Systemic Bevacizumab for Treatment of Respiratory Papillomatosis: International Consensus Statement

Douglas R. Sidell, Karthik Balakrishnan, Simon R. Best, Karen Zur, Julia Buckingham, Alessandro De Alarcon, Fuad M. Baroody, Jonathan M. Bock, Emily F. Boss, Charles M. Bower, Paolo Campisi, Sharon F. Chen, Jeffrey M. Clarke, Kevin D. Clarke, Alejandro Cocciaglia, Robin T. Cotton, Giselle Cuestas, Kara L. Davis, Victor H. DeFago, Frederik G. DikkersInes Dossans, Walter Florez, Elizabeth Fox, Aaron D. Friedman, Nazaneen Grant, Osama Hamdi, Norman D. Hogikyan, Kaalan Johnson, Liane B. Johnson, Romaine F. Johnson, Peggy Kelly, Adam M. Klein, Claire M. Lawlor, Nicolas Leboulanger, Alejandro G. Levy, Derek Lam, Greg R. Licameli, Steve Long, David G. Lott, Dayse Manrique, James Scott McMurray, Kara D. Meister, Anna H. Messner, Michael Mohr, Pamela Mudd, Anthony J. Mortelliti, Daniel Novakovic, Julian Ongkasuwan, Shazia Peer, Krysztof Piersiala, Jeremy D. Prager, Seth M. Pransky, Diego Preciado, Tiffany Raynor, Rico N.P.M. Rinkel, Hugo Rodriguez, Verónica P. Rodríguez, John Russell, María Laura Scatolini, Patrick Scheffler, David F. Smith, Lee P. Smith, Marshall E. Smith, Richard J.H. Smith, Abraham Sorom, Amalia Steinberg, John A. Stith, Dana Thompson, Jerome W. Thompson, Patricio Varela, David R. White, Andre M. Wineland, Christina J. Yang, Carlton J. Zdanski, Craig S. Derkay

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)E1941-E1949
Issue number6
StatePublished - Jun 2021


  • Avastin
  • Systemic bevacizumab
  • consensus

ASJC Scopus subject areas

  • Otorhinolaryngology


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