Systemic bevacizumab for treatment of recurrent respiratory papillomatosis

• Published in: European archives of oto-rhino-laryngology Vol. 281; no. 4; pp. 1865 - 1875
• Main Authors: Zhao, Xiaoyun, Wang, Jiajia, Chen, Qi, Wu, Xiufa, Mao, Wenjing, Ma, Jingru, Fang, Rui, He, Peijie, Wei, Chunsheng
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.04.2024
• Subjects: Adult; Bevacizumab - therapeutic use; Child; Head and Neck Surgery; Humans; Laryngology; Medicine; Medicine & Public Health; Neurosurgery; Otorhinolaryngology; Papillomavirus Infections - diagnosis; Pathologic Complete Response; Quality of Life; Respiratory Tract Infections - diagnosis; Recurrent respiratory papillomatosis; Adverse events; Adjuvant therapy; Medication regimen; Bevacizumab
• ISSN: 0937-4477; 1434-4726
• DOI: 10.1007/s00405-023-08430-x

Objectives To characterize treatment response of recurrent respiratory papillomatosis (RRP) including adult-onset RRP (AORRP) and juvenile-onset RRP (JORRP) to systemic bevacizumab (bev), and share our treatment regimen experience. Methods Patients were enrolled in bev treatment based on a pathologically confirmed diagnosis of squamous papilloma. According to lesion characteristics and medical history, systemic bev was used as preoperative adjuvant therapy, postoperative adjuvant therapy, or primary therapy. The assessment of treatment response relied on the morphological changes of lesions. Vocalization and voice-related quality of life were evaluated using the voice handicap index-30 (VHI-30) for adults and the pediatric VHI (pVHI) for children. Adverse effect was monitored through patient self-reported symptoms and regular follow-ups. Results This study included 24 patients, comprising nine AORRP and 15 JORRP cases. In AORRP, all patients (100%) exhibited various degrees of response to systemic bev, with 5 (55.56%) achieving complete response (CR). Among JORRP patients, 14 (93.33%) showed a response to systemic bev, with 8 (53.33%) achieving CR and currently being followed up. No instances of aggravation were observed during systemic bev treatment. A total of 21 patients (21/24, 87.50%) reported voice improvement, accompanied by reduced VHI-30 or pVHI scores across all aspects, including total, functional, physical, and emotional dimensions. No grade 3 or higher adverse events occurred. The most common adverse events were grade 1 gum bleeding ( n  = 4, 16.67%) and grade 1 proteinuria ( n  = 4, 16.67%). Conclusions Systemic bev can be used as a powerful therapy for both AORRP and JORRP. The findings provide a reference to the systemic bev treatment for RRP.