2017 Volume 110 Issue 4 Pages 227-236
Treatment of recurrent respiratory papillomatosis (RRP) has historically been, and still remains, a difficult challenge. Although there is no evidence-based treatment to date, surgery is generally performed and is considered as the standard treatment modality. Recent trends in respect of surgical instruments in the management of RRP in Europe, United States as well as Japan include the microdebrider and carbon dioxide (CO2) laser. However, adjuvant pharmacological treatment is increasingly being used due to the high tendency towards recurrence of the disease.
Among the various adjuvant pharmacotherapies that have been employed, intralesional cidofovir injection remains the leading option in Europe and the United States, even though its use for this indication remains off-label. Herein, we introduce our experience of the treatment for the first time in Asia; we found that the treatment showed acceptable efficacy, without obvious adverse events. However, as there is no consensus as yet in regard to the optimal treatment regimen, uncontrolled spread of this treatment should be avoided. To guide current practice of adjuvant intralesional cidofovir for RRP in adults and children, the RRP Task Force of the United States approved 18 consensus statements, which should be referred to while planning the treatment.
Numerous other pharmacotherapies are expected in the future. Based on the histological characteristics of RRP, there have been some reports of promising results achieved with relatively high doses of bevacizumab, a monoclonal antibody against vascular endothelial growth factor. In addition, based on the results of basic research showing increased expression of cyclooxygenase-2 (COX-2) in RRP, a study of the long-term safety and effectiveness of the selective COX-2 inhibitor is currently ongoing in the United States. Furthermore, vaccination against human papillomavirus (HPV) could be expected to play a role in both prophylaxis and treatment of RRP.
