Bevacizumab Infusions an Effective Adjuvant Therapy in Juvenile-Onset Recurrent Respiratory Papillomatosis

by Linda Kossoff •

How effective is systemic bevacizumab as an adjuvant therapy for recurrent respiratory papillomatosis (RRP) in children?

BOTTOM LINE

Systemic bevacizumab is an effective therapy for severe RRP cases, with promising results both in short- and long-term follow-up. 

BACKGROUND: Juvenile-onset RRP (JO-RRP) is a rare disease characterized by multiple upper airway lesions leading to potential airway obstruction. Although there has been no reliably effective adjuvant medication to reduce the need for repeated surgical debridement in children with severe disease, bevacizumab may help increase time intervals between surgeries.

STUDY DESIGN: Retrospective review.

SETTING: Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.

Figure 1. Photos of the laryngeal response in patient 5; the images are labeled for pre- and post-bevacizumab injection.

SYNOPSIS: Researchers retrospectively reviewed the records of seven children (mean age 3 years) at a single pediatric hospital who received systemic bevacizumab treatment (infusions in 5–15 mg/kg doses) for JO-RRP from 2015 to 2021. Indications for bevacizumab treatment included failure after other adjuvant treatments, having had more than four debridements in the year prior to treatment initiation, and severe disease. Three patients had only laryngeal disease on presentation; one patient had severe laryngeal and tracheal disease; and three patients had laryngeal, tracheal, and pulmonary disease. Median duration of bevacizumab therapy was 2.13 years. All patients experienced a significant and almost immediate decrease in laryngeal disease burden, and all have been able to increase intervals between infusions over time (see Figure 1). Tracheal/pulmonary disease, however, took longer to regress. There were no significant side effects. Researchers note that there is currently no consensus on infusion dosing or frequency, but that 10 mg/kg has worked well with their patient population. They report that patients reach a steady state of disease control with a regimen of bevacizumab infusion every two to three months.

CITATION: Ruiz R, Balamuth N, Javia LR, Zur KB. Systemic bevacizumab treatment for recurrent respiratory papillomatosis: long-term follow-up. Laryngoscope. 2022;132:2071–2075.