Novel treatments for recurrent respiratory papillomatosis

Abstract

Recurrent respiratory papillomatosis is a rare but often severe disease. Although benign in histology, epithelial proliferations may result in progressive hoarseness, stridor, obstruction of the airway and respiratory distress. The current standard of care is surgical therapy with a goal of complete removal or debulking of papillomas and preservation of normal structures. Frequent recurrences and the need for repeated surgical interventions make this treatment a frustrating experience for both the patient and the physician. Many adjuvant therapies have been investigated but no single treatment modality proved to be effective in eradicating recurrent respiratory papillomatosis. In contrast to HIV, cytomegalovirus and hepatitis B pharmaceutical research has been less successful with human papilloma virus vaccines for a variety of reasons. This review focuses on the current status of recurrent respiratory papillomatosis and on future directions of prevention and therapy.

HspE7 Treatment of Pediatric Recurrent Respiratory Papillomatosis: Final Results of an Open-Label Trial

“…It has also been shown to induce apoptosis in HPVpositive cells. 25 Snoeck et aI26 demonstrated a complete initial clinical response in 14 of 17 adult patients with laryngeal RRP who had local injection of cidofovir, and 10 of the 14 remained disease-free.…”

Clinical evaluation of pediatric patients with recurrent respiratory papillomatosis.

“…However, its efficacy was controversial in the literature. 11 McMurray et al 12 studied the efficacy of cidofovir in the management of aggressive form of RRP and reported a significant improvementin the Derkay Score after 12 months in both groups taking cidofovir and placebo. Also, Wierzbicka et al 13 reported that of the 32 patients having RRP, 18 experienced complete remission, and 13 demonstrated remission in lieu of cidofovir injection.…”

“…Intralesional cidofovir was associated with improvement in the clinical outcome with a controversy regarding its efficacy in the literature as specified previously. [11][12][13] Therefore, large randomized clinical controlled trials are needed to solve the controversy.…”

Recurrent respiratory papillomatosis: Cytopathological findings in an unusual case

“…The current standard of care is surgical therapy with a goal of complete removal or debulking of papillomas and preservation of normal structures. 19 More recently, cidofovir has demonstrated efficacy in selected patients. 20,21 Patients require increased surveillance including biopsies and other diagnostic modalities such as FNA.…”