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Intralesional cidofovir for recurrent respiratory papillomatosis in children
S M Pransky1, A E Magit, D B Kearns
1Pediatric Otolaryngology, Children's Hospital and Health Center, San Diego, Calif 92123, USA.
Insights
Intralesional cidofovir shows promise for treating severe pediatric respiratory papillomatosis. Four of five patients responded well, with one becoming disease-free, suggesting a potential new treatment option.
Area of Science:
- Virology
- Pediatric Otolaryngology
- Oncology
Background:
- Recurrent respiratory papillomatosis (RRP) is a rare, chronic disease caused by human papillomavirus (HPV).
- Severe RRP in pediatric patients poses significant challenges, often requiring frequent surgical interventions like laser ablation.
- Limited effective treatment options exist for severe, refractory cases of pediatric RRP.
Purpose of the Study:
- To evaluate the efficacy and safety of intralesional cidofovir as an adjunctive therapy for severe pediatric respiratory papillomatosis.
- To determine if cidofovir can reduce the frequency of surgical interventions and improve airway patency in affected children.
Main Methods:
- A prospective case series involving five pediatric patients with severe RRP.
- Patients received intralesional cidofovir injections combined with mechanical debulking and CO2 laser therapy.
- Papilloma stage and need for laryngoscopies were monitored serially.
Main Results:
- Four out of five patients demonstrated a significant positive response to cidofovir therapy at 9-month follow-up.
- One patient achieved complete disease remission, while three showed dramatic improvement.
- One patient experienced a possible improvement related to concurrent interferon therapy.
Conclusions:
- Intralesional cidofovir appears to be a beneficial treatment for severe pediatric respiratory papillomatosis.
- Further large-scale prospective studies with extended follow-up are necessary to establish cidofovir as a standard management option for RRP.
Objective:
To assess the potential benefit of intralesional administration of cidofovir, an acyclic nucleoside phosphonate with activity against several DNA viruses, for treating severe respiratory papillomas in pediatric patients.
Design:
Prospective case series.
Setting:
Tertiary care children's hospitals.
Patients:
Five pediatric patients with severe recurrent respiratory papillomatosis requiring laryngoscopy with carbon dioxide laser therapy more frequently than once a month to maintain airway patency. Each patient underwent between 12 and 33 laryngoscopies with laser treatment prior to being injected with cidofovir.
Intervention:
Microsuspension laryngoscopy with intralesional injection of cidofovir (Vistide) in conjunction with mechanical debulking and carbon dioxide laser of papillomas.
Main Outcome Measure:
Papilloma stage at time of serial laryngoscopies.
Results:
One patient was disease free and 3 patients demonstrated a dramatic response to adjuvant therapy with cidofovir at the 9-month follow-up visit after the last injection of cidofovir. One patient showed an improvement in papilloma stage that was possibly related to concurrent therapy with interferon.
Conclusions:
Intralesional injection of cidofovir seems to be of benefit in the treatment of severe respiratory papillomatosis in pediatric patients. Larger prospective studies with longer follow-up will be required before cidofovir can be considered an accepted means of managing this difficult disease.
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