Bevacizumab may stabilize patients with recurrent Respiratory Papillomatosis with pulmonary involvement

Recurrent Respiratory Papillomatosis with pulmonary involvement can be effectively and significantly managed by systemic bevacizumab. The patients with pulmonary involvement responded to systemic bevacizumab, its progression could be stabilized, and there was a major reduction in the laryngeal and tracheal disease as per a study published in the journal 'The Laryngoscope." 

Recurrent respiratory papillomatosis (RRP) is a benign papillomatous growth in the air passages along the respiratory tract. They are caused by human papillomaviral infection. An HPV vaccine is used for the prevention of RRP. Other modes of management are surgery and medical management with drugs like bevacizumab, which targets the blood vessel growth of papilloma. Due to the uncertainty about the efficacy of bevacizumab for RRP, researchers conducted a retrospective review to characterize the disease response of pulmonary RRP to systemic bevacizumab at three medical institutions. 

Patients with RRP were scrutinized, and Clinical symptoms, CT findings, and disease response were compared before and after initiation of systemic bevacizumab therapy. The disease response was categorized as complete response, partial response, stabilization, or progression for each subsite involved by papilloma. 

Key findings: 

• 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.
• The use of systemic bevacizumab therapy significantly reduced 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). 
• Compared with the 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. 

Thus, Systemic bevacizumab could effectively stabilize the progression in even the most severe cases of RRP. 

Further reading: Efficacy of Systemic Bevacizumab for Recurrent Respiratory Papillomatosis with Pulmonary Involvement.  https://doi.org/10.1002/lary.30893