Recurrent respiratory papillomatosis (RRP) is a human papilloma virus (HPV) 6/11 related, predominantly histologically benign neoplasm of the upper and lower airway affecting both younger and older patients. Though potentially declining due to HPV vaccination RRP is still challenging in management and a significant cause of affected quality of life. Systemic bevacizumab has shown efficacy for aggressive disease in other case series in juvenile-onset RRP (JORRP) as in adult-onset RRP (AORRP). We present five consecutive patients with AORRP treated with systemic bevacizumab for aggressive laryngeal and tracheal papillomatosis. Adding to the findings of previous reports we show that systemic bevacizumab treatment could have positive influence on aggressive AORRP without pulmonary spread with manageable side effects.