Cidofovir: to use or not to use?

Cidofovir is an antiviral agent that has been used increasingly in the last decade as an adjuvant therapy for recurrent respiratory papillomatosis. It has been used in patients with moderate to severe recurrent respiratory papillomatosis requiring frequent surgical intervention or if there is evidence of distal spread. Intralesional administration after surgical debulking delivers the medication directly to the site of disease and is thought to have fewer systemic side effects than intravenous infusion. This review examines recent publications for evidence of safety and efficacy. Despite its growing popularity, the potential risks related to cidofovir use in recurrent respiratory papillomatosis have not been well documented. It is known to be nephrotoxic when administered intravenously and there remains concern that cidofovir has carcinogenic potential based on animal studies (mammary adenocarcinoma in rats). A review of the literature reveals no randomized controlled trials, one case-control study, multiple case series and case reports only. Study populations are small, however complete response rates have consistently been reported in approximately 60%. Based on current opinion and research, it is likely that intralesional cidofovir will continue to have a role in the management of moderate to severe recurrent respiratory papillomatosis. Further studies are required to assess long-term outcomes.