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.