yeah insurance gets finicky about newer tech. Worth having his team fight for it if they think it's worth trying, but you're right to ask about that upfront.

One thing I'd say is your dad's performance status matters more than people think. Sounds like you already know that working in healthcare. I was able to do the surgery because I could still walk around at 0600 in the morning, you know. If he's palliative right now that's a real consideration for what his body can actually handle.

Northwestern should have all the data on TTFields coverage and outcomes for his specific staging. Ask them straight up what their success rate looks like and whether they've seen it help guys in his position. That'll tell you more than anything online will.
Family
Yeah, the pleurectomy route makes sense, especially if you had better performance status to handle surgery. I'm kicking myself a little for not asking more questions earlier about whether my dad would've been a candidate for that back in March, but we're where we are now. Did your VA oncologist give you any sense of whether they'd recommend TTFields as adjuvant after chemo, or was it more of a "we could try it" kind of thing? I'm trying to figure out if Northwestern's mentioning it because there's actual data supporting it for his specific situation or if it's just one of those things they mention when you're running out of standard options. The limited evidence piece isn't surprising but it's frustrating when you're trying to make informed decisions on a timeline.
Family
Hey, I totally get the excitement when you hear about something new because it feels like maybe there's another option, you know? My mom's oncologist mentioned some experimental stuff too and I spent like three hours reading research papers at midnight thinking I'd found the answer.

So here's what I've picked up from talking to people here and reading a ton. TTFields got approved for glioblastoma but for lung cancer and meso it's still pretty much in research mode. There are some clinical trials happening but it's not like it's a standard treatment option yet. Your dad's oncologist might be thinking about it because there's some data coming out, but honestly I'd ask him directly what stage of research it's in and whether there's an actual trial your dad could qualify for or if it's more of a "this might help someday" kind of mention.

The insurance thing is tricky because most plans won't touch experimental stuff unless it's part of an official clinical trial. When my mom was doing chemo we found out real quick that "not FDA approved yet" basically means you're paying out of pocket, and that adds up fast.

I'm not gonna sugarcoat it, the palliative route is hard to accept even when you know it's the right call. But asking these questions and understanding what's actually available versus what sounds promising is exactly what you should be doing. Your dad's lucky to have someone in healthcare asking the right questions. Maybe write down what specifically the oncologist said about TTFields and bring it to the next appointment so you can really dig into what he's thinking?
Family
Yeah the midnight research spiral is real, I've been there more times than I want to admit. Thanks for the reality check on the clinical trial piece because honestly that's what I needed to hear even though part of me was hoping for something more concrete. Did your mom's oncologist actually enroll her in anything or did they end up going a different direction? I'm trying to figure out if Northwestern is even offering it as a trial option or if they were just floating it speculatively.
Family
I haven't dealt with ttfields personally but Joe's oncologist at Moffitt mentioned it way back when we were first looking at all the options, so I remember doing some digging on it. From what I could gather, ttfields got approval for glioblastoma first which is why you know about it, but there's been some research into using it for mesothelioma and non-small cell lung cancer too. The thing is, the research is still pretty early stage for those cancers compared to brain tumors, so it's not like it's a standard go-to treatment yet.

Your dad's oncologist at Northwestern is probably thinking about it because mesothelioma and certain lung cancers can behave similarly in some ways, but whether it would actually make sense for his specific situation... that's really a conversation between him and the team there. We learned pretty quick that just because something exists doesn't mean it's the right fit, especially when you're looking at palliative care and managing quality of life.

On the insurance piece, yeah that's been a stressor for us too. Most insurance companies are still pretty hesitant about ttfields for anything other than glioblastoma since that's where the evidence is strongest. We ended up hitting a lot of dead ends when we were exploring different things, so I'd say call the insurance company directly with the specific CPT codes Northwestern would use. Don't just rely on what the office tells you they think it costs.

How's your dad doing otherwise with managing symptoms right now?
Family
Yeah, that early-stage research piece is what I kept running into too. I appreciate you confirming that because at least I know the oncologist isn't just making stuff up. Do you remember if Joe's doctor gave him any sense of timeline on the research, or was it more of a "we could try this but results are limited" kind of conversation? My dad's performance status is borderline for most aggressive treatments anyway, so I'm trying to figure out if this is something worth pursuing or if we should just focus on managing his symptoms better.
Attorney ✓ Expert Response
Good question and it's clear you're approaching this thoughtfully given your healthcare background.

So TTFields does have FDA clearance specifically for non-small cell lung cancer, that came through in 2019 under the 510(k) pathway based on the LUNAR trial data. Mesothelioma is a different situation, it's been studied in the STELLAR trial and some follow-on work, but the FDA approval pathway there is still incomplete as of my last update. So your dad's oncologist may actually be thinking about this in the lung cancer context, not the meso context, even though the primary diagnosis is pleural meso. Worth clarifying exactly which indication they're considering.

The coverage piece is honestly where things get complicated. Medicare and many commercial insurers have covered it for GBM for years, but coverage for lung cancer indications is still inconsistent depending on the payer and the plan. We had a client in 2022 whose prior auth got denied twice before going through, and the turnaround on appeal took about six weeks. Performance status does factor into medical necessity determinations, so his current PS will matter to whatever the insurer decides.

From an experience standpoint, the oncology team at Northwestern is generally sophisticated about this so if they're raising it seriously rather than just mentioning it, that's probably worth following up on as a real option rather than a long shot.

Please do consult an attorney if any of this intersects with coverage disputes or if questions about his diagnosis and potential occupational exposure ever come up, because jurisdiction matters a lot in those situations.
3 found this helpful
Family
I really appreciate you clarifying that timeline because I was getting lost in the research rabbit hole last night. So if ttfields is already approved for NSCLC, that actually gives me something concrete to work with when I talk to his oncologist about whether dad qualifies based on his specific tumor characteristics. Do you know if the insurance coverage tends to follow the FDA approvals pretty closely, or is that its own separate battle? We're dealing with United and they can be pretty rigid about what they'll greenlight.
Family
ttfields got FDA approval for non-small cell lung cancer pretty recently so your oncologist isn't just throwing darts, but honestly the data for meso specifically is still pretty limited and mostly in clinical trials. given your dad's current performance status and that he's on palliative care, that's definitely the conversation to have with the team about whether the burden of wearing the device makes sense for what they'd realistically expect to gain.
Attorney ✓ Expert Response
Good questions, and the fact that you work in healthcare means you'll track with some of the technical pieces here.

TTFields for non-small cell lung cancer actually got FDA approval in 2019, so your dad's oncologist isn't just throwing darts. The LUNAR trial showed a survival benefit when combined with standard second-line therapy, roughly 18.5 months median overall survival versus 12.1 months in the control arm. That's a real signal, not noise. For pleural meso specifically, the STELLAR trial back around 2019 showed similar promise, so the research threads are actually parallel, not the same thing.

The performance status piece matters a lot for whether he'd even tolerate wearing the arrays, because patients typically need to keep them on 18 or more hours a day. That's a real commitment when someone isn't feeling well.

On the insurance question, this is where my area actually intersects with yours. Coverage for mesothelioma patients can sometimes be argued through the manufacturer's compassionate access programs, and separately, if there's a pending or potential asbestos exposure claim, treatment costs including experimental or off-label therapies could potentially be recoverable depending on your jurisdiction and the specifics of his exposure history. I've seen cases where families didn't realize that door was open until it was nearly too late to file, and statutes of limitations for meso claims vary pretty significantly by state, some as short as one year from diagnosis.

Consult an attorney for your specific situation, but it's worth at least a conversation before you close any doors.
2 found this helpful
Family
That survival data is actually really helpful to see spelled out like that. I've been digging through pubmed but the actual numbers aren't always easy to find in abstracts. So if my dad were to consider this, it sounds like the benefit would be more meaningful if he was doing chemo alongside it rather than palliative alone, which honestly makes sense mechanistically. Did you see whether performance status was a factor in those trials, or could someone with declining functional capacity still be a candidate?

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