Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
Laryngoscope. 2024 Jul;134(7):3253-3259. doi: 10.1002/lary.31387. Epub 2024 Mar 25.
Medical therapies to limit disease recurrence are critically needed for recurrent respiratory papillomatosis (RRP). Systemic bevacizumab is emerging as an exciting adjuvant therapy toward this end, but uptake has been poor due to the lack of experience and awareness of best prescribing practices. The objective of this study was to describe a single tertiary care academic medical center's experience using systemic bevacizumab for the treatment of RRP.
A retrospective review was performed to identify patients with RRP on systemic bevacizumab. Demographic and clinical characteristics, findings on imaging reports, and disease response at all anatomic subsites involved in papilloma were documented.
Of the 17 RRP patients on systemic bevacizumab, 9 (52.9%) were male, and 12 (70.6%) were diagnosed with juvenile-onset RRP. The total lifetime number of surgeries was high, with more than half (n = 9; 52.9%) undergoing more than 50 surgeries. Following induction of systemic bevacizumab, a significant reduction in patients with laryngeal (n = 15; 94.1% vs. n = 7; 41.2%, p < 0.001) and tracheal (n = 11; 64.7% vs. n = 5; 29.4%, p = 0.04) RRP was noted. Surgical frequency was significantly lower following systemic bevacizumab (2.5 vs. 0.5 surgeries per year; p < 0.001). The most common complications were new-onset hypertension (n = 4; 23.5%) and proteinuria (n = 5; 29.4%).
Systemic bevacizumab is effective in reducing the number of surgeries needed for RRP while exhibiting a relatively safe complication profile. Papillomas in the larynx and trachea are most responsive to systemic bevacizumab, while pulmonary RRP is most likely to exhibit a partial-to-stable response.
4 Laryngoscope, 134:3253-3259, 2024.
对于复发性呼吸道乳头瘤病（RRP），迫切需要限制疾病复发的医学治疗方法。贝伐珠单抗作为一种辅助治疗方法正在崭露头角，但由于缺乏经验和对最佳处方实践的认识，其应用一直很有限。本研究的目的是描述一家三级学术医疗中心使用贝伐珠单抗治疗 RRP 的经验。
进行了一项回顾性研究，以确定接受贝伐珠单抗全身治疗的 RRP 患者。记录患者的人口统计学和临床特征、影像学报告中的发现以及所有涉及乳头瘤的解剖部位的疾病反应。
在接受贝伐珠单抗全身治疗的 17 例 RRP 患者中，9 例（52.9%）为男性，12 例（70.6%）诊断为青少年发病的 RRP。患者的总手术次数很高，超过一半（n=9；52.9%）接受了 50 多次手术。接受贝伐珠单抗全身诱导治疗后，喉部（n=15；94.1%比 n=7；41.2%，p<0.001）和气管（n=11；64.7%比 n=5；29.4%，p=0.04）RRP 患者显著减少。贝伐珠单抗全身治疗后手术频率显著降低（2.5 次/年比 0.5 次/年；p<0.001）。最常见的并发症是新发高血压（n=4；23.5%）和蛋白尿（n=5；29.4%）。
贝伐珠单抗在减少 RRP 所需手术次数方面有效，同时具有相对安全的并发症谱。喉部和气管的乳头瘤对贝伐珠单抗最敏感，而肺部 RRP 最有可能表现出部分至稳定的反应。
4 级喉镜，134：3253-3259，2024。
