Systemic Bevacizumab for Treatment of Respiratory Papillomatosis: International Consensus Statement


Douglas R. Sidell, Stanford University School of Medicine
Karthik Balakrishnan, Stanford University School of Medicine
Simon R. Best, Johns Hopkins School of Medicine
Karen Zur, University of Pennsylvania Perelman School of Medicine
Julia Buckingham, Stanford University School of Medicine
Alessandro De Alarcon, University of Cincinnati College of Medicine
Fuad M. Baroody, The University of Chicago Medicine
Jonathan M. Bock, Medical College of Wisconsin
Emily F. Boss, Johns Hopkins School of Medicine
Charles M. Bower, University of Arkansas for Medical Sciences
Paolo Campisi, Hospital for Sick Children University of Toronto
Sharon F. Chen, Lucille Packard Children's Hospital
Jeffrey M. Clarke, Duke Cancer Institute
Kevin D. Clarke, The University of British Columbia
Alejandro Cocciaglia, J.P. Garrahan Children's Hospital
Robin T. Cotton, University of Cincinnati College of Medicine
Giselle Cuestas, Hospital General de Niños Pedro de Elizalde
Kara L. Davis, Stanford University School of Medicine
Victor H. DeFago, Sanatorio del Salvador
Frederik G. Dikkers, Universiteit van Amsterdam
Ines Dossans, Centro Hospitalario Pereira Rossell
Walter Florez, Instituto Nacional de Salud del Niño San Borja
Elizabeth Fox, St. Jude Children's Research Hospital
Aaron D. Friedman, University of Cincinnati College of Medicine
Nazaneen Grant, MedStar Georgetown University Hospital
Osama Hamdi, Howard University College of Medicine
Norman D. Hogikyan, University of Michigan Medical School
Kaalan Johnson, University of Washington School of Medicine
Liane B. Johnson, Dalhousie University
Romaine F. Johnson, UT Southwestern Medical Center
Peggy Kelly, The Children's Hospital, Aurora
Adam M. Klein, Emory University School of Medicine
Claire M. Lawlor, The George Washington University School of Medicine and Health Sciences
Nicolas Leboulanger, Université de Paris

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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.

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