Watching and Waiting Still OK?

The whole issue of Watching and Waiting is still one of the most controversial among Follicular NHL experts. The idea behind it, as it was explained to me, is because there are a limited number of treatments available for fNHL, so if a patient doesn't have symptoms and is living a relatively normal life, there's no reason to give treatment ("Do no harm," as Dr. R says), saving those treatment options for later. Some say it's still a valid approach to take with newly diagnosed fNHL; others say it's unnecessary, given the number of treatments available now to Follicular patients. Given my experience (two years -- exactly -- watching and waiting), I'm a pro-W & W kind of guy.

I saw this link posted on Facebook over the weekend: an article from last June's Oncology Times, called "Follicular Lymphoma: Is ‘Watch and Wait’ Still a Reasonable Strategy for Patients with Asymptomatic, Low-Tumor-Burden Advanced-Stage Disease?" It features two lymphoma specialists, each taking a side: Dr. Morton Coleman advocating for its usefulness, and Dr. John Leonard arguing that it's no longer necessary.

What makes this debate a little bit different and interesting is that the two specialists looked at the data that came from the same study, one in which some patients watched and waited and others were given Rituxan. The pro-W & W side says that the Rituxan recipients so far have not faired any better than the waiters, in terms of overall survival. And given the cost of treatment and dealing with side effects, there's no justification.

The pro-treatment specialist points out that while there is no difference in overall survival, there is a big difference in progression-free survival -- the time it takes until the next treatment (or the initial treatment for waiters), and that some people go many years without treatment with just four rounds of Rituxan. Furthermore, for patients with high anxiety, immediate treatment can be a big help.

The bottom line to all of this? Still no consensus. Like most of Follicular NHL, treatment stratgies are decided on a patient-by-patient basis.

But all that discussion is good anyway.