Patient 2
Five-year-old male who presented at 3 years of age with hoarseness,
stridor, and snoring since infancy. Laryngoscopy showed presence of
bulky supraglottic and glottis papilloma. He underwent 15 debridement
procedures every 8.6 weeks before initiation of systemic bevacizumab. He
received four intralesional bevacizumab injections without significant
improvement.
Intravenous bevacizumab 10 mg/kg was started in July 2018. Infusions
were given every four weeks during cycles 1-4, with a gradual increase
to eight-week intervals between cycles 7-9, and every 12 weeks from
cycle 9 onward. Patient has received 13 cycles so far. Laryngoscopy
performed during the first 11 cycles showed minimal or no papilloma
(Fig. 2). Formal speech evaluation after five cycles showed improvement
in voice. Self-limited epistaxis attributed to allergic rhinitis was the
only side effect reported. No abnormalities in growth plate was noted in
X ray knee obtained after 11 cycles. Eight weeks after receiving cycle
11 bevacizumab, patient developed worsening voice quality. Flexible
nasolaryngoscopy showed recurrence of papillomas and decision was made
to resume bevacizumab at 8-week intervals.