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.