Journal of voice : official journal of the Voice Foundation · 2026
The Efficacy and Safety of Systemic Treatment for Managing Recurrent Respiratory Papillomatosis: A Systematic Review and Meta-analysis.
СтатьяНазвание и аннотация: Перевод в очереди
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Baali Mohammed H, Neazy Abdulaziz A, Altalhi Wahaj A, Almansour Sara A, Almohizea Mohammed I, Bukhari Manal A
Аннотация
PURPOSE: Surgical treatment remains the cornerstone of recurrent respiratory papillomatosis (RRP) management; however, aggressive disease often requires frequent procedures with cumulative morbidity. Contemporary systemic options now include systemic bevacizumab and human papillomavirus (HPV)-specific immunotherapies, with immune checkpoint inhibition under investigation. We systematically reviewed the efficacy and safety of systemic therapies for juvenile- and adult-onset RRP, emphasizing current clinician-relevant treatment options.
METHODS: We comprehensively searched PubMed, Scopus, Web of Science, and the Cochrane Library from inception until January 2026. The included studies evaluated any available systemic treatment for managing adult or juvenile-onset RRP. The main outcomes were complete remission, partial response, and adverse events. All the data analyses were performed using STATA 18 BE.
RESULTS: We included 35 studies comprising 925 patients. In juvenile-onset RRP, pooled complete remission with systemic bevacizumab was 60% (95% CI 34-87%), and pooled partial response was 46% (95% CI 21-71%). In adult-onset RRP, pooled complete remission with systemic bevacizumab was 44% (95% CI 26-62%), and pooled partial response was 61% (95% CI 43-79%). The most frequently reported bevacizumab adverse events were hypertension (40%), proteinuria (26%), and epistaxis (22%). HPV-specific immunotherapies (including FDA-approved zopapogene imadenovec-drba [Papzimeos; PRGN-2012] for adults and investigational INO-3107) and PD-1/PD-L1-directed therapies demonstrated encouraging early-phase activity but were too heterogeneous for quantitative pooling.
CONCLUSION: Systemic bevacizumab remains the most mature systemic option with consistent real-world evidence and published dosing guidance. HPV-specific immunotherapy has recently transformed adult RRP management with an FDA-approved, short-course treatment option; ongoing studies will clarify optimal sequencing with bevacizumab and the role of checkpoint inhibition.
METHODS: We comprehensively searched PubMed, Scopus, Web of Science, and the Cochrane Library from inception until January 2026. The included studies evaluated any available systemic treatment for managing adult or juvenile-onset RRP. The main outcomes were complete remission, partial response, and adverse events. All the data analyses were performed using STATA 18 BE.
RESULTS: We included 35 studies comprising 925 patients. In juvenile-onset RRP, pooled complete remission with systemic bevacizumab was 60% (95% CI 34-87%), and pooled partial response was 46% (95% CI 21-71%). In adult-onset RRP, pooled complete remission with systemic bevacizumab was 44% (95% CI 26-62%), and pooled partial response was 61% (95% CI 43-79%). The most frequently reported bevacizumab adverse events were hypertension (40%), proteinuria (26%), and epistaxis (22%). HPV-specific immunotherapies (including FDA-approved zopapogene imadenovec-drba [Papzimeos; PRGN-2012] for adults and investigational INO-3107) and PD-1/PD-L1-directed therapies demonstrated encouraging early-phase activity but were too heterogeneous for quantitative pooling.
CONCLUSION: Systemic bevacizumab remains the most mature systemic option with consistent real-world evidence and published dosing guidance. HPV-specific immunotherapy has recently transformed adult RRP management with an FDA-approved, short-course treatment option; ongoing studies will clarify optimal sequencing with bevacizumab and the role of checkpoint inhibition.