Inflammatory vocal fold lesions associated with angiogenesis inhibition

Abstract

Background. The vascular side effects of angiogenesis inhibitors are well known, but laryngeal effects are not widely reported. We report the first 5 cases, to our knowledge, of objective vocal fold lesions attributable to these therapies. Methods. Four patients treated with bevacizumab-paclitaxel or bevacizumab for metastatic breast or lung cancer and 1 patient treated with a pan-fibroblast growth factor receptor (FGFR) inhibitor presented with spontaneous dysphonia without other etiologic factors.Results. In all cases, we observed a well-limited mucosal lesion on the superior surface of the anterior portion both vocal folds, symmetrical, sparing the anterior commissure and the vocal process. Histopathology showed necrosis and inflammation. After discontinuation of treatment in 3 patients, their voices improved, but with persistent inflammation in 2 patients and vocal fold scarring in 1 patient. Conclusion. Clinicians should systematically perform laryngoscopy in case of dysphonia in patients treated with angiogenesis inhibitors in order to diagnose laryngeal lesions and rule out differential diagnoses.