Chemotherapy in severe nasal polyposis - a possible beneficial effect? A report of three cases

Abstract

This is the first report describing the successful treatment of severe nasal polyposis with chemotherapy. Based on this experience, we suggest a phase II trial with chemotherapy, preferably "low dose" methotrexate, in patients with severe nasal polyposis.

State of the Art Treatment of Nasal Polyposis

“…In 1996, Comet et al 97 showed that low-dose methotrexate (10 mg once weekly ϫ1 year) was an effective steroid-sparing agent. Two other promising reports (Asplund et al 98 and Buyukozturk et al 99 ) showed dramatic improvement of nasal polyposis in patients treated with low-dose methotrexate.…”

“…Two other promising reports (Asplund et al . 98 and Buyukozturk et al . 99 ) showed dramatic improvement of nasal polyposis in patients treated with low-dose methotrexate.…”

Methotrexate for recurrent chronic rhinosinusitis with nasal polyps: A randomized, controlled, phase 2 clinical trial

“…The weekly dose of MTX 10 mg was chosen based on two anecdotal reports 16,17 and considering its well-known safe and low-dose (7.5-30 mg/week) prescription in standard indications. 24 Gastrointestinal disturbances and a slight deterioration in liver function were the two most commonly observed adverse effects with 8.8 mg/week (4.6-18 mg) of MTX for an average of 36.5 weeks (27-132 weeks).…”

“…Two previous case reports have documented the regression of nasal polyps in patients who were treated with MTX for asthma and malignancy and coincidentally presented with nasal polyposis. 16,17 Inhibition of dihydrofolate reductase and T-lymphocyte proliferation and triggering T-lymphocyte apoptosis are among the autoinflammatory mechanisms of MTX. 18 Because T helper 1, 2, and 17 cells play roles in the three different types of CRSwNP, 1 MTX can be a promising treatment option.…”

Chronic rhinosinusitis and emerging treatment options

“…Many adjunctive agents have been utilized to control CRS including antimycotics,95–98 anti-IgE,99 anti-IL5,100,101 antihistamine,102,103 aspirin desensitization,104 bacterial lysates,105–108 capsaicin,109 complementary and alternative medicine,3,110–114 decongestants,115 furosemide,116 immunosuppressants,117,118 leukotriene antagonists,119,120 nasal irrigation,121–127 mucolytic agents,128 phototherapy,129 probiotics,130 and proton pump inhibitors (PPIs) 131. There was limited evidence on the effect of these options.…”