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Treatment windows of opportunity

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Greetings,

Patients may sometimes fear that reporting symptoms will lead to defensive

medicine - favoring the initiation of what may be unnecessary tests and

interventions. Being human, we also tend to delay actions that will be

unpleasant. So we might conclude that we have a bias in favor of delaying

actions and under-reporting symptoms - a reason dentists routinely call to

remind us our next appointment.

I think this tendency of delay and avoidance is also a factor contributing to

low participation in clinical trials, because if you wait to the last minute to

treat - when there's an urgent need for a fast response - your options will be

limited to the tried and true. Also, it may be that some therapies are likely

to work optimally in less advanced stages of disease, such as monoclonal

antibodies, RIT and immunotherapies.

Clearly, for indolent lymphomas watchful waiting (a time to observe without

action) is a good idea, but there is also a time in which treatment is imminent

but not yet necessary as evidenced by lab trends and steady progression. This

window of time, when treatment appears imminent but is not yet required, we

might call a Treatment Window of Opportunity (TWO).

Seems to me that the TWO provides an opportunity to choose from among the *full

range* of treatment options, including investigational. The advantage of

recognizing TWO and acting at this time is that we gain control about the

approach to treatment, and if we participate in a trial we may benefit early

from new approaches to treatment while helping to make progress against the

disease.

For example, within TWO a lower-risk therapy might be tried - and given time to

work - and there will still be time to change the approach if needed. Ideally,

such probing first therapies will be of a type that are unlikely to burn

treatment bridges - targeted therapies perhaps, or immunotherapies.

~ Karl

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