Systemic Bevacizumab for Recurrent Respiratory Papillomatosis: A Single Center Experience of Two Cases

Abstract

BACKGROUND Recurrent respiratory papillomatosis (RRP), caused by human papillomavirus (HPV), is the most common benign neoplasm of the larynx and central airways. RRP has a significant impact on quality life and high annual costs to healthcare. Currently, there is no cure for RRP, leading to repeated debulking operations for symptomatic palliation. Various local adjuvant therapies have also been studied with mixed efficacy. HPV oncogene products increase expression of vascular endothelial growth factor (VEGF) providing a potential target for treatment of RRP. Bevacizumab, a recombinant monoclonal antibody that inhibits VEGF, has shown efficacy in patients with localized disease. CASE REPORT We present two cases of extensive airway and parenchymal RRP successfully managed with systemically administered bevacizumab, a recombinant monoclonal antibody that inhibits VEGF. CONCLUSIONS Bevacizumab has shown efficacy in patients with localized disease, but here we illustrate the potential of bevacizumab for patients with extensive parenchymal burden as well as provide a brief review of the literature.

Figure 1.

Case 1: Endoscopic and computed tomography (CT) images prior to and 16 weeks following treatment with bevacizumab. (A) Case 1: Endoscopic image prior to initiation of systemic bevacizumab treatment. (B) Case 1: CT image prior to initiation of systemic bevacizumab treatment. (C) Case 1: Endoscopic image 16 weeks after initiation of systemic bevacizumab treatment. (D) Case 1: CT image 16 weeks after initiation of systemic bevacizumab treatment.

Figure 2.

Case 2: Computed tomography (CT) images of upper and lower lung fields prior to and 8 months following treatment with bevacizumab. (A) Case 2: CT image of the upper lung fields prior to initiation of systemic bevacizumab treatment. (B) Case 2: CT image of the lower lung fields prior to initiation of systemic bevacizumab treatment. (C) Case 2: CT image of the upper lung fields, 8 months after initiation of systemic bevacizumab treatment. (D) Case 2: CT image of the lower lung fields, 8 months after initiation of systemic bevacizumab treatment.