Patient 1
Ten-year-old male who presented at 11 months of age with dyspnea, snoring and apneas. Laryngoscopy revealed extensive papilloma involving the supraglottis, glottis, and proximal trachea. Pathology confirmed papilloma with changes consistent with HPV effect. The patient underwent 75 surgical debridement procedures by 10 years of age with an average of 6.6 weeks between procedures. Six injections of intralesional cidofovir were tried without significant improvement.
Intravenous bevacizumab 10mg/kg every 4 weeks was started in February 2019. The interval between treatments was four weeks between cycles 1-6, and was gradually increased to eight weeks from cycle 11 onwards. The patient has received 12 cycles so far. Voice quality improved after the first cycle with significant improvement reported after cycle 6. Laryngoscopy performed after 3 and 6 cycles showed minimal disease (Fig. 1). The only side effect observed was asymptomatic proteinuria which has remained stable since baseline examination.