Adjuvant treatments for recurrent respiratory papillomatosis: a descriptive review and proposed management guideline in adults

OBJECTIVE: Recurrent respiratory papillomatosis is a rare disease characterised by growth of papilloma within the respiratory tract. The disease course is variable but can require frequent surgical interventions alongside adjuvant medical treatments. There is no definitive curative treatment or gold-standard guidelines for management. We aimed to evaluate current and potential future adjuvant treatments and propose a management guideline for adult patients. METHODS: Relevant articles were identified through searching databases, reference lists and grey literature. RESULTS: Systemic bevacizumab appears to be the most effective adjuvant treatment currently available. However, intralesional cidofovir also achieves a high complete-response rate in adults and the Gardasil vaccine demonstrates preventative and therapeutic value. The INO-3107 DNA vaccine is a promising potential future adjuvant treatment. CONCLUSIONS: This review provides a detailed examination of current and potential future adjuvant treatments. Based on the literature, we have developed a management guideline for adult patients with recurrent respiratory papillomatosis.