Introduction
Recurrent respiratory papillomatosis (RRP), a viral disease caused by
human papillomavirus (HPV) serotypes 6 and 11, is the most common benign
pediatric laryngeal neoplasm and is characterized by recurrent
proliferation of squamous papillomas within the
airway.1 The disease is commonly progressive with age
at diagnosis <5 years associated with aggressive
disease.2 There is no cure, and the recurrent nature
has a significant negative impact on quality of life due to voice
disturbance and airway obstruction. Surgery remains the standard of
care, though up to 20% of patients require adjuvant medical therapy due
to having more than four surgeries per year, rapid regrowth of
papillomas with airway compromise, or distal multisite spread of
disease.1
Bevacizumab (Avastin, Genentech, San Francisco, CA) and its biosimilar
bevacizumab-awwb (Mvasi, Amgen) are recombinant humanized monoclonal
antibodies that target vascular endothelial growth factor (VEGF) to
inhibit angiogenesis. Despite well-established clinical efficacy in
adult oncology, bevacizumab use remains limited in
pediatrics.3,4 Intralesional bevacizumab injections
show inconsistent results with limited efficacy in multifocal
disease.5-8 Recently, systemic bevacizumab has shown
promise in advanced, treatment-resistant
papillomatosis.8-13 However, questions remain
regarding best protocols. Here, we describe the long-term use of IV
bevacizumab for severe RRP among two pediatric patients.