Summary

The study is a prospective, randomized controlled phase III trial, to test the efficacy,
safety and neurocognitive outcomes of advanced NSCLC patients, following stereotactic
radiosurgery (SRS) for 1 inoperable brain metastasis or 2-10 brain metastases, treated with
NovoTTF-200M and supportive treatment compared to supportive treatment alone. The device is
an experimental, portable, battery operated device for chronic administration of alternating
electric fields (termed TTFields or TTF) to the region of the malignant tumor, by means of
surface, insulated electrode arrays.

Objectives

PAST PRE-CLINICAL AND CLINICAL EXPERIENCE:

The effect of the electric fields (TTFields, TTF) has demonstrated significant activity in in
vitro and in vivo NSCLC pre-clinical models both as a single modality treatment and in
combination with chemotherapies. TTFields have also shown to inhibit metastatic spread of
malignant melanoma in in vivo experiment.

In a pilot study, 42 patients with advanced NSCLC who had tumor progression after at least
one line of prior chemotherapy, received pemetrexed together with TTFields (150 kHz) applied
to the chest and upper abdomen until disease progression (Pless M., et al., Lung Cancer
2011). Efficacy endpoints were remarkably high compared to historical data for pemetrexed
alone.

In addition, a phase III trial of Optune® (200 kHz) as monotherapy compared to active
chemotherapy in recurrent glioblastoma patients showed TTFields to be equivalent to active
chemotherapy in extending survival, associated with minimal toxicity, good quality of life,
and activity within the brain (14% response rate) (Stupp R., et al., EJC 2012). Finally, a
phase III trial of Optune® combined with maintenance temozolomide compared to maintenance
temozolomide alone has shown that combined therapy led to a significant improvement in both
progression free survival and overall survival in patients with newly diagnosed glioblastoma
without the addition of high grade toxicity and without decline in quality of life (Stupp R.,
et al., JAMA 2015).

Applying TTFields at 150 kHz to the brain for the treatment of 1-5 brain metastasis from
NSCLC using the NovoTTF-100M device has been demonstrated to be safe in a pilot study, where
patients were randomized after local therapy of their brain metastasis by neurosurgery and/or
stereotactic radiosurgery to receive either NovoTTF-100M treatment or supportive care alone.
Eighteen (18) patients have been enrolled in the study. There have been no device-related
serious adverse events (SAE) reported to date (Brozova H., et al., Neuro Oncol 2016).

DESCRIPTION OF THE TRIAL:

All patients included in this trial are patients with 1-10 brain metastases from NSCLC which
are amenable to stereotactic radiosurgery (SRS). In addition, all patients must meet all
eligibility criteria.

Eligible patients will be randomly assigned to one of two groups:

1. Patients undergo SRS followed by TTFields using the NovoTTF-200M System

2. Patients undergo SRS alone and receive supportive care. Patients in both arms of the
study may receive systemic therapy for their NSCLC at the discretion of their treating
physician.

Patients will be randomized at a 1:1 ratio. Baseline tests will be performed in patients
enrolled in both arms. If assigned to the NovoTTF-200M group, the patients will be treated
continuously with the device until second intracranial progression.

On both arms, patients who recur anywhere in the brain will be offered one of the following
salvage treatments (according to local practice) including, but not limited to:

- Surgery

- Repeat SRS

- Whole brain radiotherapy (WBRT) Patients on the control arm will be offered to cross
over to the NovoTTF-200M arm of the study and receive TTFields with or without salvage
therapy for second intracranial progression if the investigator believes it is in the
best interest of the patient and patient agrees.

SCIENTIFIC BACKGROUND:

Electric fields exert forces on electric charges similar to the way a magnet exerts forces on
metallic particles within a magnetic field. These forces cause movement and rotation of
electrically charged biological building blocks, much like the alignment of metallic
particles seen along the lines of force radiating outwards from a magnet.

Electric fields can also cause muscles to twitch and if strong enough may heat tissues.
TTFields are alternating electric fields of low intensity. This means that they change their
direction repetitively many times a second. Since they change direction very rapidly (150
thousand times a second), they do not cause muscles to twitch, nor do they have any effects
on other electrically activated tissues in the body (brain, nerves and heart). Since the
intensities of TTFields in the body are very low, they do not cause heating.

The breakthrough finding made by Novocure was that finely tuned alternating fields of very
low intensity, now termed TTFields (Tumor Treating Fields), cause a significant slowing in
the growth of cancer cells. Due to the unique geometric shape of cancer cells when they are
multiplying, TTFields cause electrically- charged cellular components of these cells to
change their location within the dividing cell, disrupting their normal function and
ultimately leading to cell death.. In addition, cancer cells also contain miniature building
blocks which act as tiny motors in moving essential parts of the cells from place to place.
TTFields interfere with the normal orientation of these tiny motors related to other cellular
components since they are electrically-charged as well. As a result of these two effects,
tumor cell division is slowed, results in cellular death or reverses after continuous
exposure to TTFields.

Other cells in the body (normal healthy tissues) are affected much less than cancer cells
since they multiply at a much slower rate if at all. In addition TTFields can be directed to
a certain part of the body, leaving sensitive areas out of their reach. Finally, the
frequency of TTFields applied to each type of cancer is specific and may not damage normally
dividing cells in healthy tissues. In conclusion, TTFields hold the promise of serving as a
brand new treatment for brain metastases from NSCLC with very few side effects.

Eligibility

1. 18 years of age and older
2. Life expectancy of = 3 months
3. New diagnosis of brain metastases from a histologically or cytologically confirmed primary or metastatic NSCLC tumor within 5 years of registration on the study. If the original histological proof of malignancy is greater than 5 years, then pathological confirmation is required (i.e.: from extra-cranial or intracranial disease).
4. 1 inoperable brain metastasis or 2- 10 brain lesions per screening MRI, confirmed by contrast enhanced MRI amenable to SRS according to the following criteria: a. largest tumor volume < 10 cc b. longest tumor diameter < 3 cm c. Cumulative volume of all tumors = 15 cc 6. At least one measurable disease per study protocol 7. Patients must be receiving optimal therapy for their extracranial disease according to local practice at each center. Patients may continue on systemic therapy while receiving TTFields.
5. Able to operate the NovoTTF-200M device independently or with the help of a caregiver 9. Clinical trials prior to enrollment are allowed, as long as no brain directed therapy was included (current treatment trials are exclusionary)