Systemic Bevacizumab Therapy in Recurrent Respiratory Papillomatosis: First Preliminary Study From Azerbaijan

Objective: To report the first clinical experience from Azerbaijan using systemic bevacizumab therapy for the treatment of recurrent respiratory papillomatosis (RRP) and to evaluate its efficacy in reducing recurrence and surgical burden in both pediatric and adult patients. Methods: A retrospective case series of five patients (four pediatric, one adult) with confirmed RRP treated at a single institution. All patients had a history of multiple surgical interventions and were considered candidates for adjuvant systemic therapy. A single intravenous dose of bevacizumab (5-10 mg/kg) was administered, and patients were followed clinically and endoscopically to assess remission duration and recurrence. Results: All patients achieved prolonged remission following a single intravenous dose of bevacizumab. Pediatric patients experienced remission periods ranging from 8 to 24 months, with one child remaining recurrence-free for over 2 years. The adult patient, with severe tracheobronchial involvement and a history of 112 surgeries, achieved a 6-month remission-the longest interval between interventions in over a decade. No adverse drug-related events were reported. In this small series, a single bevacizumab dose was associated with prolonged remission intervals; however, these findings should be interpreted cautiously and viewed as hypothesis-generating. Conclusion: Systemic bevacizumab may be a promising adjuvant option for selected patients with severe RRP, as it was associated with longer interventional-free intervals in this retrospective patient series. Definitive conclusions regarding efficacy and surgical burden reduction require prospective studies with standardized severity measures and comparator groups. This first reported clinical experience from Azerbaijan contributes valuable real-world data to the emerging global evidence base supporting anti-VEGF therapy in RRP. Larger prospective studies are needed to establish optimal dosing regimens and long-term outcomes.