Systemic Bevacizumab (Avastin) for Juvenile‐Onset Recurrent Respiratory Papillomatosis: A Systematic Review

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

Bevacizumab as treatment option for recurrent respiratory papillomatosis: a systematic review

“…Concurrent to our systematic review, another systematic review was published that investigated the efficacy and safety of systemic bevacizumab only for JoRRP, and similar results were found [ 32 ]. All patients experienced a considerable improvement of symptoms with a reduced need for surgical intervention during follow up (range 2 months to 5 years).…”

“…In 30% of the cases, side effects occurred, but were considered as milde or moderate. The remaining 70% did not report any side effects [ 32 ]. However, these findings are solely based on cases of JoRRP, and not AoRRP.…”

“…Furthermore, no intralesional administration of bevacizumab was investigated. As a consequence, only a small sample size of 20 participants was included [ 32 ]. To provide a complete overview of the efficacy of bevacizumab for RRP in our study, we included all case reports, case series and retrospective studies available in medical literature concerning systemically and intralesionally administered bevacizumab for JoRRP and AoRRP.…”

Recurrent respiratory papillomatosis: A 2020 perspective

“…A recent systematic review, evaluated the JORRP literature in regards to IV Avastin therapy, 20 distinct patients were identified. All patients had significant reduction in disease burden and need for operative intervention 58 . Additional case series in the adult population have shown similar benefit for patients with tracheobronchial RRP or patients with high disease burden (atleast >2 interventions per year) 59 .…”

Clinical implications of alpha, beta, and gamma HPV infection in juvenile onset recurrent respiratory papillomatosis

“…Furthermore, no reliable markers predicting the course of the disease, the risk of recurrence or malignant transformation exist [4]. However, the new adjuvant therapies appear to be promising in improving the control of the disease [5]. It could be, therefore, interesting and innovating having biological markers that can guide clinicians to select patients eligible for adjuvant therapies.…”