Editorial
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Apr 10, 2017; 8(2): 96-99
Published online Apr 10, 2017. doi: 10.5306/wjco.v8.i2.96
Watch and wait policy in advanced neuroendocrine tumors: What does it mean?
Nicola Fazio
Nicola Fazio, Unit of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, 20141 Milan, Italy
Author contributions: Fazio N solutely finished this manuscript.
Conflict-of-interest statement: Novartis and Ipsen: Honoraria for presentations and advisory boards. Novartis: Research funds (to the institution).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nicola Fazio, MD, PhD, Unit of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy. nicola.fazio@ieo.it
Telephone: +39-02-57489258 Fax: +39-02-94379224
Received: September 21, 2016
Peer-review started: September 23, 2016
First decision: October 20, 2016
Revised: December 21, 2016
Accepted: January 11, 2017
Article in press: January 13, 2017
Published online: April 10, 2017
Abstract

Neuroendocrine neoplasms (NENs) are a group of rare and heterogeneous malignancies, which can develop in various organs. The clinical course of NENs is quite heterogeneous, with different spontaneous growth rates after diagnosis, and different degrees of sensitivity to the same therapy even when they have similar characteristics. Watch and wait (W and W), is a term coined to indicate observation being conducted to assess the evolution of the tumor without administering any anti-tumor therapy. It has been applied to NENs since in extremely rare cases they tend to remain stable for a long time. Although W and W has been reported in several guidelines and recommendations it has never been validated, nor has it been specifically investigated. Furthermore it is not standardized. Therefore its application in clinical practice can differ in terms of tumor status assessment, type and timing of imaging or other exams utilized. In conclusion, while undertaking W and W to delay the first-line therapy by some weeks may be justified in good performance asymptomatic patients with low-grade NENs in order to usefully characterize the disease and patient and thereby choose the best therapy and therapeutic strategy, it seems to be far more difficult to justify W and W with the intent of avoiding an anti-tumor treatment. It should be considered that not only do NENs tend to grow even when they have very favorable biological characteristics but also that the alternative to W and W is most commonly a low toxic and effective treatment with somatostatin analogs.

Keywords: Observation, Wait and see, Watch and wait, Surveillance, Neuroendocrine tumors

Core tip:Watch and wait (W and W) is a term coined to indicate observation without therapy assessing the evolution of the tumor. Given that neuroendocrine tumors sometimes are radiologically stable over months since they tend to grow slowly observation has been reported as an option to be considered in several guidelines and recommendations. However it has neither validated nor specifically investigated so far. Therefore its application in clinical practice is arbitrary and it differs in terms of tumor status assessment, type and timing of imaging or other exams utilized. While undertaking W and W to delay the first-line therapy by some weeks may be justified in good performance asymptomatic patients with low-grade neuroendocrine neoplasms (NENs) in order to usefully characterize the disease and patient and thereby choose the best therapy and therapeutic strategy, it seems to be far more difficult to justify W and W with the intent of avoiding an anti-tumor treatment. It should be considered that not only do NENs tend to grow even when they have very favorable biological characteristics but also that the alternative to W and W is most commonly a low toxic and effective treatment with somatostatin analogs.