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Objective: To provide detailed guidance on the administration of systemic bevacizumab in patients with recurrent respiratory papillomatosis (RRP) based on a detailed review of the scientific literature and a consensus of experts with real‐world clinical experience. Methods: A bevacizumab consensus working group (N = 10) was composed of adult and pediatric otolaryngologists, adult and pediatric oncologists, and a representative from the RRP Foundation (RRPF), all with experience administering systemic bevacizumab in patients with RRP. After extensive review of the medical literature, a modified Delphi method‐based survey series was utilized to establish consensus on the following key areas: clinical and patient characteristics ideal for treatment candidacy, patient perspective in treatment decisions, treatment access, initial dosing, monitoring, guidelines for tapering and discontinuation, and reintensifying therapy. Results: Seventy‐nine statements were identified across nine critical domains, and 45 reached consensus [clinical benefits of bevacizumab (3), patient and disease characteristics for treatment consideration (7), contraindications for treatment (3), shared decision‐making (incorporating the patient perspective) (5), treatment access (3), initial dosing and administration (8), monitoring (7), tapering and discontinuation (6), and reintensification (3)]. Conclusion: This consensus statement provides the necessary guidance for clinicians to initiate systemic administration of bevacizumab and represents a potential paradigm shift toward nonsurgical treatment options for patients with RRP. Level of Evidence: 5 Laryngoscope, 134:5041–5046, 2024 [ABSTRACT FROM AUTHOR]

Objectives: Pulmonary papillomatosis is a rare but severe manifestation of recurrent respiratory papillomatosis (RRP). Efficacy data of systemic bevacizumab for pulmonary RRP are limited. This study's objective was to characterize disease response of pulmonary RRP to systemic bevacizumab. Methods: A retrospective review was performed to identify patients with pulmonary RRP seen at three medical institutions. Clinical symptoms, CT findings, and disease response were compared before and after initiation of systemic bevacizumab therapy. Disease response was categorized as complete response, partial response, stabilization, or progression for each subsite involved by papilloma. Results: Of the 12 pulmonary RRP patients treated with systemic bevacizumab, 4 (33.3%) were male, and 11 (91.7%) were juvenile‐onset RRP patients. All presented with laryngeal, tracheal, and pulmonary RRP. The median (range) age at first bevacizumab infusion was 48.1 (19.5–70.2) years. Progression to pulmonary malignancy was identified in 3 (25.0%) patients, 2 before initiation of and 1 after complete cessation of bevacizumab therapy. Clinical symptoms such as dyspnea (75.0% vs. 25.0%; p = 0.01) and dysphagia and/or odynophagia (33.3 vs. 0.0%; p = 0.03) were significantly decreased following bevacizumab therapy. Compared with pre‐treatment baseline, 9 (75.0%) patients experienced a stable‐to‐partial response in the lungs to systemic bevacizumab, and 10 (83.3%) experienced partial‐to‐complete responses in the larynx and trachea. Conclusion: Systemic bevacizumab is effective in stabilizing progression in even the most severe cases of RRP, with both a dramatic reduction in laryngeal and tracheal disease as well as a stable‐to‐partial response of pulmonary involvement in a majority of patients. Level of Evidence: 4 Laryngoscope, 134:577–581, 2024 [ABSTRACT FROM AUTHOR]

Objectives: Quality of life studies in recurrent respiratory papillomatosis (RRP) have traditionally relied upon clinician‐designed survey instruments. This study's objective is to report quality of life outcomes from a patient‐designed questionnaire. Methods: Patients who provided health information and completed a quality of life questionnaire were identified from the RRPF‐CoRDS patient registry. Demographic, clinical, and quality of life measures were collected. Means and standard deviations were calculated for continuous data, and frequencies and percentages were calculated for categorical data. Outcomes for patients with juvenile‐onset RRP (JORRP) and adult‐onset RRP (AORRP) were compared using Student's t‐tests for continuous data and χ2 analyses for categorical data. Results: Seventy‐three patients with RRP were identified (JORRP: 32; AORRP: 41). Common clinical symptoms included raspy voice (78.1%) and dyspnea (61.6%). The majority (97.3%) of patients reported feeling debilitated by their diagnosis, and 94.5% of patients reported avoiding participation in career and/or social activities due to their voice quality. Due to their RRP, 65.7% reported missing at least five work days each month. Social anxiety was reported in 79.5% of patients, though only 28.8% of the cohort reported utilizing mental health services. The median (range) lifetime number of surgeries received was 20 (1 ‐ 300). Most patients (57.5%) reported paying at least 5% of their annual income towards RRP‐related medical care. Conclusion: RRP presents high mental and fiscal burden. Our results highlight data from a quality of life questionnaire designed by RRP patients, and may help to elucidate potential disconnects between what clinicians and RRP patients consider most impactful. Level of Evidence: 4 Laryngoscope, 133:1919–1926, 2023 Quality of life outcomes for patients with recurrent respiratory papillomatosis have traditionally been derived from clinician‐designed survey instruments. In this manuscript, we are the first to describe quality of life data from a questionnaire designed by patients and other stakeholders of the Recurrent Respiratory Papillomatosis Foundation. The results of our study highlight the significant medical, mental, and fiscal burden faced by patients with recurrent respiratory papillomatosis. [ABSTRACT FROM AUTHOR]