The Cidofovir Controversy
Recurrent respiratory papillomatosis (RRP) is a disease of viral etiology and is caused by the human papilloma virus (HPV). Although it is a benign disease process, there are very serious sequelae because of its involvement in the tracheobronchial tree. Multiple treatment modalities have emerged to control aerodigestive tract proliferation, ranging from surgery to immunomodulating medications, including antiviral drugs such as cidofovir. Cidofovir is an adjunct therapy employed as an intralesional injection. While cidofovir has historically been employed without long-term consequences, there are concerns associated with its use as a papilloma treatment, including potential malignant transformation of lesions, renal failure, and neutropenia. This chapter will focus on the benefits and risks of employing cidofovir in the RRP patient population as well as suggested treatment algorithms. A summary table of clinical reports of other adjuvant therapies is provided as an appendix at the end of the chapter.
KeywordsRecurrent respiratory papillomatosis (RRP) Cidofovir Human papilloma virus (HPV)
- Avramov T, Vetckova E, Nikolova M, Valev D, Manolova A, Tafradgiiska M, Kostadinov D, Tchalacov I. Therapeutic approaches to the treatment of recurrent respiratory papillomatosis of the aerodigestive tract (a clinical study). Biotechnol Biotechnol Equip. 2014;28(4):668–73.CrossRefPubMedPubMedCentralGoogle Scholar
- CDC. National, regional, state, and selected local area vaccination coverage among adolescents aged 13–17 years—United States, 2014. 2015.Google Scholar
- Chadha NK, James A. Adjuvant antiviral therapy for recurrent respiratory papillomatosis [review]. Cochrane Database Syst Rev. 2010;1:cd005053.Google Scholar
- FDA Regulatory Information. “Off-label” and investigational use of marketed drugs, biologics, and medical devices - information sheet, 25 Jan 2016, http://www.fda.gov/RegulatoryInformation/Guidances/ucm126486.htm .
- Food and Drug Administration. FDA Approves Cidofovir for AIDS-Related Retinitis, 1996., https://aidsinfo.nih.gov/news/276/fda-approves-cidofovir-for-aids-related-retinitis.
- Gilead Sciences. Cidofovir Injection Safety Data Sheet, n.d.., http://www.gilead.com/~/media/files/pdfs/medicines/other/vistide/vistide.pdf.
- Gron AL. Malignant degeneration in laryngeal Papillomatosis. Ugeskr Laeger. 2011;173:5067.Google Scholar
- Hermann JS, Weckx LY, Monteiro Nurmberger J, Santos Junior GF, Campos Pignatari AC, Nagata Pignatari SS. Effectiveness of the human papillomavirus (types 6, 11, 16, and 18) vaccine in the treatment of children with recurrent respiratory papillomatosis. Int J Pediatr Otorhinolaryngol. 2016;83:94–8.CrossRefPubMedGoogle Scholar
- Lawrie TA, Nordin A, Chakrabarti M, Bryant A, Kaushik S, Pepas L. Medical and surgical interventions for the treatment of usual-type vulval intraepithelial neoplasia. Cochrane Database Syst Rev. 2016;1 doi: 10.1002/14651858.CD011837.pub2.
- Lindsay F, Bloom D, Pransky S, et al. Histologic review of Cidofovir-treated recurrent respiratory papillomatosis. Ann Otol Rhinol Laryngol. 2008;117:113–7.Google Scholar
- Mohr M, Schliemann C, Biermann C, Schmidt L, Kessler T, Schmidt J, Wiebe K, Muller K, Hoffmann TK, Groll AH, Werner C, Kessler C, Wiewrodt R, Rudack C, Berdel WE. Rapid response to systemic bevacizumab therapy in recurrent respiratory papillomatosis. Oncol Lett. 2014;8:1912–8.PubMedPubMedCentralGoogle Scholar
- Nodarse-Cuni H, Iznaga-Marin N, Viera-Alvarez D, Rodriguez-Gomez H, Fernandez-Fernandez H, Blanco-Lopez Y, Viada-Gonzalez C, Lopez-Saura P. Cuban Group for the Study of Interferon in Recurrent Respiratory Papillomatosis. Interferon alpha-2b as adjuvant treatment of recurrent respiratory papillomatosis in Cuba: National Programme (1994–1999 report). J Laryngol Otol. 2004;118(9):681–7.CrossRefPubMedGoogle Scholar
- Zeitels SM, Barbu AM, Landau-Zemer T, Lopez-Guerra G, Burns JA, Friedman AD, Freeman MW, Halvorsen YD, Hillman RE. Local injection of bevacizumab (Avastin) and angiolytic KTP laser treatment of recurrent respiratory papillomatosis of the vocal folds: a prospective study. Ann Otol Rhinol Laryngol. 2011;120(10):627–34.CrossRefPubMedGoogle Scholar