Efficacy of cidofovir versus bevacizumab in recurrent respiratory papillomatosis: A randomized, double-blind, placebo-controlled pilot study

Ablanedo-Terrazas, Yuria; Estrada-Camacho, Oscar; Barrera, Claudia Alvarado-de la; Ramírez-García, Arturo; Tona-Acedo, Gabriel; Bross-Soriano, Daniel; Schimelmitz-Idi, José

doi:10.1016/j.otoeng.2020.12.001

Cited by 3 publications

(2 citation statements)

References 30 publications

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“…Subsequently, in one of his multiple studies, Zeitels et al demonstrated safety and efficacy of sublesional bevacizumab injections in patients with laryngeal papillomas after performing 100 laryngeal injections in 43 patients, with more than half of the injections performed concomitantly with the use of KTP laser 25 . The following reports had both positive 26,27 and equivocal 28 improvement with intralesional injections. A transition to parenteral use in subsequent case reports and series, including our own, has shown promise in reducing the procedural burden for patients and the potential consequences of repetitive ablative instrumentation of the vocal folds 13,29–31 .…”

Section: Discussionmentioning

confidence: 99%

Long‐Term Follow‐up of Parenteral Bevacizumab In Patients with Recurrent Respiratory Papillomatosis

et al. 2023

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ObjectiveThe clinical course of recurrent respiratory papillomatosis (RRP) varies from spontaneous remission to severe airway obstruction with wide variability in recurrence. Standard treatment involves debulking to improve voice and/or breathing. Non‐surgical therapies are emerging in hopes of non‐operative disease control. This retrospective review analyzes long‐term safety, efficacy, and durability of clinical control in the largest reported series of parenteral bevacizumab in adults with RRP.MethodsTwenty‐three patients with known RRP who have been receiving off‐label systemic bevacizumab were included. Dosage, infusion interval, number of cycles, debulking requirements, subjective outcomes, adverse events, and reasons for treatment termination were investigated.ResultsPatients have been followed for an average of 791.43 (21–1468) days. The most common starting dosing regimen was 15 mg/kg at 3 weeks in 11 followed by 10 mg/kg at 6 weeks intervals in 6 individuals. Long‐term maintenance dosage varied with the least intensive regimen being 10 mg/kg at 14‐week intervals. Subjective improvement of voice and/or breathing was reported in 18/23 subjects. The median time for patients that needed a procedure after treatment was 634 days. Procedures after infusions decreased from 3.08 ± 2.48 procedures in the year prior to 0.52 ± 1.12 during systemic Bevacizumab, and to 0.86 ± 2.05 after stopping bevacizumab. Therapy termination occurred in 8 subjects where only 3 were due to adverse events.ConclusionParenteral bevacizumab remains a well‐tolerated treatment for patients with recalcitrant RRP. There appears to be a durable reduction in the frequency of debulking surgery requirements although on a maintenance regimen. Laryngoscope, 133:2725–2733, 2023

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Section: Discussionmentioning

confidence: 99%

Long‐Term Follow‐up of Parenteral Bevacizumab In Patients with Recurrent Respiratory Papillomatosis

et al. 2023

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“…Even if many studies have reported significant response rates with almost no side effects ( Tab. I ) 28-36 , in 2012 a Cochrane review of clinical trials comparing intralesional use of cidofovir vs placebo after surgical debulking found that there was no significant difference in disease control in the two groups after 12 months of follow-up and concluded that there was insufficient evidence to support the efficacy of antiviral agents as adjuvant therapy in the management of RRP 37 .…”

Section: Adjuvant Therapiesmentioning

confidence: 99%

Recurrent laryngeal papillomatosis: multimodal therapeutic strategies. Literature review and multicentre retrospective study

Bertino¹,

Pedretti²,

Mauramati³

et al. 2023

Acta Otorhinolaryngol Ital

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SUMMARY Objectives Recurrent respiratory papillomatosis (RRP) is a benign, rare disease caused by Human Papilloma Virus (HPV) that can be divided into juvenile and adult forms. The course of the disease is variable, but is usually more aggressive in the juvenile form. The standard surgical treatment is represented by CO 2 laser resection, although photoangiolytic lasers represent a valid alternative. Adjuvant therapies have been proposed for disease control in case of frequent surgical resections or spreading into the lower airways. In recent years, the development of immunotherapy led to the use of bevacizumab either intratumorally or intravenously, but the most promising therapeutic development is represented by HPV vaccination. This paper aims to present a narrative review of the literature and the experience of three different University Centres in the treatment of RRP. Methods A retrospective analysis of the clinical charts of all patients affected by laryngeal papillomatosis and treated in three different University Centres between 2002 and 2022 was performed. The following parameters were collected: sex, age at first evaluation, sites of larynx involved, HPV type, type of first surgical treatment, presence and number of recurrences, surgical treatment of recurrences, adjuvant therapies, side effects and status at last follow-up. Results Seventy-eight patients were available for evaluation. Of these, 88% had adult onset RRP (Ao-RRP) and 12% juvenile onset RRP (Jo-RRP). The glottis was the most frequently involved subsite; all patients were submitted to surgical resection with CO 2 laser under general anaesthesia. Recurrences appeared in 79% of the patients, the patients who did not recur were all adults. The mean number of recurrences was 9 (range 1-110). Recurrences were more frequent in children (M = 20; range 2-110) than adults (M = 5; range 1-21). Thirty-two (52%) of the 62 patients who recurred were re-treated with CO 2 laser under general anaesthesia, while office-based treatment with a photoangiolytic laser was preferred in the remaining 30 (48%) patients. Adjuvant treatments were applied in 26 patients. The analysis of the course of the disease showed that in the 9 patients with Jo-RRP, 6 (67%) were free of lesions at the last follow-up, while the other 3 (33%) had papillomas. Of the 69 patients with Ao-RRP, 53 (77%) were alive and free of disease at the last visit, 14 (21%) were alive with disease, 1 (1%) was lost at follow-up and 1 (1%) died for other disease. Severe side effects were not observed except for 2 patients, who developed posterior glottic stenosis. Conclusions Our results confirmed the literature review. RRP is a potentially aggressive disease, especially in juvenile onset. Surgical resection is still first-line treatment, but in case of multiple recurrences the use of adjuvant therapies mus...

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Intralesional cidofovir vs. bevacizumab for recurrent respiratory papillomatosis: a systematic review and indirect meta-analysis

Zagzoog,

Mogharbel,

Alqutub

et al. 2023

Eur Arch Otorhinolaryngol

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Efficacy of cidofovir versus bevacizumab in recurrent respiratory papillomatosis: A randomized, double-blind, placebo-controlled pilot study

Cited by 3 publications

References 30 publications

Long‐Term Follow‐up of Parenteral Bevacizumab In Patients with Recurrent Respiratory Papillomatosis

Long‐Term Follow‐up of Parenteral Bevacizumab In Patients with Recurrent Respiratory Papillomatosis

Recurrent laryngeal papillomatosis: multimodal therapeutic strategies. Literature review and multicentre retrospective study

Intralesional cidofovir vs. bevacizumab for recurrent respiratory papillomatosis: a systematic review and indirect meta-analysis

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