Systemic Bevacizumab for Treatment of Respiratory Papillomatosis: International Consensus Statement
Authors: Sidell Douglas R. , Balakrishnan Karthik , Best Simon R. , Zur Karen , Buckingham Julia , De Alarcon Alessandro , Baroody Fuad M. , Bock Jonathan M. , Boss Emily F. , Bower Charles M. , Campisi Paolo , Chen Sharon F. , Clarke Jeffrey M. , Clarke Kevin D. , Cocciaglia Alejandro , Cotton Robin T. , Cuestas Giselle , Davis Kara L. , DeFago Victor H. , Dikkers Frederik G. , Dossans Ines , Florez Walter , Fox Elizabeth , Friedman Aaron D. , Grant Nazaneen , Hamdi Osama , Hogikyan Norman D. , Johnson Kaalan , Johnson Liane B. , Johnson Romaine F. , Kelly Peggy , Klein Adam M. , Lawlor Claire M. , Leboulanger Nicolas , Levy Alejandro G. , Lam Derek , Licameli Greg R. , Long Steve , Lott David G. , Manrique Dayse , McMurray James Scott , Meister Kara D. , Messner Anna H. , Mohr Michael , Mudd Pamela , Mortelliti Anthony J. , Novakovic Daniel , Ongkasuwan Julian , Peer Shazia , Piersiala Krysztof , Prager Jeremy D. , Pransky Seth M. , Preciado Diego , Raynor Tiffany , Rinkel Rico N. P. M. , Rodriguez Hugo , Rodríguez Verónica P. , Russell John , Scatolini María Laura , Scheffler Patrick , Smith David F. , Smith Lee P. , Smith Marshall E. , Smith Richard J. H. , Sorom Abraham , Steinberg Amalia , Stith John A. , Thompson Dana , Thompson Jerome W. , Varela Patricio , White David R. , Wineland Andre M. , Yang Christina J. , Zdanski Carlton J. , Derkay Craig S. 
Published: January 2021

Objectives/Hypothesis

The purpose of this study is to develop consensus on key points that would support the use of systemic bevacizumab for the treatment of recurrent respiratory papillomatosis (RRP), and to provide preliminary guidance surrounding the use of this treatment modality.

Study Design

Delphi method‐based survey series.

Methods

A multidisciplinary, multi‐institutional panel of physicians with experience using systemic bevacizumab for the treatment of RRP was established. The Delphi method was used to identify and obtain consensus on characteristics associated with systemic bevacizumab use across five domains: 1) patient characteristics; 2) disease characteristics; 3) treating center characteristics; 4) prior treatment characteristics; and 5) prior work‐up.

Results

The international panel was composed of 70 experts from 12 countries, representing pediatric and adult otolaryngology, hematology/oncology, infectious diseases, pediatric surgery, family medicine, and epidemiology. A total of 189 items were identified, of which consensus was achieved on Patient Characteristics (9), Disease Characteristics (10), Treatment Center Characteristics (22), and Prior Workup Characteristics (18).

Conclusion

This consensus statement provides a useful starting point for clinicians and centers hoping to offer systemic bevacizumab for RRP and may serve as a framework to assess the components of practices and centers currently using this therapy. We hope to provide a strategy to offer the treatment and also to provide a springboard for bevacizumab's use in combination with other RRP treatment protocols. Standardized delivery systems may facilitate research efforts and provide dosing regimens to help shape best‐practice applications of systemic bevacizumab for patients with early‐onset or less‐severe disease phenotypes.

Level of Evidence

5 Laryngoscope, 131:E1941–E1949, 2021