Experts Debate Pediatric Airway Issues

Overall, there is insufficient evidence to prove the efficacy of cidofovir but there is the need for additional randomized prospective trials, Dr. Yellon said.

The current indications for cidofovir by the multidisciplinary RRP Task Force state that intralesional cidofovir should be used for moderate to severe disease requiring surgical treatment at least four times a year, aggressive disease with airway compromise, or severely impaired communication. However, informed consent discussing the nephrotoxicity and the carcinogenic potential of the drug should be required for these patients, and it should be written in the chart; and that all adverse responses should be reported to the task force, he said.

Con: David Tunkel, MD.

Dr. Tunkel agreed with the cautionary points made by Dr. Yellon about the drug. He concurred that nephrotoxicity was the biggest immediate concern, and noted there have also been case reports of patients with dysplasia. However, there’s a risk of spontaneous malignant degeneration of RRP without intralesional cidofovir [and] that malignant generation of RRP to squamous cell carcinoma may not involve progression through dysplasia.

From his own survey of the medical literature, he concluded that cidofovir appears to help RRP patients. However, the literature is varied and not completely convincing, with the most worrisome side effect being potential carcinogenesis.

Remember, it is an off-label use. You need to have a frank discussion with parents of patients about this. They tend to be pretty well informed because they come in with literature from patient support groups. I don’t think it’s yet for routine use; it’s for the severe patients, the patients who require multiple surgeries or the patients who have progression before your eyes, Dr. Tunkel said.

©2009 The Triological Society