Bevacizumab Therapy Shows Promise for Pulmonary Recurrent Respiratory Papillomatosis

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Pulmonary papillomatosis, a rare and severe manifestation of recurrent respiratory papillomatosis (RRP), has long presented challenges to medical practitioners due to limited treatment options. However, a recent retrospective study conducted across 3 medical institutions has shed new light on the potential efficacy of systemic bevacizumab therapy in managing the condition.

The primary objective of the study was to investigate the disease response of pulmonary RRP to systemic bevacizumab. As an uncommon disease with few treatment options, investigators sought to understand whether bevacizumab could offer hope to patients facing the progression of RRP.

The study involved a retrospective review of patients with pulmonary RRP from 3 medical institutions. Investigators analyzed clinical symptoms, CT findings, and disease response before and after initiating systemic bevacizumab therapy.

Disease response was classified into 4 categories: complete response, partial response, stabilization, or progression for each subsite affected by papilloma.

Out of the 12 patients with pulmonary RRP who received systemic bevacizumab treatment, 4 (33.3%) were male, and 11 (91.7%) had juvenile-onset RRP. All patients presented with laryngeal, tracheal, and pulmonary RRP. The median age at the first bevacizumab infusion was 48.1 years, with an age range of 19.5 - 70.2 years.

Encouragingly, the study observed that 9 (75%) patients experienced a stable-to-partial response in their lungs following systemic bevacizumab treatment. Additionally, 10 (83.3%) patients showed partial-to-complete responses in the larynx and trachea, indicating a substantial reduction in disease severity in these regions.

Notably, clinical symptoms such as dyspnea and dysphagia, and/or odynophagia saw significant improvement after bevacizumab therapy. Dyspnea decreased from 75.0% - 25.0% (P = 0.01), and dysphagia and/or odynophagia reduced from 33.3% - 0.0% (P = 0.03).

Investigators acknowledged that progression to pulmonary malignancy was identified in 3 (25%) patients, with 2 cases occurring before the initiation of bevacizumab therapy and 1 case after the complete cessation of treatment. Although this highlights the complexity of the condition, the study stated the overall results still provide hope for patients suffering from severe RRP.

The team emphasized the potential of systemic bevacizumab therapy in managing even the most severe cases of pulmonary RRP. The remarkable reduction in laryngeal and tracheal disease, coupled with a majority of patients experiencing stable-to-partial responses in pulmonary involvement, offers potential for improved outcomes and enhanced quality of life for those battling this rare condition.

While further research is needed to fully understand the long-term effects and potential side effects of bevacizumab therapy, investigators noted the findings of this study open the door to a new era of treatment possibilities for individuals with pulmonary RRP.

References:

1. So, R.J., Hidalgo Lopez, J.C., Ballestas, S.A., Klein, A.M., Steuer, C., Shin, D.M., Abousaud, M., Teng, Y., Saba, N.F., Tkaczuk, A.T., Schaefer, E.S., Seiwert, T.Y., McClellan, K. and Best, S.R. (2023), Efficacy of Systemic Bevacizumab for Recurrent Respiratory Papillomatosis with Pulmonary Involvement. The Laryngoscope. https://doi.org/10.1002/lary.30893