Recurrent Respiratory Papillomatosis Foundation Position Statement on the Management of Adults With RRP

Area of Science:

• Otolaryngology
• Immunology
• Oncology

Background:

• Recurrent respiratory papillomatosis (RRP) is a rare disease caused by human papillomavirus (HPV).
• Current management often involves repeated surgical debulking, carrying significant risks.
• Advances in HPV-specific immunotherapy and systemic bevacizumab necessitate updated treatment guidelines.

Purpose of the Study:

• To propose a contemporary management algorithm for adult RRP patients.
• To incorporate newly approved HPV-specific immunotherapy and systemic bevacizumab into RRP treatment strategies.
• To provide a resource for physicians and patients considering RRP management options.

Main Methods:

• Development of a management algorithm by RRP Foundation Key Opinion Leaders.
• Consideration of published literature and commercial availability of treatments.
• Case-by-case deliberation of risks and benefits for procedural versus medical management.

Main Results:

• Preventative HPV vaccination is recommended for all patients.
• HPV typing and pulmonary imaging are crucial for decision-making.
• HPV-specific immunotherapy is the recommended first-line medical treatment for durable disease control.
• Systemic bevacizumab is the recommended second-line medical treatment for patients not responding to immunotherapy.
• Adjuvant therapies may be considered for patients undergoing debulking procedures.

Conclusions:

• The proposed algorithm offers a contemporary guide for adult RRP management.
• It emphasizes a personalized approach, balancing procedural and medical interventions.
• The algorithm aims to optimize outcomes and patient care in RRP treatment.