Gefitinib therapy for life-threatening laryngeal papillomatosis

Respiratory papillomatosis is a potentially life-threatening condition that is caused by a human papillomavirus infection of the respiratory epithelium.^1,2 Patients whose condition is diagnosed at a younger age are at high risk for recurrent aggressive disease.³ The primary management approach focuses on the removal of the papillomas by surgical debulking, although persistence of the human papillomavirus genome with subsequent recurrence of disease are the typical outcome. In a minority of patients, surgical management must be supplemented with adjuvant medical therapy, with interferon being the best studied and most commonly used. Other adjuvant treatments include photodynamic therapy, indole-3-carbinol, mumps immunization, ribavirin, and cidofovir.⁴ Large controlled trials are lacking for all such treatments other than interferon, making it extremely difficult to assess clinical benefit and risk in a systematic fashion at the current time. As with surgical management, viral persistence occurs after treatment with these adjuvant modalities, further contributing to the challenge of treating patients who have this potentially devastating disease. Because epidermal growth factor receptor (EGFR) is expressed in laryngeal papillomas, we elected to try an EGFR tyrosine kinase inhibitor in a patient with end-stage disease in whom other therapies had failed.⁵.