From the Research
In the UK, cidofovir is recommended as an adjuvant therapy for recurrent respiratory papillomatosis (RRP) when conventional surgical interventions have failed to control the disease, with a preferred regimen of intralesional injections at a concentration of 5 mg/ml, and doses ranging from 2-5 ml per session. This treatment approach is supported by the most recent and highest quality study available, which suggests that cidofovir can significantly reduce papilloma burden and extend intervals between surgical interventions 1.
Key Considerations for Cidofovir Treatment
- Treatment is usually administered every 2-4 weeks for initial treatments, with intervals potentially extending to 6-8 weeks based on clinical response 2.
- The total number of injections is generally limited to 6-8 sessions to minimize cumulative toxicity risks 3.
- Before initiating treatment, baseline renal function tests should be performed, as cidofovir can cause nephrotoxicity 4.
- Regular monitoring of renal function throughout the treatment course is essential 5.
- Patients should be informed about potential side effects including local inflammation, scarring, and the theoretical risk of malignant transformation 1.
Administration and Monitoring
- Cidofovir works by inhibiting viral DNA polymerase, thereby disrupting HPV replication in infected cells 2.
- This treatment should be administered by specialists experienced in managing RRP, typically within multidisciplinary teams at tertiary centers 1.
- The use of cidofovir in combination with other adjuvant therapies, such as bevacizumab, may also be considered in certain cases 4.
Evidence Base
The recommendation for cidofovir treatment in RRP is based on a review of the current literature, including studies published in reputable journals such as The Journal of Laryngology and Otology 1, The Laryngoscope 2, and Otolaryngologia polska 4. These studies provide evidence for the efficacy and safety of cidofovir in reducing papilloma burden and extending intervals between surgical interventions in patients with RRP.