Bevacizumab in Adults With Recurrent Respiratory Papillomatosis (RRP)

Background: Recurrent respiratory papillomatosis (RRP) is a rare disease that causes wart-like growths in the airways. These growths come back when removed; some people may need 2 or more surgeries per year to keep their airways clear. Better treatments are needed. Objective: To see if a drug called bevacizumab can reduce the number of surgeries needed in people with RRP. Eligibility: People aged 18 and older with recurrent RRP; they must need surgery to remove the growths in their airways. Design: Participants will be screened. Their ability to breathe and speak will be evaluated. They will have an endoscopy: a flexible tube with a light and camera will be inserted into their nose and throat. They will have a test of their heart function and imaging scans of their chest. Participants will have surgery to remove the growths in their airways. Bevacizumab is given through a small tube placed in a vein in the arm. After the surgery, participants will receive 11 doses of this drug: every 3 weeks for 3 doses, and then every 6 weeks for 8 more doses. They will come to the clinic for each dose; each visit will be about 8 hours. Tissue samples of the growths will be collected after the second treatment; this will be done under general anesthesia. Participants may undergo apheresis: Blood will be drawn from a needle in an arm. The blood will pass through a machine that separates out the cells needed for the study. The remaining blood will be returned to the body through a second needle. Follow-up will continue for 1 year after the last treatment....

* INCLUSION CRITERIA: * Age \>= 18 years old. * Histologically confirmed diagnosis of RRP. * Individuals must require procedure(s) to remove papillomatous disease per standard of care.(not required for re-treatment) * A history of 2 or more surgeries within 12 months prior to treatment initiation in order to control laryngeal and/or tracheal RRP (not required for re-treatment). * At least one of the following (not required for re-treatment): * A Derkay score of 8 or greater * Measurable disease per RECIST 1.1 (participants with pulmonary RRP only) * Tracheal involvement with RRP that has required two or more clinical interventions in the last 12 months (two or more clinical interventions) * Tracheostomy. * ECOG performance status of 0-1. * Individuals must have adequate organ and marrow function as defined below: * White blood cells (WBC): \>2,000/microL * Absolute neutrophil count (ANC): \>=1,500/microL * Hemoglobin: \>9.0 g/dL * Platelets: \>=100,000/microL * Total bilirubin: \ 1 year prior to treatment initiation (not applicable for re-treatment) * Individuals able to become pregnant and their partners must agree to use highly effective method of contraception (hormonal, intrauterine device (IUD), surgical sterilization ) for the duration of bevacizumab treatment and up to 6 months after completion of bevacizumab treatment. NOTE: Abstinence, defined as no heterosexual sexual intercourse when this is in line with the preferred and usual lifestyle of the individual is also acceptable. * Breastfeeding individuals must be willing to discontinue breastfeeding from study treatment initiation through 6 months after bevacizumab treatment discontinuation. * All individuals must have the ability to understand and willingness to sign a written informed consent. * All individuals must be willing to undergo mandatory biopsy during the study (not applicable for re-treatment). EXCLUSION CRITERIA: * History of significant (i.e., active) cardiovascular disease or thromboembolic event: cerebral vascular accident/stroke (within 6 months prior to treatment initiation), myocardial infarction (within 6 months prior to treatment initiation), unstable angina, congestive heart failure (\>= New York Heart Association Classification Class II), or serious cardiac arrhythmia requiring medication as assessed by EKG. * History of abdominal fistula or gastrointestinal perforation within 6 months prior to treatment initiation. * Major surgery within 4 weeks prior to treatment initiation. * Non-healing wound, active ulcer, or untreated bone fracture. * History of hemoptysis (\>2.5 mL of bright red blood per episode) within 1 month prior to treatment initiation. * Evidence of bleeding diathesis or significant coagulopathy (with or without current therapeutic anticoagulation). * Significant vascular disease (e.g., aortic aneurysm requiring surgical repair or recent peripheral arterial thrombosis) within 6 months prior to treatment initiation. * Inadequately controlled hypertension (defined as systolic blood pressure (BP) \>150 mmHg and/or diastolic blood pressure \> 100 mmHg), an average of 3 BP readings on 2 sessions will be used to measure blood pressure if initial reading indicates inadequately controlled hypertension. NOTE: Anti-hypertensive therapy to achieve blood pressures below these parameters is allowed. * Prior history of hypertensive crisis or hypertensive encephalopathy. * Persisting toxicity related to prior therapy of Grade \>1 per Common Terminology Criteria for Adverse Events (CTCAE) v 5.0. NOTE: alopecia, sensory neuropathy Grade \