Recurrent Respiratory papillomatosis (RRP) can result in significant morbidity due to effects on voice and breathing and often requires frequent debulking procedures, which can disrupt quality of life. Responses to current surgical and medical treatments are inconsistent and there are no systemic treatments proven to be consistently effective in managing this disease. Bevacizumab, an anti-angiogenic agent that targets the vascular endothelial growth factor (VEGF) has been used as systemic agent for the treatment of RRP. We present a retrospective analysis of safety, efficacy and clinical outcomes in thirteen patients who were treated with systemic bevacizumab.
We present a retrospective analysis of patients with severe RRP who received 10mg/kg or 15mg/kg systemic bevacizumab at 3 weekly intervals at a single academic tertiary care center. They were monitored for toxicity and response to treatment as measured by need for further surgical interventions and improvement of symptoms.
Twelve patients received at least 2 doses of systemic bevacizumab for an average of 5 cycles. Overall the treatment was well tolerated with minimal side effects. The most common side effect was hypertension, which was experienced by 4 out of 12 patients. Two patients discontinued treatment due to side effects. One experienced grade 3 epistaxis and another patient developed hypertension and thrombocytopenia. Two other individuals tolerated treatment well however, therapy was suspended due to insurance denial. All patients reported an improvement in symptoms including, improved quality of voice and breathing as well as decreased cough. The average number of surgical interventions in the year prior to administration of systemic bevacizumab was 4, with most individuals requiring intervention at a frequency of 2-4 months. Following treatment, only 4 of the 12 patients required one surgical intervention.
Systemic bevacizumab appears to be a safe and well tolerated treatment option for patients with severe RRP. It demonstrates promising efficacy on symptoms including voice quality and improved breathing as well as decreased requirement for surgical therapy.
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All authors have declared no conflicts of interest.