Case Report 1
An 8-year-old boy who presented at 22 months of age with hoarseness
since birth was diagnosed with RRP (HPV serotype 6). He required 26
surgeries for aggressive laryngeal recurrence by 6 years of age,
averaging two months between procedures. He failed adjuvant medical
therapies including recombinant HPV vaccine (types 6, 11, 16, 18) and
nineteen intralesional bevacizumab injections. Given the subglottic
extension of disease despite 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 epiglottis, bilateral
aryepiglottic folds, and bilateral true and false cords with subglottic
extension (Panel A). There was no tracheal involvement, and a chest CT
scan showed no pulmonary disease. In June 2020, the patient underwent
his first intravenous bevacizumab-awwb infusion of 10 mg/kg, ultimately
receiving four cycles every three weeks. After cycle one, the patient
had significant improvement in voice. Direct laryngoscopy after cycle
three showed only few small papillomas on the laryngeal surface of the
epiglottis (Panel A). After cycle four, time between infusions was
increased by three weeks after each set of three cycles (i.e., 3 cycles
at 6-week intervals followed by 3 cycles at 9-week intervals followed by
3 cycles at 12-week intervals). The only side effect was a mild
stomachache that resolved after cycle one. As of May 2022, the patient
completed his final 12-week interval cycle and remains asymptomatic with
last surgery in July 2020. His infusions will be spaced to 3 cycles at
16-week intervals starting June 2022 before reaching a planned stable
infusion interval at every 6 months.