Case Report 2
A 7-year-old girl who presented at 18 months of age with hoarseness
since birth was diagnosed with RRP (HPV serotype 11). She required 30
surgeries for aggressive laryngeal recurrence by 6 years of age,
averaging 2-3 months between procedures. She failed adjuvant medical
therapies including recombinant HPV vaccine (types 6, 11, 16, 18), six
intralesional modified vaccinia Ankara E2 virus vaccine injections, and
four intralesional bevacizumab injections. Given the need for frequent
procedures, systemic bevacizumab-awwb treatment was planned under the
supervision of pediatric oncology. Direct laryngoscopy prior to first
bevacizumab cycle showed extensive papillomas along the left true cord,
ventricle, and false cord extending to the laryngeal surface of the
epiglottis (Panel B). There was no tracheal extension, and a chest CT
scan showed no pulmonary disease. In February 2021, the patient
presented for surgical debridement and, five days later, underwent her
first systemic bevacizumab-awwb infusion of 10 mg/kg, ultimately
receiving four cycles every three weeks. After cycle one, the patient
had significant improvement in voice and breathing. Direct laryngoscopy
after cycle four showed no evidence of laryngeal papillomas and a scar
band in the posterior glottis (Panel B). Subsequently, time between
infusions was increased as in Case 1. The only side effect was trace
proteinuria that resolved after cycle one. As of May 2022, the patient
completed her final 9-week interval cycle and remains asymptomatic with
last surgery in February 2021. Her infusions will be spaced to 12 weeks
apart beginning June 2022 with plans to continue spacing per Case 1.