Value of Treatment? Mayo study

[Guest guest]

We are told, we don't treat numbers, we treat patients.

Sure, numbers are to be part of any decision to treat, or at

least some test results. However numbers alone can't be the

only answer since we hear over and over how patients who

have been treated, perhaps 'too early' for some tastes, are

glad they did. This seems to be true of those who have had

Rituxan single agent and in some Alemtuzemab, again without

C and F... tho we have some patients who are glad they

availed themselves of that option as well.

Perhaps the 'value' is in the eye of the beholder. For many

who seem to be asymptomatic, or who are quite comfortable,

and low risk, watch and wait may make sense. For older, and

high risk patients this may be an entirely different story.

The ACS however lists 'anxiety' as a 'side effect' of watch

and wait, or opting not to treat. Are we ignoring this as a

valid disease experience?

Risk tolerance is a major consideration in any investment

strategy, perhaps it should be in cancer treatment as well.

Since many or even most patients are not 'risk' tested, I

suppose statistics are all they have to go on. There are

however, higher risk patients whose quality of life is

affected so that PFS may be perfectly acceptable to them.

This is true especially in cases where 'unstable' genomic

patterns have been documented. In this latter class, the

newer, less aggressive treatments may be their best option.

'Waiting' particularly in those cases can mean even more

anxiety. If there are trial drugs out there, and they wish

to avail themselves of those, I see no reason to discourage

them. This is especially true in a trial since for many

patients this is their only chance to get a clear picture of

where their disease is, (ie more complete testing) have the

risks explained to them by CLL experts, and thus have a

clear picture of what their risks are for doing nothing vs,

treating now.

Below is a link to a Mayo study that seems to be suggesting

that early treatment for those with progressive disease

benefit greatly from the treatment.

http://www.ncbi.nlm.nih.gov/pubmed/18759253

seems to be saying early treatment with A, or R in high risk

patients may be worth doing... no conclusions as to OS, but

PFS was near 90%...and even CR of 37%. again what is

quality of life worth?

all the best,

beth fillman

[Guest guest]

For those who are fairly new to our list, PFS = progression-

free survival. ACS = American Cancer Society. Probably a

good idea to spell out in parens some of our acronyms as we

forget what it's like to be dumped into the CLL alphabet

soup. Thanks Beth for the interesting link.

Lynn