Many lymphoma-focused outlets (including this one) described a presentation at the December ASH conference as "possibly the end of watch-and-wait." The ASH presentation gave data from a study that divided 462 follicular lymphoma patients into groups that watched-and-waited and that received Rituxan right away, and then every two months for two years. The study showed that progression-free survival was better for the Rituxan group -- it took longer for them to need chemotherapy or other treatment than it did for the watch-and-waiters.
But this month's issue of Clinical Oncology News (which is aimed at oncologists who treat patients, rather than at, say, researchers) has an article by Jennifer R. Brown, MD, PhD (wow) called "Hyped Follicular Lymphoma Rx Not Ready for Practice." Dr. Brown points out some potential problems with following this protocol. For example, more Rituxan early on could result in Rituxan-resistance later on, when it might be used more effectively when combined with chemo. She also briefly mentions other issues that need more time to be fully explored: the effects of Rituxan on transformation; effects on quality of life; even problems with cost and convenience of such frequent treatment. Dr. Brown suggests that the Rituxan study is an important first step, but only a first step.
Very interesting perspective. Part of me is happy to see that there needs to be more done before we can be sure that watching-and-waiting is no longer necessary, if only because it makes me feel a little better about having made that choice myself. But I also want to make sure that whatever we decide will become the "Gold Standard for First Line Care" will be something effective for everyone who faces that decision.
Brown's critique also makes me want to high five Dr. R, who advised against Rituxan maintenance after my initial rounds of treatment. I wanted to get a little help at keeping things at bay by doing another few rounds of Rituxan, six months after I was done; he thought it would be better to hold off on any treatment until absolutely necessary. So Dr. R gets the point for that one, given what Dr. Brown says about getting too much too soon.
It would be wonderful if we had some easy answers. But as susual, it's important to stay patient and remember that we have plenty of other treatment options to choose from right now. Other, better options will come with time. Maybe not all that much time...
But this month's issue of Clinical Oncology News (which is aimed at oncologists who treat patients, rather than at, say, researchers) has an article by Jennifer R. Brown, MD, PhD (wow) called "Hyped Follicular Lymphoma Rx Not Ready for Practice." Dr. Brown points out some potential problems with following this protocol. For example, more Rituxan early on could result in Rituxan-resistance later on, when it might be used more effectively when combined with chemo. She also briefly mentions other issues that need more time to be fully explored: the effects of Rituxan on transformation; effects on quality of life; even problems with cost and convenience of such frequent treatment. Dr. Brown suggests that the Rituxan study is an important first step, but only a first step.
Very interesting perspective. Part of me is happy to see that there needs to be more done before we can be sure that watching-and-waiting is no longer necessary, if only because it makes me feel a little better about having made that choice myself. But I also want to make sure that whatever we decide will become the "Gold Standard for First Line Care" will be something effective for everyone who faces that decision.
Brown's critique also makes me want to high five Dr. R, who advised against Rituxan maintenance after my initial rounds of treatment. I wanted to get a little help at keeping things at bay by doing another few rounds of Rituxan, six months after I was done; he thought it would be better to hold off on any treatment until absolutely necessary. So Dr. R gets the point for that one, given what Dr. Brown says about getting too much too soon.
It would be wonderful if we had some easy answers. But as susual, it's important to stay patient and remember that we have plenty of other treatment options to choose from right now. Other, better options will come with time. Maybe not all that much time...
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