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.