Experience of 11 years use of cidofovir in recurrent respiratory papillomatosis

Abstract

Recurrent respiratory papillomatosis (RRP) is a viral induced disease, associated with exophytic epithelial lesions affecting the upper airways. Problem of treatment is the high recurrence of papilloma growth after surgical removal; therefore adjuvant therapy schemes have been established. Cidofovir was one of the agents used off-label in adjuvant therapy in the last years. However, there is ongoing discussion about the effectiveness and possible side effects. Aim of our study was to share our experience in treatment of RRP with cidofovir during the last 11 years. We analyzed all the data of patients treated for RRP at the Department for Phoniatrics of the Medical University of Graz between 1999 and 2011. 25 out of the 34 treated patients are at the moment under complete remission, in six patients partial remission could be achieved and two patients showed poor response to therapy, therefore the treatment with cidofovir was stopped. 21 patients received one cycle of monthly cidofovir, 11 patients received two and one patient three cycles of therapy. Number of procedures reached from one to six during each cycle. Average cumulative dose of one cycle was 79.7 mg (15-277.5 mg), in one patient 435 mg were used. One patient developed temporary, borderline neutropenia without symptoms. Despite the retrospective approach of this study with the limitation of several incomplete records, our results show promising long-term effects of adjuvant use of cidofovir. During this period, we did not observe any relevant side effects.

Insights into the mechanism of action of cidofovir and other acyclic nucleoside phosphonates against polyoma- and papillomaviruses and non-viral induced neoplasia

“…CDV represents an option to reduce the risks of frequent surgical debulking and airway obstruction in children and adults with recurrent or severe disease (Derkay et al, 2013). CDV is nowadays recognized as an adjuvant therapy for the management of this disease (Tjon Pian Gi et al, 2013;Graupp et al, 2013). A type specific real-time PCR to measure HPV6 and HPV11 DNA loads in patients with recurrent respiratory papillomatosis treated with CDV, indicated that the drug significantly reduced viral load following intralesional application (Mikolajczak et al, 2012).…”

<p>Juvenile-Onset Recurrent Respiratory Papillomatosis Diagnosis and Management – A Developing Country Review</p>

“…While uncontrolled and retrospective studies have shown intralesional cidofovir to be effective for RRP with approximately 40-50% of patients achieving remission, a systematic review on adjuvant antiviral therapy for the treatment of RRP identified only one randomized double-blind, placebo-controlled trial of intralesional cidofovir administered at the time of surgical debulking with significant clinical improvements in both the cidofovir and placebo groups and no significant difference between the two groups. [76][77][78][79][80] Bevacizumab is a recombinant humanized monoclonal antibody that blocks angiogenesis by binding to and inhibiting the biological activity of human vascular endothelial growth factor A (VEGF-A). 81 Intralesional bevacizumab has been shown to prolong the intersurgical interval in small case series, 81 while systemic bevacizumab has been shown to be of benefit in patients with highly aggressive disease and those with pulmonary involvement.…”

Eficacia del cidofovir intralesional en el tratamiento de papilomatosis respiratoria recurrente juvenil: una revisión sistemática

“…De esta manera, quedaron 22 artículos relacionados específicamente con el uso de cidofovir en papilomatosis respiratoria recurrente juvenil, enfocados a la recurrencia de la enfermedad. Este grupo de estudios incluyó un ensayo clínico aleatorizado, 17 18 series de casos, [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] un estudio de casos y controles 36 y dos reportes de casos.…”