Patient 3
Eight-year-old female who was diagnosed with RRP at eight months of age. Before starting IV bevacizumab the patient underwent 35 procedures at our institution on average every 8.2 weeks. She developed worsening hoarseness and stridor prior to debridement procedures. The papilloma burden affected patient’s activities of daily living due to dyspnea with exercise, snoring and mockery at school. She underwent four intralesional bevacizumab injections without significant improvement.
Patient started 10mg/kg IV bevacizumab in October of 2018. Interval between cycles was four weeks between cycles 1-4 and gradually increased to every 8 weeks by cycle 10. Parents noted improvement in voice and exercise tolerance after one cycle. Laryngoscopy examinations after starting bevacizumab showed small or no papillomas. After eight cycles, speech evaluation showed moderate symptoms of vocal disruption including a rough, raspy voice without impact on function, with parents reporting voice as being at its best. Only side effects reported was self-resolving epistaxis after the first cycle.