Parenteral Bevacizumab for the Treatment of Severe Respiratory Papillomatosis in an Adult Population

Objectives/Hypothesis Recurrent respiratory papillomatosis (RRP) is a rare, potentially life‐threatening, disease that impacts the voice, breathing, and quality of life of patients. Frequent surgical interventions may be needed to control symptoms. We examined the safety and efficacy of utilizing pa...

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Bibliographic Details
Published in:The Laryngoscope 2021-03, Vol.131 (3), p.E921-E928
Main Authors: Tkaczuk, Andrew, Trivedi, Sumita, Mody, Mayur D., Steuer, Conor E., Shin, Dong M., Klein, Adam M., Saba, Nabil F.
Format: Article
Language:English
Subjects:
Adult
Aged
Angiogenesis Inhibitors - administration & dosage
Bevacizumab - administration & dosage
Drug Administration Schedule
Female
Humans
Infusions, Parenteral
Male
Middle Aged
Papillomavirus Infections - drug therapy
Papillomavirus Infections - pathology
Recurrent respiratory papillomatosis
Respiratory Tract Infections - drug therapy
Respiratory Tract Infections - pathology
Retrospective Studies
systemic bevacizumab
tracheal papilloma
Treatment Outcome
Young Adult
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Summary:Objectives/Hypothesis Recurrent respiratory papillomatosis (RRP) is a rare, potentially life‐threatening, disease that impacts the voice, breathing, and quality of life of patients. Frequent surgical interventions may be needed to control symptoms. We examined the safety and efficacy of utilizing parenteral bevacizumab in the management of severe RRP in adults. Study Design This is a retrospective review of clinical management approaches in a group of patients with severe RRP defined as having a high disease burden, frequent need for debridement, and/or tracheobronchial disease. Patients were initially treated with 15 mg/kg of bevacizumab at 3‐week intervals. Bevacizumab dosing and frequency was then individually titrated down. Results Fourteen adults received a median of 8.5 (range 2–17) bevacizumab infusions over approximately 24 months. All had a history of laryngeal RRP with 6/14 having additional tracheobronchial lesions. Patients required a median of 4 (range 2–11) procedures in the year prior to treatment. Only 3/10 (30%) patients who continued therapy required any additional procedures. Bevacizumab administration was generally well tolerated, with four patients discontinuing therapy. Medical reasons included severe epistaxis and hypertension and thrombocytopenia in an individual with systemic lupus erythematosus. Common side effects included hypertension (grade 2), headache (grades 1–2), elevated creatinine (grades 1–2), and epistaxis (grade 3). Conclusions Intravenous bevacizumab for the primary treatment of severe RRP in adults appears clinically effective and safe. Expected and typically mild side effects related to bevacizumab were observed. Continued investigation of bevacizumab through a prospective clinical trial is warranted. Level of Evidence 4. Laryngoscope, 131:E921–E928, 2021
ISSN:0023-852X
1531-4995
DOI:10.1002/lary.29133