Work Group Delivers Consensus Statement on Administration of Systemic Bevacizumab in Patients with Recurrent Respiratory Papillomatosis

CLINICAL QUESTION

Based on scientific literature and expert consensus, what is the most current guidance for the administration of systemic bevacizumab in patients with recurrent respiratory papillomatosis (RRP)?

BOTTOM LINE

This consensus statement highlights the importance of consultative discussions with patients with RRP and their caregivers regarding bevacizumab as a possible nonsurgical treatment and outlines numerous specific considerations concerning systemic administration of the drug.

BACKGROUND: Recurrent respiratory papillomatosis is a rare chronic disease that results in the formation of squamous papillomas in the larynx, trachea, and lungs. The traditional standard of care for RRP is repeated debulking surgeries that inevitably cause anatomical damage and negative long-term psychological effects, underscoring the need for nonsurgical treatments.

STUDY DESIGN: Literature- and expert-based opinion study

SETTING: Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore

SYNOPSIS: Researchers formed a consensus working group of otolaryngologists, oncologists, and a representative from the RRP Foundation (n=10), all of whom had experience administering systemic bevacizumab in patients with RRP. Members received a literature review of studies, statements, reviews, and letters regarding such treatment. A modified Delphi method-based survey series was used to establish consensus. The group identified nine critical domains needed to select candidates for and successfully administer systemic bevacizumab. Of the 79 statements that were identified across the domains, 45 reached a consensus: clinical benefits of bevacizumab, patient and disease characteristics for treatment consideration, contraindications for treatment, shared decision making with patients, treatment access, initial dosing and administration, monitoring, tapering and discontinuation, and re-intensification. Among the consensus points were the promotion of shared decision-making, education, and quality-of-life conversations with patients and the need for a holistic approach to monitoring treatment response. The authors say that this guiding consensus statement represents a potential paradigm shift toward nonsurgical treatment options for patients with RRP and emphasize the importance of data sharing to further bolster the evidence base for the efficacy and safety of systemic bevacizumab in the RRP patient population.

CITATION: Best SR, et al. A consensus statement on the administration of systemic bevacizumab in patients with recurrent respiratory papillomatosis. Laryngoscope. 2024;134:5041-5046. doi: 10.1002/lary.31670.