Systemic Bevacizumab for Recurrent Respiratory Papillomatosis: A National Survey
Systemic Bevacizumab for Recurrent Respiratory Papillomatosis: A National Survey
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DOI：
10.1002/lary.26662
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发表时间：
2017-10-01
期刊：
影响因子：
2.6
通讯作者：
Zur, Karen B.
中科院分区：
文献类型：
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作者：
Best, Simon R.;Mohr, Michael;Zur, Karen B.
目的/假设：侵袭性喉、气管和肺乳头状瘤是一个极具挑战性的临床问题，目前尚无有效的治疗方案。最近的一份德国报告记录了全身性贝伐单抗的有希望的结果。本研究的目的是报告这种新的治疗在美国的复发性呼吸道乳头状瘤病（RRP）的初步经验。研究设计：Cases series.Methods：美国儿科耳鼻喉科学会RRP工作组的电子调查，美国支气管食管学会，和医生已知的作者已经使用系统性贝伐单抗RRP。在3例病例中，临床上考虑了全身性贝伐珠单抗，但未给予。8例患者接受全身性贝伐单抗治疗，均为手术和辅助治疗未控制的侵袭性乳头状瘤病，其中7/8例患有肺部疾病。治疗剂量范围为5 - 10 mg/kg，每2 - 4周一次，所有患者均缓解（7/8例部分缓解，1/8例完全缓解）。在4例接受贝伐单抗治疗后胸部成像的患者中，3例显示疾病改善，1例稳定。7例患者的治疗间隔可以延长，临床反应得以维持。1例长期肺病患者（>10年）在治疗期间被诊断为恶变，停用贝伐珠单抗代替其他化疗药物。所有其他患者继续全身性贝伐单抗最小的并发症（咯血n = 1，蛋白尿n = 1）。结论：全身性贝伐单抗似乎有显着的承诺，在最难治性和侵略性的乳头状瘤病的形式与低并发症的配置文件。这些结果表明，贝伐单抗应在RRP的正式临床试验中研究。
Objectives/Hypothesis: Aggressive laryngeal, tracheal, and pulmonary papilloma is an extremely challenging clinical problem without proven treatment options. A recent German report documented promising results with systemic bevacizumab. The objective of this study is to report the initial experience of this novel treatment in the United States for recurrent respiratory papillomatosis (RRP).Study Design: Cases series.Methods: Electronic survey of the RRP Task Force of the American Society of Pediatric Otolaryngology, American Broncho-Esophagological Association, and physicians known to the authors to have used systemic bevacizumab for RRP.Results: Eleven completed surveys were obtained. In three cases, systemic bevacizumab was considered clinically but not administered. Eight patients were treated with systemic bevacizumab, all for aggressive papillomatosis uncontrolled by surgical and adjuvant therapy, including seven of eight with pulmonary disease. Treatment dosing ranged from 5 to 10 mg/kg every 2 to 4 weeks, with all patients responding (7/8 partial response, 1/8 complete response). In four patients who had postbevacizumab chest imaging, three demonstrated improvement of disease and one stabilization. Treatment interval could be lengthened in seven patients and clinical response maintained. One patient with long-standing pulmonary disease (>10 years) was diagnosed with malignant transformation while on treatment, and bevacizumab was discontinued in lieu of other chemotherapeutic agents. All other patients continue on systemic bevacizumab with minimal complications (hemoptysis n = 1, proteinuria n = 1).Conclusions: Systemic bevacizumab appears to have significant promise in the most treatment-resistant and aggressive forms of papillomatosis with a low complication profile. These results suggest bevacizumab should be studied in a formal clinical trial for RRP.