Evaluating the efficacy and safety of intralesional bevacizumab in the treatment of recurrent respiratory papillomatosis: A systematic review

Abstract

Purpose

Recurrent respiratory papillomatosis (RRP) represents a clinical challenge, often necessitating multiple interventions to help mitigate against disease recurrence or airway obstruction. Multiple management strategies have been advocated by specialists regarding the management of RRP. However, the success rates and disease progression still vary widely. One promising treatment is bevacizumab, a vascular endothelial growth factor (VEGF) monoclonal antibody, which had been initially introduced systemically. More recently, intralesional bevacizumab has become one of the newest arms in dealing with RRP.

The aim of this study is to systematically review the literature on the effectiveness, applicability and usage of intralesional bevacizumab in the treatment of RRP.

Methods

A systematic search was carried out on MEDLINE, Embase, Journals@Ovid and PubMed. PRISMA guidelines were adhered to in the reporting of this study. Study quality and bias risk was assessed using the Newcastle-Ottawa Scale (NOS).

Results

6 studies have met our inclusion and exclusion criteria, one randomised doubled blinded placebo-controlled pilot study, one case series, three prospective and one retrospective study, encompassing a total of 108 patients. Anatomical, functional and objective outcomes are presented and scrutinised. Where reported, complete remission or minimal recurrence was identified in 34/38 (89 %) patients following treatment with intralesional bevacizumab. However, outcome measures were not consistent across all studies making it difficult to draw direct comparisons. Of the 6 studies, 2 (33 %) were deemed poor quality and 4 (66 %) fair quality. No adverse effects of intralesional bevacizumab were reported.

Conclusions

This study's findings suggest a potential role for intralesional bevacizumab in the management of RRP objectively and functionally. Further research is required to necessitate a stronger evidence base, paying close attention to dose optimisation, assessment of long-term side effects and management of less severe disease phenotypes.