Best Simon R, Mohr Michael, Zur Karen B
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A.
Department of Medicine, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany.
Laryngoscope. 2017 Oct;127(10):2225-2229. doi: 10.1002/lary.26662. Epub 2017 Jun 28.
OBJECTIVES/HYPOTHESIS: Aggressive laryngeal, tracheal, and pulmonary papilloma is an extremely challenging clinical problem without proven treatment options. A recent German report documented promising results with systemic bevacizumab. The objective of this study is to report the initial experience of this novel treatment in the United States for recurrent respiratory papillomatosis (RRP).
Cases series.
Electronic survey of the RRP Task Force of the American Society of Pediatric Otolaryngology, American Broncho-Esophagological Association, and physicians known to the authors to have used systemic bevacizumab for RRP.
Eleven completed surveys were obtained. In three cases, systemic bevacizumab was considered clinically but not administered. Eight patients were treated with systemic bevacizumab, all for aggressive papillomatosis uncontrolled by surgical and adjuvant therapy, including seven of eight with pulmonary disease. Treatment dosing ranged from 5 to 10 mg/kg every 2 to 4 weeks, with all patients responding (7/8 partial response, 1/8 complete response). In four patients who had postbevacizumab chest imaging, three demonstrated improvement of disease and one stabilization. Treatment interval could be lengthened in seven patients and clinical response maintained. One patient with long-standing pulmonary disease (>10 years) was diagnosed with malignant transformation while on treatment, and bevacizumab was discontinued in lieu of other chemotherapeutic agents. All other patients continue on systemic bevacizumab with minimal complications (hemoptysis n = 1, proteinuria n = 1).
Systemic bevacizumab appears to have significant promise in the most treatment-resistant and aggressive forms of papillomatosis with a low complication profile. These results suggest bevacizumab should be studied in a formal clinical trial for RRP.
目的/假设：侵袭性喉、气管和肺乳头状瘤是一个极具挑战性的临床问题，目前尚无经证实有效的治疗方案。最近一份德国报告记录了使用全身性贝伐单抗取得的有前景的结果。本研究的目的是报告这种新疗法在美国治疗复发性呼吸道乳头状瘤（RRP）的初步经验。
病例系列。
对美国儿科学耳鼻喉科学会RRP特别工作组、美国支气管食管学会以及作者所知的使用全身性贝伐单抗治疗RRP的医生进行电子调查。
共获得11份完整的调查问卷。在3例病例中，临床上考虑使用全身性贝伐单抗但未给药。8例患者接受了全身性贝伐单抗治疗，均为手术和辅助治疗无法控制的侵袭性乳头状瘤，其中8例中有7例患有肺部疾病。治疗剂量为每2至4周5至10mg/kg，所有患者均有反应（8例中有7例部分缓解，1例完全缓解）。在4例接受贝伐单抗治疗后进行胸部成像的患者中，3例病情改善，1例病情稳定。7例患者的治疗间隔可以延长，且临床反应得以维持。1例患有长期肺部疾病（>10年）的患者在治疗期间被诊断为恶变，停用贝伐单抗而改用其他化疗药物。所有其他患者继续接受全身性贝伐单抗治疗，并发症极少（咯血1例，蛋白尿1例）。
全身性贝伐单抗在最具治疗抵抗性和侵袭性的乳头状瘤形式中似乎有显著前景，且并发症较少。这些结果表明，应在RRP的正式临床试验中研究贝伐单抗。
4。《喉镜》，2017年，第127卷，第2225 - 2229页
