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Parenteral Bevacizumab for the Treatment of Severe Respiratory Papillomatosis in an Adult Population
Author(s) -
Tkaczuk Andrew,
Trivedi Sumita,
Mody Mayur D.,
Steuer Conor E.,
Shin Dong M.,
Klein Adam M.,
Saba Nabil F.
Publication year - 2021
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.29133
Subject(s) - medicine , bevacizumab , recurrent respiratory papillomatosis , surgery , chemotherapy , larynx
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