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Lepine C, Leboulanger N, Badoual C. Juvenile onset recurrent respiratory papillomatosis: What do we know in 2024 ? Tumour Virus Res 2024; 17:200281. [PMID: 38685530 PMCID: PMC11088349 DOI: 10.1016/j.tvr.2024.200281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/19/2024] [Accepted: 04/21/2024] [Indexed: 05/02/2024] Open
Abstract
Juvenile onset recurrent respiratory papillomatosis is a lifelong benign squamous lesion associated with HPV infection, particularly HPV6 and HPV11 genotypes. These lesions are rare, but can lead to laryngeal obturations, which can cause disabling dyspnea, or transform into squamous cell carcinoma. The aim here is to provide an epidemiological, biological and clinical overview of this pathology, particularly in children, in order to understand the issues at stake in terms of research and the development of medical and therapeutic management tools.
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Affiliation(s)
- Charles Lepine
- Pathology Department, CHU de Nantes, F-44000 Nantes, France; Nantes University, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, Nantes, France
| | - Nicolas Leboulanger
- Otolaryngology - Head and Necker Surgery Department, Necker Enfants Malades University Hospital, 149 Rue de Sèvres 75015 Paris, France; Université Paris Cité, France
| | - Cécile Badoual
- Université Paris Cité, France; Pathology Department, European George Pompidou Hospital, APHP, 20 Rue Leblanc 75015 Paris, France.
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2
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Gorelik D, Frantz A, Dome JS, Reilly BK. Recurrent Respiratory Papillomatosis With Complete Response to Systemic Bevacizumab Therapy. EAR, NOSE & THROAT JOURNAL 2024; 103:100-101. [PMID: 34392730 DOI: 10.1177/01455613211040578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Recurrent respiratory papillomatosis is a condition caused by human papilloma virus, usually sub types 6 and 11. Papillomas are benign neoplasms that are most commonly found on the larynx and can be often associated with significant airway involvement. Frequency of episodes varies among patients as do the clinical symptoms. Patients often present with symptoms such as hoarseness but there is potential for respiratory compromise and even complete airway obstruction.
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Affiliation(s)
- Daniel Gorelik
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Amy Frantz
- Division of Oncology, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Jeffrey S Dome
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Division of Oncology, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Brian K Reilly
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Division of Otolaryngology-Head & Neck Surgery, Children's National Medical Center, Washington, DC, USA
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3
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So RJ, Hidalgo Lopez JC, Ballestas SA, Klein AM, Steuer C, Shin DM, Abousaud M, Teng Y, Saba NF, Tkaczuk AT, Schaefer ES, Seiwert TY, McClellan K, Best SR. Efficacy of Systemic Bevacizumab for Recurrent Respiratory Papillomatosis with Pulmonary Involvement. Laryngoscope 2024; 134:577-581. [PMID: 37470254 DOI: 10.1002/lary.30893] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/20/2023] [Accepted: 07/02/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVES Pulmonary papillomatosis is a rare but severe manifestation of recurrent respiratory papillomatosis (RRP). Efficacy data of systemic bevacizumab for pulmonary RRP are limited. This study's objective was to characterize disease response of pulmonary RRP to systemic bevacizumab. METHODS A retrospective review was performed to identify patients with pulmonary RRP seen at three medical institutions. Clinical symptoms, CT findings, and disease response were compared before and after initiation of systemic bevacizumab therapy. Disease response was categorized as complete response, partial response, stabilization, or progression for each subsite involved by papilloma. RESULTS Of the 12 pulmonary RRP patients treated with systemic bevacizumab, 4 (33.3%) were male, and 11 (91.7%) were juvenile-onset RRP patients. All presented with laryngeal, tracheal, and pulmonary RRP. The median (range) age at first bevacizumab infusion was 48.1 (19.5-70.2) years. Progression to pulmonary malignancy was identified in 3 (25.0%) patients, 2 before initiation of and 1 after complete cessation of bevacizumab therapy. Clinical symptoms such as dyspnea (75.0% vs. 25.0%; p = 0.01) and dysphagia and/or odynophagia (33.3 vs. 0.0%; p = 0.03) were significantly decreased following bevacizumab therapy. Compared with pre-treatment baseline, 9 (75.0%) patients experienced a stable-to-partial response in the lungs to systemic bevacizumab, and 10 (83.3%) experienced partial-to-complete responses in the larynx and trachea. CONCLUSION Systemic bevacizumab is effective in stabilizing progression in even the most severe cases of RRP, with both a dramatic reduction in laryngeal and tracheal disease as well as a stable-to-partial response of pulmonary involvement in a majority of patients. LEVEL OF EVIDENCE 4 Laryngoscope, 134:577-581, 2024.
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Affiliation(s)
- Raymond J So
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Julio C Hidalgo Lopez
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, U.S.A
| | - Samir A Ballestas
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, U.S.A
| | - Adam M Klein
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, U.S.A
| | - Conor Steuer
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, U.S.A
| | - Dong M Shin
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, U.S.A
| | - Marin Abousaud
- Department of Pharmaceutical Sciences, Emory University, Atlanta, Georgia, U.S.A
| | - Yong Teng
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, U.S.A
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, U.S.A
| | - Andrew T Tkaczuk
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, U.S.A
| | | | - Tanguy Y Seiwert
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Kim McClellan
- Recurrent Respiratory Papillomatosis Foundation, Lawrenceville, New Jersey, U.S.A
| | - Simon R Best
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
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4
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Ballestas SA, Hidalgo Lopez J, Klein AM, Steuer C, Shin DM, Abousaud M, Schmitt NC, Teng Y, Saba NF, Tkaczuk AT. Long-Term Follow-up of Parenteral Bevacizumab In Patients with Recurrent Respiratory Papillomatosis. Laryngoscope 2023; 133:2725-2733. [PMID: 36815602 DOI: 10.1002/lary.30617] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE The 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. METHODS Twenty-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. RESULTS Patients 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. CONCLUSION Parenteral 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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Affiliation(s)
- Samir A Ballestas
- Department of Otolaryngology - Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Julio Hidalgo Lopez
- Department of Otolaryngology - Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Adam M Klein
- Department of Otolaryngology - Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Conor Steuer
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USA
| | - Dong M Shin
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USA
| | - Marin Abousaud
- Department of Pharmaceutical Sciences, Emory University, Atlanta, Georgia, USA
| | - Nicole C Schmitt
- Department of Otolaryngology - Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Yong Teng
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USA
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USA
| | - Andrew T Tkaczuk
- Department of Otolaryngology - Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
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Collette F, Lawson G, Hassid S, Delahaut G, Bachy V, Van Der Vorst S, Faugeras L, Gilliaux Q, D'Hondt L. Aggressive recurrent respiratory papillomatosis: A series of five consecutive patients successfully treated with adjuvant intravenous bevacizumab. A single Belgian academic center experience. Head Neck 2023; 45:1071-1079. [PMID: 36840929 DOI: 10.1002/hed.27300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/22/2022] [Accepted: 01/23/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Recurrent respiratory papillomatosis (RRP) is a currently incurable benign neoplasm caused by human papilloma virus (HPV) infection. It usually reduces voice, respiratory, and general quality of life, and is sometimes life-threatening. Patients usually need repeated operations. The use of adjuvant bevacizumab, a monoclonal antibody targeting vascular endothelial growth factor A, has been described in several case reports, with a good efficacy and safety profile. METHODS We report the cases of five patients with aggressive RRP who were treated with adjuvant systemic bevacizumab in a single Belgian tertiary center. RESULTS A complete response was achieved in four patients after a median of 4.5 months, and a partial response in one. In all cases, the number of surgeries was drastically reduced, and quality of life improved. Toxicity was easily managed. CONCLUSIONS Systemic bevacizumab seems to be an effective and safe adjuvant treatment for aggressive RRP.
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Affiliation(s)
- Fanny Collette
- Department of Oncology, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Georges Lawson
- Department of ENT and Head and Neck Surgery, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Samantha Hassid
- Department of ENT and Head and Neck Surgery, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Gilles Delahaut
- Department of ENT and Head and Neck Surgery, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Vincent Bachy
- Department of ENT and Head and Neck Surgery, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Sébastien Van Der Vorst
- Department of ENT and Head and Neck Surgery, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Laurence Faugeras
- Department of Oncology, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Quentin Gilliaux
- Department of Oncology, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Lionel D'Hondt
- Department of Oncology, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
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6
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Liu Z, Xiao Y, Xu J, Liu M, Han M, Hu W, Zhu D. Systemic bevacizumab for pediatric patients with aggressive recurrent respiratory papillomatosis: One single‐center experience of eight patients. Laryngoscope Investig Otolaryngol 2023; 8:435-440. [PMID: 37090874 PMCID: PMC10116968 DOI: 10.1002/lio2.1013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/02/2023] [Indexed: 02/11/2023] Open
Abstract
Recurrent respiratory papillomatosis (RRP) is a human papilloma virus (HPV)-driven benign neoplasm, affecting larynx, trachea, and even lung, leading to voice disorders, airway obstruction, and postobstructive pneumonia. Several case reports have documented the promising efficacy of intravenous bevacizumab in reducing the need for surgical intervention among RRP patients. Herein, we present our experience on systemic bevacizumab for pediatric patients with aggressive RRP. Methods We retrospectively analyzed clinical, laboratory, radiological, and bronchoscopy findings of pediatric patients with aggressive RRP treated with systemic bevacizumab from July 26, 2021 to March 1, 2022. Results Eight consecutive patients were included. Median age at treatment initiation was 5.5 (range 2.5-8) years old. Twenty-five percentage (2/8) of patients experienced tracheotomy. Pulmonary papilloma was present in 62.5% (5/8) patients. Patients received median 10 cycles of bevacizumab (range 5-12). Patients received initial dosing of 4-7.5 mg/kg every 2-10 weeks of bevacizumab and subsequently extended after achieving the maximum response. None of the patients required surgical intervention during a median 10 (range 8.2-15.4) months follow-up after initiating bevacizumab treatment. Both patients with evaluable lung lesions showed objective response. Only Grade 1 abdominal pain and Grade 1 hyperuricemia were recorded. Conclusion Systemic bevacizumab seems to be a well-tolerated and effective treatment option for pediatric patients with aggressive RRP.
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Affiliation(s)
- Zengjun Liu
- Tumor Research and Therapy Center, Shandong Provincial Hospital Shandong University Jinan Shandong China
- Rare tumors Department, Shandong Cancer Hospital and Institute Shandong First Medical University and Shandong Academy of Medical Sciences Jinan Shandong China
| | - Yang Xiao
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital Capital Medical University Beijing China
| | - Jing Xu
- Rare tumors Department, Shandong Cancer Hospital and Institute Shandong First Medical University and Shandong Academy of Medical Sciences Jinan Shandong China
| | - Mengyao Liu
- Rare tumors Department, Shandong Cancer Hospital and Institute Shandong First Medical University and Shandong Academy of Medical Sciences Jinan Shandong China
| | - Mingyong Han
- Tumor Research and Therapy Center, Shandong Provincial Hospital Shandong University Jinan Shandong China
| | - Wenyu Hu
- Rare tumors Department, Shandong Cancer Hospital and Institute Shandong First Medical University and Shandong Academy of Medical Sciences Jinan Shandong China
| | - Dongyuan Zhu
- Rare tumors Department, Shandong Cancer Hospital and Institute Shandong First Medical University and Shandong Academy of Medical Sciences Jinan Shandong China
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7
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[Recurrent laryngeal papillomatosis]. HNO 2023; 71:77-82. [PMID: 36477391 PMCID: PMC9895037 DOI: 10.1007/s00106-022-01250-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 12/12/2022]
Abstract
Human papillomaviruses (HPV) 6 and 11 cause 90% of recurrent laryngeal papillomatosis (RLP). It is unclear whether recurrences are caused by new infections or the spread of infected cells. Symptomatic and sometimes curative treatment is laser surgery or conventional microsurgical removal. RLP surgery aims to relieve shortness of breath and improve the voice. Patients (especially children) are affected by voice problems, repetitive surgeries, pulmonary manifestations, and psychological trauma. Vaccination with Gardasil 9 (Merck & Co., Rahway, NJ, USA) prevents new infections with HPV 6, 11, 16, 18, 31, 33, 45, 52, and 58 and induces vaccine antigen-specific antibodies and CD4+ T helper cells. According to current studies, RLP can be avoided with prophylactic vaccination. The treatment is associated with a general vaccination risk (European Medicines Agency approval: girls and boys from 9 years). Studies also show that the vaccine after removal of HPV-associated neoplasia/papilloma prevents recurrences. Extension of the vaccination recommendation to prevent recurrences of HPV-associated diseases in men may promote applicability and herd immunity. For rare and treatment-refractory cases with laryngotracheal involvement, systemic therapy with bevacizumab (e.g. Avastin; Genentech, San Francisco, CA, USA), a VEGF antibody, is a promising adjuvant treatment option.
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8
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Systemic Bevacizumab for Recurrent Respiratory Papillomatosis: A Scoping Review from 2009 to 2022. CHILDREN (BASEL, SWITZERLAND) 2022; 10:children10010054. [PMID: 36670605 PMCID: PMC9856545 DOI: 10.3390/children10010054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 12/05/2022] [Accepted: 12/14/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Respiratory recurrent papillomatosis (RRP) is a fatal disease with no known cure. In severe RRP cases, systemic bevacizumab (SB) could be used as adjuvant therapy. OBJECTIVE This study aims to determine the extent and type of evidence in relation to the clinical outcomes of RRP after SB treatment. METHODS Participants with RRP of all genders are included in this scoping review. There were no exclusion criteria (country, language, or document type). The information sources included experimental, quasi-experimental, and analytical observational studies. Unpublished data will not be covered, but gray literature was covered. Screening, paper selection, and data extraction were all done by two independent reviewers. This procedure was performed blindly. RESULTS Of the 175 unique records found, 15 were eligible for inclusion. Fourteen studies were included after applying inclusion and exclusion criteria. Thirty-four patients in these studies came from the United States, India, Germany, Colombia, Argentina, Chile, and Spain. In total, 17 and 34 patients were below 18 years old and were adults respectively. The most commonly reported dose was 10 mg/kg, which was received by 25 (73.5%) patients. According to reports, 58.8% of patients completed the questionnaire. Twelve (35%) patients did not require a repeat surgery. The time interval between surgical procedures has increased for patients who require them. CONCLUSION SB may be a promissory treatment and control option for RRP. More research is needed to evaluate the efficiency and adverse effects in various populations.
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9
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Systemic and Intralesional Bevacizumab in Juvenile Onset Recurrent Respiratory Papillomatosis: A Report of Two Cases. Indian J Otolaryngol Head Neck Surg 2022; 74:5098-5101. [PMID: 34426784 PMCID: PMC8372222 DOI: 10.1007/s12070-021-02814-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 08/08/2021] [Indexed: 02/07/2023] Open
Abstract
Recurrent respiratory papillomatosis (RRP) is a stubborn disease. Despite volumes of researches done for a definite cause and management, the scientific community offers only theories for causation and options for treatments. Bevacizumab has emerged as a promising solution to the fear of sufferers of RRP of undergoing repeated surgeries. The patients who received bevacizumab, either systemically or intralesionally, show decreased need for surgeries mostly and even remission in a few. Till date there are limited studies of use of bevacizumab, in adults, but only reports of its use in pediatric population. This is a report of two cases of juvenile onset RRP with use of systemic bevacizumab infusion in a child and intralesional injection in an adult.
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10
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Tatineni S, Warren Z, Applebaum MA, Baroody FM. Systemic Bevacizumab for Severe Recurrent Respiratory Papillomatosis. Case Rep Oncol Med 2022; 2022:2767996. [PMID: 36483909 PMCID: PMC9726241 DOI: 10.1155/2022/2767996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 10/20/2022] [Accepted: 11/10/2022] [Indexed: 07/21/2023] Open
Abstract
Recurrent respiratory papillomatosis (RRP) is the most common benign pediatric laryngeal neoplasm. Various adjuvant medical therapies have failed to reliably decrease surgical frequency in this challenging airway disease. Recently, systemic bevacizumab has shown promise in advanced, treatment-resistant papillomatosis. We describe the use of systemic bevacizumab in two children with severe RRP unresponsive to other therapies. Voice and breathing improved dramatically in both patients with minimal side effects. Both patients have not required surgery in 24 months and 16 months, respectively. Systemic bevacizumab is a promising long-term treatment for severe RRP, with oncology playing an important role in patient care.
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Affiliation(s)
- Swetha Tatineni
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Zachary Warren
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, The University of Chicago, Chicago, Illinois, USA
| | - Mark A Applebaum
- Department of Pediatrics, The University of Chicago, Chicago, Illinois, USA
| | - Fuad M Baroody
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, The University of Chicago, Chicago, Illinois, USA
- Department of Pediatrics, The University of Chicago, Chicago, Illinois, USA
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11
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Pai SI, Wasserman I, Ji YD, Gilman M, Hung YP, Faquin WC, Mino-Kenudson M, Muniappan A. Pulmonary manifestations of chronic HPV infection in patients with recurrent respiratory papillomatosis. THE LANCET. RESPIRATORY MEDICINE 2022; 10:997-1008. [PMID: 35863360 PMCID: PMC10634185 DOI: 10.1016/s2213-2600(22)00008-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 12/13/2021] [Accepted: 12/21/2021] [Indexed: 10/17/2022]
Abstract
Human papillomavirus (HPV) types 6 and 11 can infect the squamous epithelium of the respiratory tract. Up to 8·9% of patients with HPV-associated recurrent respiratory papillomatosis (RRP) have pulmonary involvement. Pulmonary manifestations of HPV infection are associated with considerable morbidity, in part because treatment options and management guidelines are lacking. Patients with pulmonary RRP have a 32-times increased lifetime risk of malignant transformation compared with the overall RRP population. We review the clinical and radiographic presentation, pathological features, and genetics of pulmonary RRP, and we provide management algorithms based on our clinical experience with this complex patient population. In patients with suspected pulmonary involvement, tissue-sparing procedures to address growing lesions might be warranted given the chronicity and multifocality of the disease over a patient's lifetime. However, malignant transformation of pulmonary lesion(s) warrants standard-of-care treatment for primary lung squamous cell carcinoma. Large cohort studies are needed to understand the clinical course of pulmonary RRP and to identify molecular markers of increased risk of malignant transformation in order to develop guidelines for optimal and standardised surveillance and treatment.
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Affiliation(s)
- Sara I Pai
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA; Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Isaac Wasserman
- Harvard Medical School, Boston, MA, USA; Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, USA
| | - Yisi D Ji
- Harvard Medical School, Boston, MA, USA
| | - Matthew Gilman
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Yin P Hung
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Ashok Muniappan
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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12
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Huebner MJ, Schützenberger A, Traxdorf M, Dittrich S, Iro H, Mueller SK. Juvenile Larynxpapillomatose. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01536-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Zusammenfassung
Hintergrund
Trotz multipler Therapieoptionen ist heutzutage eine Heilung der juvenilen rezidivierenden respiratorischen Larynxpapillomatose (JORRP, „juvenile onset recurrent respiratory laryngeal papillomatosis“) nicht möglich. Außerdem weisen viele Medikamente nicht zu unterschätzende Nebenwirkungen auf.
Fragestellung
Darstellung aktueller und früherer Therapieoptionen der JORRP mit Diskussion von Wirkstoff, Darreichungsart und Dosierungen.
Materialien und Methoden
Literaturrecherche und -zusammenfassung. Analyse der Therapieoptionen anhand von Wirkstoff, Darreichungsart, Dosierungen und Nebenwirkungen.
Ergebnisse
Die chirurgische Therapie bleibt weiterhin Grundlage der Therapie. Multiple Therapieoptionen werden beschrieben, jedoch keine mit der Aussicht auf eine vollständige Remission. Der Funktionserhalt der Stimme sowie die Verlängerung des Zeitintervalls zwischen den Eingriffen bzw. die Verminderung der Papillommasse im Rezidivfall bleiben oberstes Gebot. Neue immunmodulatorische Therapieoptionen werden aktuell näher untersucht.
Schlussfolgerungen
Einige der mannigfaltigen Therapieoptionen scheinen zwar vielversprechend zu sein und ein sicheres Nebenwirkungsprofil aufzuweisen, jedoch reicht die aktuelle Datenlage, die überwiegend auf Fallserien basiert, nicht für eine generelle Therapieempfehlung aus. Weitere prospektive Studien mit einer größeren Patientenzahl sind nötig.
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13
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Pogoda L, Ziylan F, Smeeing DPJ, Dikkers FG, Rinkel RNPM. Bevacizumab as treatment option for recurrent respiratory papillomatosis: a systematic review. Eur Arch Otorhinolaryngol 2022; 279:4229-4240. [PMID: 35462578 PMCID: PMC9363326 DOI: 10.1007/s00405-022-07388-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/02/2022] [Indexed: 11/28/2022]
Abstract
Purpose To this day, there is no cure for recurrent respiratory papillomatosis (RRP). Multiple surgical procedures are performed to achieve symptom relief and prevention of airway obstruction. A promising drug for RRP is the vascular endothelial growth factor (VEGF) binding antibody bevacizumab. This chemotherapeutic agent has an angiogenesis-inhibiting effect which inhibits tumor growth. The objective of this review was to investigate the efficacy of bevacizumab as treatment option for RRP, and to explore the difference of its effects between intralesional and systemic treatment. Methods A systematic search was conducted in Cochrane, PubMed, and Embase. Articles were included if bevacizumab treatment was given intralesionally and/or systemically. The methodological quality of the studies was assessed using the CAse REport (CARE) guidelines. Results Of 585 unique articles screened by title and abstract, 15 studies were included, yielding a total of 64 patients. In 95% of the patients treated with systemic bevacizumab, the post-bevacizumab surgical interval was considerably prolonged. More than half of them did not need any surgical intervention during mean follow-up of 21.6 months. Treatment with intralesional bevacizumab showed a lower efficacy: in 62% of the patients, the post-bevacizumab surgical interval (mean, 1.8 months follow-up) was extended when compared to the interval before the treatment. Conclusion Systemically and intralesionally administered bevacizumab are effective treatment options for severe RRP. A systemic administration might be the treatment of first choice. Further prospective research with long term follow-up is advocated to elucidate this important topic.
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Affiliation(s)
- Louis Pogoda
- Department of Otorhinolaryngology-Head and Neck Surgery, Amsterdam University Medical Center, Location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Fuat Ziylan
- Department of Otorhinolaryngology-Head and Neck Surgery, Amsterdam University Medical Center, Location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Diederik P J Smeeing
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Frederik G Dikkers
- Department of Otorhinolaryngology-Head and Neck Surgery, Amsterdam University Medical Center, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Rico N P M Rinkel
- Department of Otorhinolaryngology-Head and Neck Surgery, Amsterdam University Medical Center, Location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
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14
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Ruiz R, Balamuth N, Javia LR, Zur KB. Systemic Bevacizumab Treatment for Recurrent Respiratory Papillomatosis: Long-Term Follow-Up. Laryngoscope 2022; 132:2071-2075. [PMID: 35043981 DOI: 10.1002/lary.30021] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/21/2021] [Accepted: 01/04/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Systemic bevacizumab is a new adjuvant therapy for recurrent respiratory papillomatosis (RRP) that has shown promising preliminary results in children. The objective of this study was to report the largest series to date that includes long-term follow-up data on bevacizumab treatment. STUDY DESIGN Retrospective chart review. METHODS Retrospective review of seven pediatric patients treated within the past 6 years with systemic bevacizumab for RRP refractory to traditional debridement. RESULTS All seven patients had a significant reduction in disease burden after initiation of systemic bevacizumab. There have been no major complications associated with systemic therapy so far. Median duration of bevacizumab treatment was 2.13 years. Three of the seven patients have been on treatment for over 3 years with the longest duration of treatment in our first patient now at 5.5 years. One patient experienced significant disease recurrence on two occasions when therapy was temporarily discontinued and was recently diagnosed with squamous cell carcinoma of the lung. CONCLUSION Systemic bevacizumab is an effective therapy for cases of severe RRP with promising results both in short-term and long-term follow-up. Side effects are minimal. Patients must be followed closely to determine appropriate dosing intervals to control disease and to screen for disease progression. LEVEL OF EVIDENCE IV Laryngoscope, 2022.
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Affiliation(s)
- Ryan Ruiz
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Naomi Balamuth
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Luv R Javia
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Karen B Zur
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
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15
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HPV and Recurrent Respiratory Papillomatosis: A Brief Review. Life (Basel) 2021; 11:life11111279. [PMID: 34833157 PMCID: PMC8618609 DOI: 10.3390/life11111279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 12/26/2022] Open
Abstract
Recurrent Respiratory Papillomatosis (RRP) is a rare but severe manifestation of human papillomavirus (HPV). As our knowledge about HPV infections has expanded, it has become possible to understand the course of RRP disease and unravel plausible efficient methods to manage the disease. However, the surge in reports on HPV has not been accompanied by a similar increase in research about RRP specifically. In this paper, we review the clinical manifestation and typical presentation of the illness. In addition, the pathogenesis and progression of the disease are described. On the other hand, we discuss the types of treatments currently available and future treatment strategies. The role of vaccination in both the prevention and treatment of RRP will also be reviewed. We believe this review is essential to update the general knowledge on RRP with the latest information available to date to enhance our understanding of RRP and its management.
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16
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Enrique OH, Eloy SH, Adrian TP, Perla V. Systemic bevacizumab as adjuvant therapy for recurrent respiratory papillomatosis in children: A series of three pediatric cases and literature review. Am J Otolaryngol 2021; 42:103126. [PMID: 34175693 DOI: 10.1016/j.amjoto.2021.103126] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/13/2021] [Indexed: 11/16/2022]
Abstract
Recurrent respiratory papillomatosis (RRP), a viral disease caused by human papillomavirus (HPV), is the most common benign neoplasm of the larynx among children and the second most frequent cause of infantile hoarseness. The course of the disease is variable; some patients experience spontaneous remission, while others may develop an aggressive respiratory compromise. Especially juvenile-onset RRP cases experience shorter intervals between surgical interventions and thus more surgeries overall, causing high rates of depression and voice-related quality of life. Various local adjuvant therapies have been studied with mixed efficacy and some early potential but have failed to show consistent effect across large cohorts of patients. Bevacizumab, a recombinant monoclonal antibody that inhibits VEGF, has shown efficacy in patients with rapid regrowth of papillomas with severe airway compromise, and/or distal multisite spread of disease. We present three juvenile-onset RRP cases successfully managed with systemically administered bevacizumab.
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Affiliation(s)
- Ortiz H Enrique
- Antiguo Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico.
| | - Sanchez H Eloy
- Antiguo Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
| | - Trujillo P Adrian
- Antiguo Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
| | - Villamor Perla
- Centro Hospitalario Serena del Mar. Cartagena, Colombia.
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17
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Donne AJ, Kinshuck A. Pharmacotherapy for recurrent respiratory papillomatosis (RRP): a treatment update. Expert Opin Pharmacother 2021; 22:1901-1908. [PMID: 34080517 DOI: 10.1080/14656566.2021.1935870] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Recurrent respiratory papillomatosis is a rare human papillomavirus (HPV)-induced condition where warts grow within the airway and especially the larynx to effect voice and restrict breathing.Areas covered: A PubMed search using the following search terms was performed: respiratory papillomatosis and cidofovir, alpha-interferon, bevacizumab, PD1, and HPV vaccines. Surgery remains the mainstay of treatment. There has been a change in options available for adjuvant therapies with systemic bevacizumab and the potential benefits of prophylactic HPV vaccine. Despite efforts to identify a drug therapy to control RRP, no therapy yet remains which is predictable and effective in all. The current status of therapeutic vaccines and immunotherapy is discussed.Expert opinion: The current adjuvant therapies do offer a reasonable expectation of control but the effect for the individual is unpredictable despite the therapies being based on good science. The current therapies would allow an escalating treatment strategy to be formulated, however a single therapy is unlikely to be curative. Multi-center trials are required such that adequate numbers to show an effect are achieved.
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Affiliation(s)
- Adam J Donne
- Consultant Paediatric Otolaryngologist, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Andy Kinshuck
- Consultant in Otolaryngology/Head & Neck Surgery, Aintree University Hospital, Liverpool, UK
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18
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Verma H, Chandran A, Shaktivel P, Singh A, Kaushal S, Sikka K, Thakar A, Irugu DVK. The serum and tissue expression of vascular endothelial growth factor-in recurrent respiratory papillomatosis. Int J Pediatr Otorhinolaryngol 2021; 146:110737. [PMID: 33979678 DOI: 10.1016/j.ijporl.2021.110737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/20/2021] [Accepted: 04/24/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Recurrent respiratory papillomatosis (RRP) is known for its recurrent relapse despite various surgical and non-surgical treatments. Vascular Endothelial growth factor (VEGF) receptor expression on tissue is reported to be raised in RRP, and anti-VEGF targeted treatment is being explored to decrease recurrences. This study aims to identify the patients most suitable for systemic anti-VEGF therapy. METHODS The study design was a prospective cohort evaluation. The study group included all consecutive cases of RP treated surgically from November 2016-June 2019. Tissue receptor expression and serum levels of VEGF were assessed by immunohistochemistry and ELISA assay. Control samples for normal levels obtained by serum samples of healthy individuals and tissue samples obtained from healthy non-inflamed peripheral tissue of laryngectomy specimens. The tissue expression and serum levels of VEGF were compared with various disease-related factors of RP. RESULTS 32 cases of RRPs were included in the study with a median age of 20.85 years (range: 3-60 years). The glottis was involved in all patients and tracheobronchial involvement was seen among 6 patients (18.75%). The systemic and tissue expression of VEGF-A was significantly higher among cases than controls (p= <0.001). The serum level of VEGF-A was significantly higher among cases with higher Derkay's score (>20) (p = 0.02) and tissue expression of VEGF-A was significantly higher in tracheobronchial RRP (p = 0.04). CONCLUSION Patients of RP with tracheobronchial involvement and high Derkay's score with strong tissue receptor expression & high serum level of VEGF can be identified as the patients wherein anti-VEGF monoclonal antibody treatment is more likely to be effective and merits further investigation to prove this.
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Affiliation(s)
- Hitesh Verma
- Department of Otolaryngology, Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Ashwin Chandran
- Department of Otolaryngology, Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Pirabu Shaktivel
- Department of Otolaryngology, Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Archana Singh
- Department of Otolaryngology, Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Kaushal
- Department of Otolaryngology, Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Sikka
- Department of Otolaryngology, Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Thakar
- Department of Otolaryngology, Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - D V K Irugu
- Department of Otolaryngology, Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
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19
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Marcus K, Lee DJ, Wilson JS, Smith RJH, Puricelli M. Pembrolizumab Induced Acute Persistent Airway Disease in a Patient with Recurrent Respiratory Papillomatosis (RRP). Ann Otol Rhinol Laryngol 2021; 131:331-336. [PMID: 34056952 DOI: 10.1177/00034894211021276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To present an uncommon but serious, recently identified complication of checkpoint inhibitor therapy in a patient treated with pembrolizumab infusion for disseminated recurrent respiratory papillomatosis (RRP). METHODS Case report. RESULTS A 43-year-old woman with underlying asthma developed acute hypoxic respiratory failure within 24 hours of her third infusion of pembrolizumab for treatment of intractable, disseminated recurrent respiratory papillomatosis. Pulmonary function testing revealed a severe intra-thoracic obstructive ventilatory defect. Discontinuation of pembrolizumab, ventilatory support, and treatment with systemic and inhaled corticosteroids resulted in resolution of respiratory failure; however, her underlying asthma remains poorly controlled. CONCLUSION To our knowledge, this case is the first report of pembrolizumab-induced obstructive respiratory failure in a patient being treated for RRP.
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Affiliation(s)
- Kathryn Marcus
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Daniel J Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Jeffrey S Wilson
- Department of Internal Medicine-Pulmonology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Richard J H Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Michael Puricelli
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.,Division of Otolaryngology - Head and Neck Surgery, University of Wisconsin-Madision, Madison, WI, USA
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20
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Benedict JJ, Derkay CS. Recurrent respiratory papillomatosis: A 2020 perspective. Laryngoscope Investig Otolaryngol 2021; 6:340-345. [PMID: 33869767 PMCID: PMC8035938 DOI: 10.1002/lio2.545] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/14/2021] [Accepted: 02/23/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Despite recent advancement recurrent respiratory papillomatosis (RRP) remains a rare but challenging benign airway neoplasm. In recent years there has been significant shifts in incidence of this disease due to changes in vaccination and prevention for human papilloma virus (HPV) and its related pathology. This review will highlight the epidemiology, prevention and treatment of RRP. METHODS The PubMed database was searched using relevant MeSH terms including "recurrent respiratory papillomatosis." The titles and abstracts were reviewed to assess relevance and unrelated articles were excluded. A full-text review for select articles was performed, the data and discussions were interpreted and synthesized to create a concise update on the management of RRP. RESULTS With the increasing utilization of the 9-valent and quadrivalent HPV vaccine in Australia, we have seen a significant decrease in the incidence of RRP. Preliminary data in the US shows a similar trend of decreased incidence after implementation of vaccination. Single dose Gardasil in developing countries has shown sustained immunization for at least 7 years. Preliminary clinical trials and retrospective studies have shown the HPV vaccine may have benefit as a treatment method in addition to prevention for HPV related diseases. Bevacizumab (Avastin), a VEGF monoclonal antibody, has shown promise as a systemic treatment for RRP. The Corona Virus Disease 2019 (COVID-19) pandemic has affected perioperative management of RRP. CONCLUSION RRP continues to decline in incidence since the implementation of HPV vaccination. Advancement in the medical management including Bevacizumab show promise as an additional option for the management of RRP.
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Affiliation(s)
- Jacob J. Benedict
- Department of Otolaryngology – Head and Neck Surgery, Eastern Virginia Medical SchoolSentara Norfolk General HospitalNorfolkVirginiaUSA
| | - Craig S. Derkay
- Department of Otolaryngology – Head and Neck Surgery, Eastern Virginia Medical SchoolChildren's Hospital of the King's DaughtersNorfolkVirginiaUSA
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21
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22
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Ruiz R, Zur KB. Recurrent Respiratory Papillomatosis. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-020-00328-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Sidell DR, Balakrishnan K, Best SR, Zur K, Buckingham J, De Alarcon A, Baroody FM, Bock JM, Boss EF, Bower CM, Campisi P, Chen SF, Clarke JM, Clarke KD, Cocciaglia A, Cotton RT, Cuestas G, Davis KL, DeFago VH, Dikkers FG, Dossans I, Florez W, Fox E, Friedman AD, Grant N, Hamdi O, Hogikyan ND, Johnson K, Johnson LB, Johnson RF, Kelly P, Klein AM, Lawlor CM, Leboulanger N, Levy AG, Lam D, Licameli GR, Long S, Lott DG, Manrique D, McMurray JS, Meister KD, Messner AH, Mohr M, Mudd P, Mortelliti AJ, Novakovic D, Ongkasuwan J, Peer S, Piersiala K, Prager JD, Pransky SM, Preciado D, Raynor T, Rinkel RNPM, Rodriguez H, Rodríguez VP, Russell J, Scatolini ML, Scheffler P, Smith DF, Smith LP, Smith ME, Smith RJH, Sorom A, Steinberg A, Stith JA, Thompson D, Thompson JW, Varela P, White DR, Wineland AM, Yang CJ, Zdanski CJ, Derkay CS. Systemic Bevacizumab for Treatment of Respiratory Papillomatosis: International Consensus Statement. Laryngoscope 2021; 131:E1941-E1949. [PMID: 33405268 DOI: 10.1002/lary.29343] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/08/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES/HYPOTHESIS The purpose of this study is to develop consensus on key points that would support the use of systemic bevacizumab for the treatment of recurrent respiratory papillomatosis (RRP), and to provide preliminary guidance surrounding the use of this treatment modality. STUDY DESIGN Delphi method-based survey series. METHODS A multidisciplinary, multi-institutional panel of physicians with experience using systemic bevacizumab for the treatment of RRP was established. The Delphi method was used to identify and obtain consensus on characteristics associated with systemic bevacizumab use across five domains: 1) patient characteristics; 2) disease characteristics; 3) treating center characteristics; 4) prior treatment characteristics; and 5) prior work-up. RESULTS The international panel was composed of 70 experts from 12 countries, representing pediatric and adult otolaryngology, hematology/oncology, infectious diseases, pediatric surgery, family medicine, and epidemiology. A total of 189 items were identified, of which consensus was achieved on Patient Characteristics (9), Disease Characteristics (10), Treatment Center Characteristics (22), and Prior Workup Characteristics (18). CONCLUSION This consensus statement provides a useful starting point for clinicians and centers hoping to offer systemic bevacizumab for RRP and may serve as a framework to assess the components of practices and centers currently using this therapy. We hope to provide a strategy to offer the treatment and also to provide a springboard for bevacizumab's use in combination with other RRP treatment protocols. Standardized delivery systems may facilitate research efforts and provide dosing regimens to help shape best-practice applications of systemic bevacizumab for patients with early-onset or less-severe disease phenotypes. LEVEL OF EVIDENCE 5 Laryngoscope, 131:E1941-E1949, 2021.
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Affiliation(s)
- Douglas R Sidell
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A.,Aerodigestive and Airway Reconstruction Center, Lucile Packard Children's Hospital Stanford, Stanford, California, U.S.A
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A.,Aerodigestive and Airway Reconstruction Center, Lucile Packard Children's Hospital Stanford, Stanford, California, U.S.A
| | - Simon R Best
- Department of Otolaryngology-Head and Neck Surgery, Division of Laryngology, and, Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Karen Zur
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Julia Buckingham
- Maternal and Child Health Research Institute, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford University, Stanford, California, U.S.A
| | - Alessandro De Alarcon
- Department of Otolaryngology, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Fuad M Baroody
- Section of Otolaryngology-Head and Neck Surgery and Department of Pediatrics, University of Chicago Medicine and The Comer Children's Hospital, Chicago, Illinois, U.S.A
| | - Jonathan M Bock
- Department of Otolaryngology and Communication Sciences, Division of Laryngology and Professional Voice, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Emily F Boss
- Department of Otolaryngology-Head and Neck Surgery and the Department of Health Policy and Management, Division of Pediatric Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Charles M Bower
- Department of Otolaryngology Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Arkansas for Medical Sciences (UAMS), Arkansas Children's Hospital, Little Rock, Alaska, U.S.A
| | - Paolo Campisi
- Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Sharon F Chen
- Department of Pediatrics, Division of Infectious Diseases, Lucile Packard Children's Hospital Stanford, Stanford, California, U.S.A
| | - Jeffrey M Clarke
- Department of Medicine, Division of Oncology, Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, U.S.A
| | - Kevin D Clarke
- Pediatric Otolaryngology, Division of Otolaryngology Head and Neck Surgery, University of British Columbia (UBC, UVIc), Victoria General Hospital, Victoria, British Columbia, Canada
| | - Alejandro Cocciaglia
- ENT-Respiratory Endoscopy Department, Garrahan Children's Hospital, Buenos Aires, Argentina
| | - Robin T Cotton
- Department of Otolaryngology, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Giselle Cuestas
- Respiratory Endoscopy Section, ENT Department, Hospital General de Niños "Dr. Pedro de Elizalde", Buenos Aires, Argentina
| | - Kara L Davis
- Department of Pediatrics, Division of Pediatric Oncology, Bass Center for Childhood Cancer and Blood Disorders, Stanford University, Stanford, California, U.S.A
| | - Victor H DeFago
- Pediatric Surgery, Sanatorio del Salvador Privado SA, Cordoba, Argentina
| | - Frederik G Dikkers
- Department of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ines Dossans
- Otolaryngology-Head and Neck Surgery, Hospital Pereira Rossell, Montevideo, Uruguay
| | - Walter Florez
- Department of Otolaryngology, Instituto Nacional de Salud del Niño de San Borja, Lima, Peru
| | - Elizabeth Fox
- Comprehensive Cancer Center, St Jude Children's Research Hospital, Memphis, Tennessee, U.S.A
| | - Aaron D Friedman
- Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio, U.S.A
| | - Nazaneen Grant
- Department of Otolaryngology, Division of Laryngology, Medstar Georgetown University Hospital, Georgetown, Washington, District of Columbia, U.S.A
| | - Osama Hamdi
- Howard University College of Medicine, Washington, District of Columbia, U.S.A
| | - Norman D Hogikyan
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A
| | - Kaalan Johnson
- University of Washington School of Medicine, Department of Otolaryngology Head and Neck Surgery, Division of Pediatric Otolaryngology, Seattle, Washington, District of Columbia, U.S.A
| | - Liane B Johnson
- Department of Surgery, Dalhousie University, Division of Paediatric Otolaryngology-Head and Neck Surgery, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Romaine F Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Texas (UT) Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Peggy Kelly
- Department of Otolaryngology, Head and Neck Surgery, Division of Pediatric Otolaryngology, Children's Hospital Colorado affiliated with University of Colorado, Anschutz, Aurora, Colorado, U.S.A
| | - Adam M Klein
- Department of Otolaryngology-Head and Neck Surgery, Division of Laryngology, Emory Voice Center, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Claire M Lawlor
- Department of Otolaryngology, Division of Pediatric Otolaryngology, Children's National Health System, George Washington University School of Medicine, Washington, District of Columbia, U.S.A
| | - Nicolas Leboulanger
- Head and Neck Surgery, Pediatric Otolaryngology, Necker Enfants Malades Hospital, Paris University, Paris, France
| | - Alejandro G Levy
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, Arnold Palmer Hospital Center for Children's Cancer and Blood Disorders, Orlando Health, Orlando, Florida, U.S.A
| | - Derek Lam
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Greg R Licameli
- Department of Otolaryngology, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Steve Long
- Department of Head and Neck Surgery, Kaiser Permanente, Hillsboro, Oregon, U.S.A
| | - David G Lott
- Department of Otorhinolaryngology, Division of Laryngology, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | - Dayse Manrique
- Department of Otorhinolaryngology, Universidad Federal de Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - James Scott McMurray
- Pediatric Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Kara D Meister
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A.,Aerodigestive and Airway Reconstruction Center, Lucile Packard Children's Hospital Stanford, Stanford, California, U.S.A
| | - Anna H Messner
- Department of Otolaryngology/Head and Neck Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Michael Mohr
- Department of Hematology, Oncology and Respiratory Medicine, University Hospital Muenster, Muenster, Germany
| | - Pamela Mudd
- Department of Otolaryngology, Division of Pediatric Otolaryngology, Children's National Health System, George Washington University School of Medicine, Washington, District of Columbia, U.S.A
| | - Anthony J Mortelliti
- Department of Otolaryngology-Head and Neck Surgery, State University of New York (SUNY) Upstate Medical University, Syracuse, New York, U.S.A
| | - Daniel Novakovic
- Department of Otolaryngology, Head and Neck Surgery, Central Clinical School, Faculty of Medicine and Health, University of Sydney, The Canterbury Hospital, Sydney, New South Wales, Australia
| | - Julian Ongkasuwan
- Department of Otolaryngology, Division of Adult and Pediatric Laryngology, Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Shazia Peer
- Division of Otorhinolaryngology, University of Cape Town and Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Krysztof Piersiala
- Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Karolinksa University Hospital, Stockholm, Sweden
| | - Jeremy D Prager
- Department of Otolaryngology, Head and Neck Surgery, Division of Pediatric Otolaryngology, Children's Hospital Colorado affiliated with University of Colorado, Anschutz, Aurora, Colorado, U.S.A
| | | | - Diego Preciado
- Department of Otolaryngology, Division of Pediatric Otolaryngology, Children's National Health System, George Washington University School of Medicine, Washington, District of Columbia, U.S.A
| | - Tiffany Raynor
- Department of Otolaryngology, Head and Neck Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Rico N P M Rinkel
- Department of Otolaryngology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Hugo Rodriguez
- Respiratory Endoscopy Department, Hospital de Pediatria Prof Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Verónica P Rodríguez
- Respiratory Endoscopy Section, ENT Department, Hospital General de Niños "Dr. Pedro de Elizalde", Buenos Aires, Argentina
| | - John Russell
- Department of Paediatric Otolaryngology, Children's Health Ireland, Dublin, Ireland
| | - María Laura Scatolini
- Respiratory Endoscopy Department, Hospital de Pediatria Prof Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Patrick Scheffler
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - David F Smith
- Divisions of Pediatric Otolaryngology, Pulmonary Medicine, and the Sleep Center, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Lee P Smith
- Division of Otolaryngology-Head and Neck Surgery, Pediatric Otolaryngology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, New York, U.S.A
| | - Marshall E Smith
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Richard J H Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Abraham Sorom
- Otolaryngology, Head and Neck Surgery, Confluence Health, Wenatchee, Washington, District of Columbia, U.S.A
| | - Amalia Steinberg
- Otolaryngology, Head and Neck Surgery, Alaska Native Medical center, Anchorage, Alaska, U.S.A
| | - John A Stith
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, SSM Cardinal Glennon Children's Hospital Medical Center, St. Louis, Missouri, U.S.A
| | - Dana Thompson
- Division of Pediatric Otolaryngology Head and Neck Surgery Ann and Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Jerome W Thompson
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric ENT, LeBonheur Children's Hospital, College of Medicine, University of Tennnessee, Memphis, Tennessee, U.S.A
| | - Patricio Varela
- Pediatric Surgery Department, Universidad de Chile, Mackenna Children Hospital, Clinica Las Condes Medical center, Santiago, Chile
| | - David R White
- Division of Pediatric Otolaryngology, Medical University of South Carolina (MUSC) Shawn Jenkins Children's Hospital, Charleston, South Carolina, U.S.A
| | - Andre M Wineland
- Department of Otolaryngology-Head and Neck Surgery and the Department of Health Policy and Management, Division of Pediatric Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Christina J Yang
- Department of Otolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Children's Hospital at Montefiore, New York, New York, U.S.A
| | - Carlton J Zdanski
- Department of Otolaryngology/Head and Neck Surgery, Division of Pediatric Otolaryngology/Head and Neck Surgery, North Carolina Children's Hospital, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Craig S Derkay
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Norfolk, Virginia, U.S.A
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Evers G, Schliemann C, Beule A, Schmidt LH, Schulze AB, Kessler C, Hoffmann TK, Wiewrodt R, Groll AH, Bleckmann A, Rudack C, Berdel WE, Mohr M. Long-Term Follow-Up on Systemic Bevacizumab Treatment in Recurrent Respiratory Papillomatosis. Laryngoscope 2020; 131:E1926-E1933. [PMID: 33382105 DOI: 10.1002/lary.29351] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 11/17/2020] [Accepted: 12/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Recurrent respiratory papillomatosis (RRP) is a primarily benign disease affecting the entire respiratory tract. Treatment is challenging and usually involves surgical interventions and adjuvant medications. Previously, promising results on systemic administration of bevacizumab have been reported. However, experience on long-term systemic use in patients with RRP is not yet available. Here, we present our long-term follow-up on RRP patients undergoing systemic bevacizumab treatment. STUDY DESIGN Case series. METHODS To describe experience on long-term systemic bevacizumab administration, we performed the underlying investigation. Clinical, radiological, and bronchoscopy data were collected. RESULTS To date, a total of n = 5 patients has been treated with systemic bevacizumab at Muenster University Hospital. With a median follow-up since first systemic bevacizumab administration of 95.5 months long-term follow-up is illustrated. Following bevacizumab treatment partial remission or very good partial remission were achieved in all patients. After papilloma recurrence/progression due to bevacizumab discontinuation, further response was documented in all patients in whom bevacizumab was started again. In one patient, bevacizumab was discontinued due to loss of efficacy. Lung cancer developed in one patient with pulmonary papillomatosis prior to bevacizumab administration whereas three patients suffered from malignant transformation during bevacizumab treatment. Systemic bevacizumab led to long-term reduction in surgical interventions in all patients. Except from mild proteinuria and hypertension in two patients therapy was well tolerated. CONCLUSIONS Systemic bevacizumab represents a promising long-term treatment option for aggressive forms of papillomatosis. Rate of malignant transformation under bevacizumab treatment, optimal treatment schedule, and influence on survival should be further evaluated in clinical trials. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1926-E1933, 2021.
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Affiliation(s)
- Georg Evers
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Christoph Schliemann
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Achim Beule
- Department of Otolaryngology/Head and Neck Cancer, University Hospital Muenster, Muenster, Germany
| | - Lars-Henning Schmidt
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Arik B Schulze
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Christina Kessler
- Department of Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Thomas K Hoffmann
- Department of Otolaryngology/Head and Neck Cancer, University Hospital Ulm, Ulm, Germany
| | - Rainer Wiewrodt
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Andreas H Groll
- Department of Pediatric Hematology/Oncology, University Hospital Muenster, Muenster, Germany
| | - Annalen Bleckmann
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Claudia Rudack
- Department of Otolaryngology/Head and Neck Cancer, University Hospital Muenster, Muenster, Germany
| | - Wolfgang E Berdel
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Michael Mohr
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
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25
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Baday YI, Ongkasuwan J, Venkatramani R. Systemic bevacizumab for recurrent respiratory papillomatosis. Int J Pediatr Otorhinolaryngol 2020; 138:110352. [PMID: 32906078 DOI: 10.1016/j.ijporl.2020.110352] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 11/15/2022]
Abstract
Recurrent respiratory papillomatosis (RRP) is a benign tumor of the respiratory tract associated with human papillomavirus 6 and 11. Patients undergo multiple surgical debridements for management of growing papilloma. Adjuvant treatment options for RRP in children are often ineffective and do not decrease the need for repeated surgical debridement. We report on three patients with severe disease refractory to surgery who were treated with 10 mg/kg systemic bevacizumab every 4 weeks. All patients had improvement in voice and reduced need for surgical debridement. Interval between bevacizumab doses was gradually increased to every 8-12 weeks. Adverse events included mild proteinuria and self-resolving epistaxis.
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Affiliation(s)
- Yiressy Izaguirre Baday
- Department of Pediatrics, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA; Texas Children's Cancer Center, Texas Children's Hospital, 6701 Fannin St #1400, Houston, TX, 77030, USA.
| | - Julina Ongkasuwan
- Baylor College of Medicine, Department of Otolaryngology, Head and Neck Surgery, 1 Baylor Plaza, Houston, TX, 77030, USA; Texas Children's Hospital, Pediatric Otolaryngology, 6701 Fannin St, Houston, TX, 77030, USA.
| | - Rajkumar Venkatramani
- Department of Pediatrics, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA; Texas Children's Cancer Center, Texas Children's Hospital, 6701 Fannin St #1400, Houston, TX, 77030, USA.
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26
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Tkaczuk A, Trivedi S, Mody MD, Steuer CE, Shin DM, Klein AM, Saba NF. Parenteral Bevacizumab for the Treatment of Severe Respiratory Papillomatosis in an Adult Population. Laryngoscope 2020; 131:E921-E928. [PMID: 33107615 DOI: 10.1002/lary.29133] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/14/2020] [Accepted: 08/30/2020] [Indexed: 11/07/2022]
Abstract
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.
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Affiliation(s)
- Andrew Tkaczuk
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, U.S.A
| | - Sumita Trivedi
- Department of Hematology and Medical Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Mayur D Mody
- Division of Medical Oncology, Department of Medicine, Emory University, Atlanta, Georgia, U.S.A
| | - Conor E Steuer
- Division of Medical Oncology, Department of Medicine, Emory University, Atlanta, Georgia, U.S.A
| | - Dong M Shin
- Division of Medical Oncology, Department of Medicine, Emory University, Atlanta, Georgia, U.S.A
| | - Adam M Klein
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, U.S.A
| | - Nabil F Saba
- Division of Medical Oncology, Department of Medicine, Emory University, Atlanta, Georgia, U.S.A
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Eckel HE, Simo R, Quer M, Odell E, Paleri V, Klussmann JP, Remacle M, Sjögren E, Piazza C. European Laryngological Society position paper on laryngeal dysplasia Part II: diagnosis, treatment, and follow-up. Eur Arch Otorhinolaryngol 2020; 278:1723-1732. [PMID: 33058010 PMCID: PMC8131286 DOI: 10.1007/s00405-020-06406-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/16/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW To give an overview of the current knowledge regarding the diagnosis, treatment, and follow-up of laryngeal dysplasia (LD) and to highlight the contributions of recent literature. The diagnosis of LD largely relies on endoscopic procedures and on histopathology. Diagnostic efficiency of endoscopy may be improved using videolaryngostroboscopy (VLS) and bioendoscopic tools such as Narrow Band Imaging (NBI) or Storz Professional Image Enhancement System (SPIES). Current histological classifications are not powerful enough to clearly predict the risk to carcinoma evolution and technical issues such as sampling error, variation in epithelial thickness and inflammation hamper pathological examination. Almost all dysplasia grading systems are effective in different ways. The 2017 World Health Organization (WHO) system should prove to be an improvement as it is slightly more reproducible and easier for the non-specialist pathologist to apply. To optimize treatment decisions, surgeons should know how their pathologist grades samples and preferably audit their transformation rates locally. Whether carcinoma in situ should be used as part of such classification remains contentious and pathologists should agree with their clinicians whether they find this additional grade useful in treatment decisions. Recently, different studies have defined the possible utility of different biomarkers in risk classification. The main treatment modality for LD is represented by transoral laser microsurgery. Radiotherapy may be indicated in specific circumstances such as multiple recurrence or wide-field lesions. Medical treatment currently does not have a significant role in the management of LD. Follow-up for patients treated with LD is a fundamental part of their care and investigations may be supported by the same techniques used during diagnosis (VLS and NBI/SPIES).
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Affiliation(s)
- Hans Edmund Eckel
- Department of Oto-Rhino-Laryngology, Klagenfurt General Hospital, Klagenfurt am Wörthersee, Austria
| | - Ricard Simo
- Department of Otorhinolaryngology Head and Neck Surgery, Guy's and St Thomas' Hospital, London, UK
| | - Miquel Quer
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital de la Santa Creu i Sant Pau. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Edward Odell
- Department of Head and Neck Pathology, King's College London Guy's Hospital, London, UK
| | - Vinidh Paleri
- Department of Otorhinolaryngology Head and Neck Surgery, Royal Marsden Hospital, London, UK
| | - Jens Peter Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Marc Remacle
- Department of Otorhinolaryngology, Head and Neck Surgery, CH Luxembourg, Luxembourg, Belgium
| | - Elisabeth Sjögren
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - Cesare Piazza
- Department of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
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Ryan MA, Leu GR, Upchurch PA, Tunkel DE, Walsh JM, Boss EF. Systemic Bevacizumab (Avastin) for Juvenile-Onset Recurrent Respiratory Papillomatosis: A Systematic Review. Laryngoscope 2020; 131:1138-1146. [PMID: 32959914 DOI: 10.1002/lary.29084] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/31/2020] [Accepted: 08/12/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Juvenile onset recurrent respiratory papillomatosis (JORRP) can cause severe or disseminated disease. Surgical treatment may be inadequate. Systemic bevacizumab has shown initial success for severe JORRP. The objective of this systematic review was to assess usage, effectiveness, and safety of this treatment. METHODS We searched PubMed, Embase, and Web of Science for studies of humans with JORRP treated with systemic bevacizumab. Two researchers independently reviewed the studies to determine inclusion and aggregate data on patient characteristics, dosing protocols, treatment response, adverse events, and level of evidence. RESULTS Of 80 identified articles, 12 studies were included detailing 20 distinct cases. At a mean age of 12.8 years (range = 1-43 years) patients received initial dosing of 5 to 10 mg/kg of bevacizumab followed by ongoing doses at a mean 3-week intervals (range = 2-5 weeks). All patients had clinically significant disease reduction with reduced need for surgery. Six patients (30%) had complete response in at least one involved anatomic site. Eleven (55%) required no surgery after initiating treatment. There was recurrence in all four patients whose treatment was stopped, but had rapid improvement with treatment resumption. Six (30%) experienced mild or moderate adverse events. CONCLUSIONS Marked improvement in severe JORRP has been reported from systemic bevacizumab. Treatment protocols vary, and treatment discontinuation was not feasible in any reported patient. Based on currently available data, systemic bevacizumab can be considered for severe JORRP as it appears to be well tolerated and effective. A clinical trial could enhance the understanding of its safety and efficacy for this indication. Laryngoscope, 131:1138-1146, 2021.
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Affiliation(s)
- Marisa A Ryan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Grace R Leu
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A
| | - Patrick A Upchurch
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, U.S.A.,Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - David E Tunkel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Jonathan M Walsh
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Emily F Boss
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
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29
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Ballestas SA, Shelly S, Soriano RM, Klein A. Trends in recurrent respiratory papillomatosis treatment. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 72:109-120. [PMID: 32312478 DOI: 10.1016/j.otorri.2019.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/23/2019] [Accepted: 11/08/2019] [Indexed: 11/27/2022]
Abstract
Recurrent respiratory papillomatosis (RRP) consist of benign tumours along the airway caused by human papillomavirus infection. Papillomas may cause changes in phonation and obstruct the airway. The purpose of this study was to evaluate the different surgical and adjuvant therapies available for the treatment of this condition reported between 2014-2018. A PubMed search was performed for RRP treatment articles published between 2014 -2018. Forty articles that encompassed 1425 patients with RRP met the criteria. Of these, 24 articles evaluate the use of adjuvant therapies such as bevacizumab, human papillomavirus vaccine and cidofovir. There has been an increase in adjuvant therapy options for RRP in the literature in recent years. An awareness of these options highlights gaps and opportunities in the care of these patients, opens the door to new protocols to control disease and increase intersurgical intervals, and guides us towards new management paradigms in the future.
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Affiliation(s)
- Samir A Ballestas
- Departamento de Otorrinolaringología y Cirugía de Cabeza y Cuello, Emory University School of Medicine, Atlanta, Estados Unidos
| | - Sandeep Shelly
- Departamento de Otorrinolaringología y Cirugía de Cabeza y Cuello, Emory University School of Medicine, Atlanta, Estados Unidos
| | - Roberto M Soriano
- Departamento de Otorrinolaringología y Cirugía de Cabeza y Cuello, Emory University School of Medicine, Atlanta, Estados Unidos
| | - Adam Klein
- Departamento de Otorrinolaringología y Cirugía de Cabeza y Cuello, Emory University School of Medicine, Atlanta, Estados Unidos.
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30
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Seedat RY. Juvenile-Onset Recurrent Respiratory Papillomatosis Diagnosis and Management - A Developing Country Review. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2020; 11:39-46. [PMID: 32099513 PMCID: PMC7007786 DOI: 10.2147/phmt.s200186] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 01/14/2020] [Indexed: 01/04/2023]
Abstract
Recurrent respiratory papillomatosis (RRP) is a condition caused by human papillomavirus (HPV), usually HPV types 6 and 11, which is characterized by recurrent papillomas of the respiratory tract, mainly the larynx. Patients usually present between the ages of 2 and 6 years. The initial presenting symptom is progressive dysphonia, followed by stridor and respiratory distress. Treatment consists of repeated microlaryngoscopic procedures to remove the papillomas as there is no cure. The poor availability and accessibility of appropriate healthcare services in developing countries are barriers to the early diagnosis and appropriate management of patients with juvenile-onset recurrent respiratory papillomatosis (JoRRP), requiring many patients to have a tracheostomy. The introduction of prophylactic vaccines that include HPV6 and HPV11 is necessary in order to reduce the incidence of JoRRP.
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Affiliation(s)
- R Y Seedat
- Department of Otorhinolaryngology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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31
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Lawlor C, Balakrishnan K, Bottero S, Boudewyns A, Campisi P, Carter J, Cheng A, Cocciaglia A, DeAlarcon A, Derkay C, Fayoux P, Hart C, Hartnick C, LeBoulanger N, Moreddu E, Muntz H, Nicollas R, Peer S, Pransky S, Rahbar R, Russell J, Rutter M, Seedat R, Sidell D, Smith R, Soma M, Strychowsky J, Thompson D, Triglia JM, Trozzi M, Wyatt M, Zalzal G, Zur KB, Nuss R. International Pediatric Otolaryngology Group (IPOG): Juvenile-onset recurrent respiratory papillomatosis consensus recommendations. Int J Pediatr Otorhinolaryngol 2020; 128:109697. [PMID: 31698245 DOI: 10.1016/j.ijporl.2019.109697] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/26/2019] [Accepted: 09/26/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To develop consensus recommendations for the evaluation and management of juvenile-onset recurrent respiratory papillomatosis (JORRP) in pediatric patients. METHODS Expert opinion by the members of the International Pediatric Otolaryngology Group (IPOG). The mission of the IPOG is to develop expertise-based consensus recommendations for the management of pediatric otolaryngologic disorders with the goal of improving patient care. The consensus recommendations herein represent the first publication by the group. RESULTS Consensus recommendations including diagnostic considerations, surgical management, systemic adjuvant therapies, postoperative management, surveillance, and voice evaluation. These recommendations are based on the collective opinion of the IPOG members and are targeted for otolaryngologists, primary care providers, pulmonologists, infectious disease specialists, and any other health care providers that manage patients with JORRP. CONCLUSIONS Pediatric JORRP consensus recommendations are aimed at improving care and outcomes in this patient population.
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Affiliation(s)
- Claire Lawlor
- Department of Otolaryngology, Children's National Health System, Washington, DC, United States.
| | | | - Sergio Bottero
- Department Pediatric Surgery, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - An Boudewyns
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Paolo Campisi
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - John Carter
- Department of Otolaryngology, Ochsner Health System, New Orleans, LA, United States
| | - Alan Cheng
- Department of Pediatric Otolaryngology, The Sydney Children's Hospital Network-Westmead Campus, The University of Sydney, Sydney, NSW, Australia
| | - Alejandro Cocciaglia
- Servicio de Endoscopía Respiratoria, Hospital de Pediatría Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
| | - Alessandro DeAlarcon
- Division of Pediatric Otolaryngology-Head & Neck Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | - Craig Derkay
- Department of Otolaryngology - Head and Neck Surgery, Eastern Virginia Medical School, Sentara Norfolk General Hospital, Norfolk, VA, United States
| | - Pierre Fayoux
- Department of Pediatric Otolaryngology-Head Neck Surgery, Jeanne de Flandre Hospital-CHU Lille, Lille, France
| | - Catherine Hart
- Division of Pediatric Otolaryngology-Head & Neck Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | - Christopher Hartnick
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, United States
| | - Nicolas LeBoulanger
- Department of Otorhinolaryngology, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Eric Moreddu
- Department of Pediatric Otolaryngology Head and Neck Surgery, La Timone Children's Hospital (Aix-Marseille University), Marseille, France
| | - Harlan Muntz
- Division of Otolaryngology - Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Richard Nicollas
- Department of Pediatric Otolaryngology Head and Neck Surgery, La Timone Children's Hospital (Aix-Marseille University), Marseille, France
| | - Shazia Peer
- Department of Otorhinolaryngology, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Seth Pransky
- Pediatric Specialty Partners, San Diego, CA, United States
| | - Reza Rahbar
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, United States
| | - John Russell
- Department of Otorhinolaryngology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| | - Michael Rutter
- Division of Pediatric Otolaryngology-Head & Neck Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | - Riaz Seedat
- Department of Otorhinolaryngology, Universitas Academic Hospital, Bloemfontein, South Africa
| | - Douglas Sidell
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, CA, United States
| | - Richard Smith
- Department of Otolaryngology -Head and Neck Surgery, Carver College of Medicine, University of Iowa Health Care, Iowa City, IA, United States
| | - Marlene Soma
- Department of Paediatric Otolaryngology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Julie Strychowsky
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital at London Health Sciences Centre, Western University, London, ON, Canada
| | - Dana Thompson
- Division of Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, And Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Jean-Michel Triglia
- Department of Pediatric Otolaryngology Head and Neck Surgery, La Timone Children's Hospital (Aix-Marseille University), Marseille, France
| | - Marilena Trozzi
- Department Pediatric Surgery, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Michelle Wyatt
- Great Ormond Street Hospital for Children, London, United Kingdom
| | - George Zalzal
- Department of Otolaryngology, Children's National Health System, Washington, DC, United States
| | - Karen B Zur
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Roger Nuss
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, United States
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Systemic bevacizumab for end-stage juvenile recurrent respiratory papillomas: A case report. Int J Pediatr Otorhinolaryngol 2020; 128:109706. [PMID: 31610441 DOI: 10.1016/j.ijporl.2019.109706] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/01/2019] [Accepted: 10/01/2019] [Indexed: 11/23/2022]
Abstract
We report on two cases of severe recurrent respiratory papillomatosis (RRP) involvement where the anti-vascular endothelial growth factor (VEGF) antibody bevacizumab IV has been administered for treatment. Notably, there have not been any episodes of urgent transfer to the hospital for obstructive events since the bevacizumab was started. It is important to note however, that the disease has not been eliminated. While some pulmonary nodules continue to grow, they have become cavitated. Overall, the number and size of pulmonary lesions has decreased. Therefore, VEGF-targeted therapies, Bevacizumab, could prove to be a promising novel approach for long-term treatment of severe RRP.
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Abstract
Recurrent respiratory papillomatosis (RRP) remains a challenging disease afflicting children and adults, resulting in an estimated $120 million per year in United States healthcare-related costs, with annual costs per patient approaching $60,000. Although the prevalence of RRP has declined, RRP remains the most common benign laryngeal neoplasm in children. RRP is unique in its high rate of multisite recurrence, its high burden on patient quality of life, and its high associated healthcare costs. This article summarizes current understanding of the natural history and quality of life burden of RRP, and basic science advancements in prevention and treatment.
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Affiliation(s)
- Craig S Derkay
- Department of Otolaryngology-Head and Neck Surgery, Pediatric Otolaryngology, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, 601 Children's Lane, 2nd Floor, Norfolk, VA 23507, USA.
| | - Andrew E Bluher
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Sentara Norfolk General Hospital, 600 Gresham Drive, Suite 1100, Norfolk, VA 23507, USA
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Kumar N, Preciado D. Airway Papillomatosis: New Treatments for an Old Challenge. Front Pediatr 2019; 7:383. [PMID: 31620412 PMCID: PMC6759931 DOI: 10.3389/fped.2019.00383] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/05/2019] [Indexed: 12/14/2022] Open
Abstract
Recurrent respiratory papillomatosis (RRP) is the recurrent growth of small, benign tumors, or papillomas, in the respiratory tract, caused by human papillomavirus (HPV). Currently, there is no cure. Palliative treatments seek to prevent airway obstruction, keep underlying tissues healthy, and maintain voice quality. The most common intervention, the local surgical removal of papillomas, may be inadequate as a standalone treatment for pediatric populations that experience rapid papilloma regrowth, as repeated surgeries cause increased damage to the surrounding tissues and impose significant emotional and economic burden on families. Interferon α and Cidofovir have been shown to lengthen the time between surgical interventions and/or decrease the total number of procedures needed, although the evidence of their efficacy and safety is controversial. Novel therapies, including photodynamic therapy, indole-3-carbinol, anti-reflux medication, heat shock protein, and Mumps and HPV vaccination, may provide potential avenues for treatment, but require further research. Among all the novel therapies investigated, systemic bevacizumab seems to offer the most promising alternative to surgery. Randomized control trials to investigate its impact, especially in a pediatric population, should be conducted before implementing it as a standard form of care. This review will summarize the latest literature on medical care for aggressive RRP disease.
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Affiliation(s)
- Nankee Kumar
- Sheikh Zayed Center for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, United States
| | - Diego Preciado
- Sheikh Zayed Center for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, United States.,Division of Pediatric Otolaryngology, Children's National Health System, Washington, DC, United States
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Carnevale C, Ferrán-De la Cierva L, Til-Pérez G, Peña-Zarza JA, Osona-Rodriguez B, Martinez-Lozano J, Sarría-Echegaray P, Arancibia-Tagle D, Tomás-Barberán M. Safe use of systemic bevacizumab for respiratory recurrent papillomatosis in two children. Laryngoscope 2018; 129:1001-1004. [PMID: 30588638 DOI: 10.1002/lary.27674] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/10/2018] [Accepted: 10/17/2018] [Indexed: 01/09/2023]
Abstract
Recurrent respiratory papillomatosis can be a devastating condition for a child, with severe consequences. Currently, there is no proven successful medical treatment. We describe the use of systemic bevacizumab to treat two children affected by aggressive recurrent respiratory papillomatosis. Respiratory symptoms and quality of life improved dramatically in both patients, without observing any toxicity. The only complication was mild proteinuria. Systemic bevacizumab is a promising adjuvant treatment in aggressive recurrent respiratory papillomatosis in children. It is effective and well tolerated. Further studies are needed to establish the optimal dosing frequency and duration of therapy. Laryngoscope, 129:1001-1004, 2019.
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Affiliation(s)
- Claudio Carnevale
- Department of Otolaryngology-Head and Neck Surgery and Pediatric Department, Son Espases University Hospital, Palma de Mallorca, Spain
| | | | - Guillermo Til-Pérez
- Department of Otolaryngology-Head and Neck Surgery and Pediatric Department, Son Espases University Hospital, Palma de Mallorca, Spain
| | - José Antonio Peña-Zarza
- Department of Otolaryngology-Head and Neck Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Borja Osona-Rodriguez
- Department of Otolaryngology-Head and Neck Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | | | - Pedro Sarría-Echegaray
- Department of Otolaryngology-Head and Neck Surgery and Pediatric Department, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Diego Arancibia-Tagle
- Department of Otolaryngology-Head and Neck Surgery and Pediatric Department, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Manuel Tomás-Barberán
- Department of Otolaryngology-Head and Neck Surgery and Pediatric Department, Son Espases University Hospital, Palma de Mallorca, Spain
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Shah SQ, Mahmood S. Evaluation of 99mTc-Labeled Bevacizumab- N-HYNIC Conjugate in Human Ovarian Tumor Xenografts. Cancer Biother Radiopharm 2018; 33:96-102. [PMID: 29634355 DOI: 10.1089/cbr.2017.2323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Aim: The aim of the present investigation was to examine the suitability of 99mTc-N-HYNIC-BZMB as a specific vascular endothelial growth factor (VEGF)-targeting agent. Bevacizumab is a recombinant humanized monoclonal antibody that inhibits VEGF. Methods: N-hydroxysuccinimide-2-hydrazinonicotinic acid (N-HYNIC) was conjugated to BZMB, followed by labeling with 99mTc using N-[Tris(hydroxymethyl)methyl] glycine (tricine), ethylenediamine-N,N'-diacetic acid (EDDA), and nicotinic acid as coligands. 99mTc-labeled BZMB was characterized in terms of 99mTcO4, radiocolloids, and labeled N-HYNIC-BZMB using thin-layer chromatography and HPLC. Poor metastatic SKOV-3 and high metastatic SKOV-3.ip1 human ovarian cancer cell lines were used for in vitro binding uptake of 99mTc-N-HYNIC-BZMB. Biodistribution and scintigraphy accuracy were examined in human ovarian tumor xenografts in rats and rabbits. Results: 99mTc-N-HYNIC-BZMB prepared by using a mixture of tricine and EDDA demonstrated relatively high radiochemical purity (more than 98%). In L-cysteine and serum, it exhibited a stable behavior up to 16 h. In vitro binding uptake indicated that it targets high metastatic SKOV-3.ip1 tumors. Biodistribution in human ovarian tumor xenografts in rats confirmed a significant uptake in SKOV-3.ip1 tumors (5.69% ± 1.86%, 4 h). Scintigraphic accuracy in human ovarian tumor xenografts in rabbits validated its suitability as a high metastatic SKOV-3.ip1 radiotracer. Conclusion: High radiochemical purity, stability in saline and serum, biodistribution, and scintigraphy of 99mTc-N-HYNIC-BZMB in human ovarian tumor xenografts in rats and rabbits confirmed its suitability as a potential radiotracer for imaging high metastatic SKOV-3.ip1 sites.
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Affiliation(s)
- Syed Qaiser Shah
- Biochemistry Section, Institute of Chemical Sciences, University of Peshawar, Peshawar, K.P.K., Pakistan
| | - Samia Mahmood
- Biochemistry Section, Institute of Chemical Sciences, University of Peshawar, Peshawar, K.P.K., Pakistan
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Katsuta T, Miyaji Y, Offit PA, Feemster KA. Treatment With Quadrivalent Human Papillomavirus Vaccine for Juvenile-Onset Recurrent Respiratory Papillomatosis: Case Report and Review of the Literature. J Pediatric Infect Dis Soc 2017; 6:380-385. [PMID: 28992265 DOI: 10.1093/jpids/pix063] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 07/10/2017] [Indexed: 11/14/2022]
Abstract
Although juvenile-onset recurrent respiratory papillomatosis (JoRRP) generally involves a benign tumor on the larynx and other respiratory tract areas, almost all patients with this disease require repeated surgical intervention (to prevent airway obstruction during the course of illness) and various adjuvant therapies such as interferon, cidofovir, acyclovir, ribavirin, indole-3-carbinol, HspE7, mumps vaccine, photodynamic therapy, propranolol, cimetidine, and bevacizumab. Some case reports recently described the effectiveness of the quadrivalent human papillomavirus vaccine (HPV4) as an adjuvant therapy. On the basis of these reports, we administered HPV4 to a 2-year-old boy with JoRRP. However, no therapeutic effect was found. A review of the available literature revealed that current evidence for the effectiveness of therapeutic HPV4 and other adjuvant therapies for JoRRP is inconsistent. Therefore, the prophylactic use of currently available HPV vaccine for adolescents is the most effective strategy for preventing not only anogenital cancers but also genital warts, which might be a risk factor for JoRRP among their children in the future.
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Affiliation(s)
- Tomohiro Katsuta
- Department of Pediatrics, St Marianna University School of Medicine, Kawasaki, Japan.,Vaccine Education Center
| | - Yusuke Miyaji
- Department of Pediatrics, Kawasaki Municipal Tama Hospital, Kawasaki, Japan
| | - Paul A Offit
- Vaccine Education Center.,Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kristen A Feemster
- Vaccine Education Center.,Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Best SR, Mohr M, Zur KB. Systemic bevacizumab for recurrent respiratory papillomatosis: A national survey. Laryngoscope 2017; 127:2225-2229. [PMID: 28657692 DOI: 10.1002/lary.26662] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 04/10/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Aggressive laryngeal, tracheal, and pulmonary papilloma is an extremely challenging clinical problem without proven treatment options. A recent German report documented promising results with systemic bevacizumab. The objective of this study is to report the initial experience of this novel treatment in the United States for recurrent respiratory papillomatosis (RRP). STUDY DESIGN Cases series. METHODS Electronic survey of the RRP Task Force of the American Society of Pediatric Otolaryngology, American Broncho-Esophagological Association, and physicians known to the authors to have used systemic bevacizumab for RRP. RESULTS Eleven completed surveys were obtained. In three cases, systemic bevacizumab was considered clinically but not administered. Eight patients were treated with systemic bevacizumab, all for aggressive papillomatosis uncontrolled by surgical and adjuvant therapy, including seven of eight with pulmonary disease. Treatment dosing ranged from 5 to 10 mg/kg every 2 to 4 weeks, with all patients responding (7/8 partial response, 1/8 complete response). In four patients who had postbevacizumab chest imaging, three demonstrated improvement of disease and one stabilization. Treatment interval could be lengthened in seven patients and clinical response maintained. One patient with long-standing pulmonary disease (>10 years) was diagnosed with malignant transformation while on treatment, and bevacizumab was discontinued in lieu of other chemotherapeutic agents. All other patients continue on systemic bevacizumab with minimal complications (hemoptysis n = 1, proteinuria n = 1). CONCLUSIONS Systemic bevacizumab appears to have significant promise in the most treatment-resistant and aggressive forms of papillomatosis with a low complication profile. These results suggest bevacizumab should be studied in a formal clinical trial for RRP. LEVEL OF EVIDENCE 4. Laryngoscope, 127:2225-2229, 2017.
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Affiliation(s)
- Simon R Best
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Michael Mohr
- Department of Medicine, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Karen B Zur
- Pediatric Otolaryngology, The Children's Hospital of Philadelphia, The University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, The University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
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