Watch and Wait? A Case Study

The Watch-and-Wait question never really goes away.

The question is usually asked in some variation of: "Now that Rituxan is so common, do we really need watch-and-wait?"

You'll get as many different answers as there are oncologists to answer it (not to mention know-it-all patients like me).

Earlier this month, the ASH Education Book featured a case study designed to respond to that question. The case study and response were written by Dr. Brad Kahl of the University of Wisconsin's Carbone Cancer Center. It's a pretty thorough treatment of the question, I think -- as would be expected, given that it was written to educate other oncologists (not to mention know-it-all patients like me).

Dr. Kahl's focus is on low tumor-burden Follicular NHL patients. Interestingly, as he points out, there is very little hard data on such patients (me included); most research focuses on fNHL patients with high tumor burden. And what little exists was mostly done before Rituxan was common, so we really can't rely on that data.

Dr. Kahl offers a case of a 47 year old male with low tumor burden and some anxiety about it all. It's pretty interesting to read, actually; there are a bunch of parallels between this patient's case and my own. Except this guy is an accountant, and Lord knows I am not. Also, the patient in the case is not a know-it-all, but his wife seems to be.

Dr. Kahl offers three possibilities for this patient, and provides pros and cons for all three, including quality of life considerations. the options are 1) watch-and-wait; 2) Rituxan plus chemo (CVP, CHOP, or MCP, and maybe something else, but I can't tell what from the title of the citation); or 3) Rituxan alone.

So which one does Dr. Kahl choose for this 47 year old accountant?

You'll need to read that for yourself.  But it's all certainly educational.