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Recurrent Respiratory Papillomatosis: Frontiers
Much progress is being made as the medical clinical and research communities continue to seek better treatment options for RRP. Some of the remaining challenges in understanding and treating RRP are summarized below.
Why is there such a tremendous variability in how RRP affects different patients?
Some patients suffer from aggressive papilloma growth, resulting in extreme voice disorders and frequent surgeries over many years. Others experience spontaneous remissions after only a few surgeries. It is unknown what makes these cases different.
Why do some patients respond to some therapies and yet others – often the aggressive cases with distal respiratory involvement – are unresponsive?
Perhaps one of the greatest RRP therapeutic frustrations is the lack of any effective method of treating patients with pulmonary papillomas. This represents a significant challenge to the RRP clinical research community.
Why is RRP disease expression so low, despite much higher estimates of human papilloma virus ( HPV) infection? Approximately 5 of 100 Americans may have HPV-positive, normal laryngeal tissues, but the prevalence of RRP is estimated to be less than 5 in 100,000 Americans. This raises the question as to whether some people are more susceptible to RRP, possibly due to differences in their immune systems.
Can juvenile-onset RRP be prevented?
Children born to HPV-positive mothers are at risk of developing juvenile onset RRP. Although the risk of transmission from mother to child is small, it appears to increase significantly when genital warts are present during pregnancy and if the child is the first born, is delivered vaginally, and the maternal age is under 20.
A prospective study coupled with a cost-benefit analysis is needed so that the gynecological community will be able to provide better treatment options for expectant mothers with HPV.
What new drugs are being developed to treat RRP?
It is hoped that in the near future some new treatment aimed at boosting the immune system (immunotherapeutic treatment) to treat RRP will become available.
Despite slow progress and some disappointments, there have been some encouraging early results involving vaccines for HPV. In clinical trials, at least one HPV vaccine has shown encouraging effectiveness in treating patients with HPV-related anal dysplasia and HPV6/11 genital warts.
A clinical trial involving RRP patients is anticipated in the near future.
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