Department of Otolaryngology - Head and Neck Surgery, Emory University, Atlanta, Georgia, USA.
Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USA.
Laryngoscope. 2023 Oct;133(10):2725-2733. doi: 10.1002/lary.30617. Epub 2023 Feb 23.
The clinical course of recurrent respiratory papillomatosis (RRP) varies from spontaneous remission to severe airway obstruction with wide variability in recurrence. Standard treatment involves debulking to improve voice and/or breathing. Non-surgical therapies are emerging in hopes of non-operative disease control. This retrospective review analyzes long-term safety, efficacy, and durability of clinical control in the largest reported series of parenteral bevacizumab in adults with RRP.
Twenty-three patients with known RRP who have been receiving off-label systemic bevacizumab were included. Dosage, infusion interval, number of cycles, debulking requirements, subjective outcomes, adverse events, and reasons for treatment termination were investigated.
Patients have been followed for an average of 791.43 (21-1468) days. The most common starting dosing regimen was 15 mg/kg at 3 weeks in 11 followed by 10 mg/kg at 6 weeks intervals in 6 individuals. Long-term maintenance dosage varied with the least intensive regimen being 10 mg/kg at 14-week intervals. Subjective improvement of voice and/or breathing was reported in 18/23 subjects. The median time for patients that needed a procedure after treatment was 634 days. Procedures after infusions decreased from 3.08 ± 2.48 procedures in the year prior to 0.52 ± 1.12 during systemic Bevacizumab, and to 0.86 ± 2.05 after stopping bevacizumab. Therapy termination occurred in 8 subjects where only 3 were due to adverse events.
Parenteral bevacizumab remains a well-tolerated treatment for patients with recalcitrant RRP. There appears to be a durable reduction in the frequency of debulking surgery requirements although on a maintenance regimen. Laryngoscope, 133:2725-2733, 2023.
复发性呼吸道乳头瘤病（RRP）的临床病程变化多样，从自发缓解到严重气道阻塞均有发生，且复发率差异很大。标准治疗包括切除以改善声音和/或呼吸。非手术治疗方法的出现，旨在实现疾病的非手术控制。本回顾性研究分析了最大系列接受贝伐单抗治疗的成人 RRP 患者中，该药长期的安全性、疗效和临床控制的持久性。
纳入 23 例已知患有 RRP 且接受贝伐单抗治疗的患者。研究了剂量、输注间隔、周期数、切除需求、主观结局、不良事件以及治疗终止的原因。
患者平均随访 791.43（21-1468）天。最常见的起始剂量方案为 11 例患者采用 15mg/kg，每 3 周一次，6 例患者采用 10mg/kg，每 6 周一次。长期维持剂量因个体而异，最不密集的方案为每 14 周 10mg/kg。23 例患者中有 18 例报告声音和/或呼吸改善。治疗后需要手术的患者中位时间为 634 天。与贝伐单抗治疗前每年 3.08±2.48 次手术相比，输注后手术次数减少至 0.52±1.12 次，停止贝伐单抗治疗后降至 0.86±2.05 次。8 例患者停止治疗，其中仅 3 例因不良事件停药。
贝伐单抗仍是治疗复发性 RRP 患者的一种耐受良好的治疗方法。尽管采用维持方案，但似乎可持久减少切除手术需求的频率。喉镜，133:2725-2733，2023。
