At the Spring 2001 meehttp://ting of the American Society of Pediatric Otolaryngology (ASPO), Dr. Nigel Pashley presented results of his protocol for intralesional injections of the mumps vaccine to treat RRP. His reports of success coupled with anecdotal reports of success from RRP patients and parents are encouraging and justify this therapy as a credible adjunct treatment for RRP.

N, Pahley, 2001. Can Mumps Vaccine Induce Remission in Recurrent Respiratory Papilloma?

Reports from issues of the RRP Newsletter:

Remission attributed to mumps vaccine - [ from "Remission News" RRP Newsletter Spring 1999]

Thirty-two year old Joe from Ohio, has not had a recurrence of respiratory papillomas since May 1997. He was diagnosed in September of
1994 and was having surgery about every 3-4 weeks for a period of time after that. Joe tried I3C and also PDT with no response. In April of
1997 he traveled to Denver, Colorado to have a mumps vaccine treatment from Dr. Nigel Pashley . He had a second treatment in May of 1997

and has been in remission ever since.

Mumps Vaccine- an Update [ from RRP Newsletter Spring 1998]

The RRPF continues to follow the mumps vaccine as an adjunct treatment for RRP. The therapy involves local injections of the mumps vaccine into the site of the papilloma after laser removal of the papilloma (see details of the protocol developed by Dr. Nigel Pashley in the Fall 1996 RRPF Newsletter). To date, a controlled study has not been conducted on this protocol, so this report is based on anecdotal information provided by doctors and patients.
The spring 1997 RRPF Newsletter reported that Dr. Pashley had injected 13 patients with the mumps vaccine and 9 patients had a complete response. Since the Spring 1997 newsletter, the total number of patients injected has increased to 19 with a response rate of 11 patients. As noted in prior RRPF Newsletters, the protocol is for laser removal of the papillomas and then an injection of the mumps vaccine into the site of the removed papillomas. Each time the patient returns for laser removal, the site of the removed papillomas is re-vaccinated and, generally, within 3-4 injections, a change is noted in the size of the papilloma and the rate of recurrence. Since a number of injections can be required (generally 3-4) to induce change, it raises questions as to the classification of the newly treated patients. We do not know if they are non-responders or, if in each individual case, they have not received enough of the vaccine to induce the desired changes. While this treatment is encouraging, we are also aware of one patient in the above group who has received a number of treatments and no change has been noted.

The RRPF will continue to follow this protocol and invites other practitioners and patients to report their experiences to us.



Mumps Vaccine Therapy for RRP - an Update [ from RRP Newsletter Spring 1997]

                                               by 

                                      Bill Stern and Chris Neuberger

The RRPF continues to follow the mumps vaccine as an adjunct treatment for RRP. The therapy involves local injection of the mumps
vaccine into the larynx after laser removal of papilloma. (Details of the protocol developed by Dr. Nigel Pashley may be found in the Fall 96
Newsletter issue.) To date there has been no carefully controlled study or clinical trial, so this report is based on anecdotal information provided
to us by several doctors and patients.

Dr. Pashley has had the most experience by far among RRP practitioners. To date he has injected 13 patients with the mumps vaccine and
claims that 9 patients have had a complete response and a partial response in another patient. We did have an opportunity to talk with the
patient who has had a partial response. He has had four treatments and at each successive mumps vaccine treatment thus far fewer papilloma
have been found. In an attempt to better understand how the mumps vaccine works, Dr. Pashley has been collecting a history of tissue
specimens from his patients. In collaboration with a pathologist, they are looking for markers in the tissue samples that would indicate a level
of local immune response. Dr. Pashley encourages other doctors who try this therapy to also keep a tissue sample history of their RRP
patients. 

Mumps Vaccine Therapy for RRP - an Update [ from RRP Newsletter Fall 1996]

 by Bill Stern

The Spring 96 issue of the RRP Newsletter suggested the possibility that mumps vaccine might help to slow (or stop) the growth of
respiratory papilloma. This was based on anecdotal information obtained from Dr. Nigel Pashley and mothers of two of his patients.

Dr. Pashley has kindly provided the RRPF with details of his mumps vaccine/surgical protocol. We quote him as follows:

"The way we have applied this is to remove the papillomas with a laser and remove as many papillomas as is possible without risking
scarring in the anterior part of the larynx. Once the papillomas are removed, we inject Mumpsvax, which comes as a vial of powdered material.
This is reconstituted by mixing the powder with 2 cc of normal saline. We then draw this mixture into a 3 cc syringe using a laryngeal
injection needle (purchased from the Pilling Company). We fill the needle (which takes about 1 cc) and then inject into the base of the
papilloma areas as much Mumpsvax as can be tolerated, without creating undue airway obstruction. In a child of about 5 years old, this would
be approximately 1/2 to 1 cc total injected on both sides.

We have also injected the areas where papillomas have been deliberately left in place. Each time the patient returns for laser surgery, this
treatment has been applied and usually within 3-4 injections, we see a dramatic change, not only in the size of the papilloma, but also in their
rate of recurrence."

Thus far Dr. Pashley has treated nine RRP patients and seven of them are in "remission". Of the seven in remission, one patient responded
after only a single injection, while the remainder have required up to five injections. The two who are not in remission have shown some
partial response with an approximate doubling of their surgical intervals.

Dr. Pashley's protocol is now being tried by at least one other surgeon (Dr. Parson's at the University of Missouri).  

Can Mumps Vaccine be used therapeutically for RRP? [ from RRP Newsletter Spring 1996]

by Bill Stern

Late last year I was contacted by a member of our support network, Lisa Talve, to tell me of a
dramatic improvement in her daughter (Talia) since she had received mumps vaccine therapeutically
for her RRP. I made a note of this, but did not investigate any further until recently, when the
mother of a second RRP patient called with a similar account. A recent update on Talia Talve
indicates that she had approximately 30 surgeries between ages 2 and 4 1/2, with the longest
interval between any surgery being 7 weeks. She had been treated with the mumps vaccine during
the past year and now at age 5 1/2 appears clear of respiratory papillomas as determined by two direct 
laryngoscopes in the past three months. 

These phone calls motivated me to contact their treating Otolaryngologist, Dr. Nigel Pashley. Dr.
Pashley indicated that he first heard of using mumps vaccine to treat RRP during a presentation at
an Otolaryngology meeting in the early 80s. He doesn't believe that there is any published article on
this therapy. (I also could not find any references involving mumps vaccine for papillomas via a
medline search back to 1966.) 

He first tried this therapy in 1983 on a girl with fairly aggressive RRP. His approach was to remove
the papillomas and then inject the vaccine locally into the sites where the papilloma growths
previously had been. In this case he administered the vaccine only once. Following treatment the
interval between surgeries extended until the patient went into a remission. He lost contact with this
patient for 3 years after the vaccination was applied, but he does know that she has been disease
free for at least the last 4 years. 

In recent years Dr. Pashley has used the vaccine more regularly. He has given this vaccine to seven
juvenile RRP patients, who had regular recurrence intervals ranging from 2 to 6 weeks. His
approach in these cases has again been to inject the vaccine locally following excision of
papillomas, but now he is re-vaccinating each time the patient returns until no new growths appear.
Six of the seven cases are now in some stage of "remission" or at least a no new growth status and
the seventh case has seen the interval between surgeries more than double. 

Dr. Pashley is cautiously optimistic about this RRP treatment approach. He readily admits that his
methodology here would not nearly satisfy rigorous, controlled scientific research standards.
However, these anecdotal successes are highly suggestive of some real cause and effect. Since all
of his patients should have mumps virus antigens as per early childhood inoculations, one might
speculate that introduction of a new mumps vaccine booster shot in the larynx could trigger some
locally elevated inflammatory response which, in a non-specific fashion, may suppress HPV
reactivation during the process of healing from surgery. 

Dr. Pashley is happy to discuss his work with other RRP practitioners and RRP researchers. He can
be contacted at: 

Nigel Pashley, MD
1601 East 19th Ave.
Suite 5500
Denver, CO 80218
phone: (303) 839-7900
fax: (303) 839-7930 


last updated on 09-09-2001