Watch and wait policy in advanced neuroendocrine tumors: What does it mean?

Core Tip

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.