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.