Use of Adjuvant Bevacizumab for the Treatment of Recurrent Respiratory Papillomatosis: Experience with Five Cases

Introduction: Our hospital is a reference center for the treatment of Recurrent Respiratory Papillomatosis (RRP), receiving patients nationwide. Many patients have extensive and aggressive disease, requiring multiple surgical procedures. Some underwent cidofovir injections, without satisfactory results. Increasing evidence supports the use of bevacizumab for the adjuvant treatment of RRP. On the basis of these evidences, we decided to offer this therapeutic alternative to patients referred to our service.

Objectives: The aim of this study is to describe our experience with intralesional bevacizumab for adjuvant treatment of RRP, including patients who underwent other adjuvant therapies previously

Resume: Two children and three adults were included in the study, all of them with aggressive disease. A series of four consecutive injections were administered with a 5-week interval between doses, associate with CO₂ laser ablation or cold steel excision. The bevacizumab dose was 1.25 mg in children and 30 mg in adults at each session. There were no adverse effects or alterations in ancillary exams. Three patients had complete remission of the papillomatosis, including the two who had tracheostomy. One of whom could be decannulated, and the other one was not decannulated because of obstructive endotracheal papillomatosis. There was an improvement of Derkay score in one patient, from 15 to 2. The remaining patient persisted with lesion, and an additional cycle of injections was proposed.

Conclusions: The use of bevacizumab for the adjuvant treatment of RRP seems to be, despite of the small number of patients, a safe and effective therapy. These results corroborate other previous reports. We continue to enroll cases to confirm the benefits of bevacizumab.