In some patients, the results can be dramatic, he said, sharing the experience of one of his patients on systemic bevacizumab. “I’ve actually not operated on them in over a year, and this is a patient that we were taking to the operating room basically every three to six weeks,” he said. “It can really change an outcome for a patient when you’re not having to do work on them anymore.”
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June 2022Long-term results with the drug aren’t known, however and, as with NF2, the therapy isn’t a cure. About 50% of practices have tried the antiviral cidofovir for RRP, but in more than 20 uncontrolled trials and case series, the treatment has shown mixed results, Dr. de Alarcon said. One randomized controlled trial showed no difference using cidofovir compared to a placebo. Cidofovir also has the potential to cause scarring, as well as a possible risk of dysplasia and cancer, he said (Ann Otol Rhinol Laryngol. 2008;117:477-483).
Non-human papillomavirus (HPV) vaccines are thought to cause a local inflammatory response not specific to HPV and could help with RRP and periods between RRP procedures, added Dr. de Alarcon.
DNA vaccines are another promising option on the horizon for driving antigen expression and boosting the host immune response, he said. Open-label trials in adults are ongoing, and there have been reports of two RRP patients treated with a DNA vaccine who had their interval between surgeries increase from six months to more than 500 days, Dr. de Alarcon said (Vaccines (Basel). 2020;8:56).
“There are lots of promising groups, including our own at Cincinnati Children’s, that are doing more basic science and biology [to improve] understanding of RRP with the goal of really trying to identify other algorithms for treatment, whether it’s other biologics or medications to treat these patients.”
Thomas R. Collins is a freelance medical writer based in Florida.