Overview of the benefits and potential issues of the nonavalent HPV vaccine

Abstract

| INTRODUCTIONApproximately 5% of all human cancers are caused by HPV infection, resulting in more than 600 000 new cases per year worldwide. 1 The cervix, penis, vulva, vagina, anus, and oropharynx are among the tissues for which the International Agency for Research on Cancer has acknowledged a direct causal correlation between HPV and disease, although the strength of the correlation does vary. 2 Therefore, HPV is considered the most important oncogenic virus affecting humans and the primary cause of uterine cervical cancer. 2 Among the high-risk genotypes for neoplastic transformation, HPV16 and HPV18 show the most biologically aggressive behavior and are the main contributors to HPV-related carcinogenesis. 3 However, other high-risk genotypes are also involved in cancer transformation, with their contribution varying with anatomic region. In the uterine cervix, the contribution of non-HPV16/HPV18 genotypes to HPV-related tumor genesis is approximately 30% (Fig. 1), whereas in the anal, vulvovaginal, penile, and oropharyngeal areas, their contribution is less relevant. 4 Two available vaccines, one of which is bivalent against HPV16 and HPV18 (2vHPV) and the other quadrivalent Efficacy data come from a pivotal trial, which was conducted among women aged 16-26 years randomly assigned to receive either the 9vHPV or the quadrivalent HPV (4vHPV) vaccine. The 9vHPV vaccine was shown to have potential benefits as compared with 4vHPV, increasing the overall estimated rate of prevention to 90% for cervical cancer and up to 80% for precancerous cervical lesions. For all other HPVrelated pre-invasive and invasive lesions, 9vHPV showed potentially greater disease reduction, depending on the anatomic region examined. Thus, the 9vHPV vaccine shows clinical potential for the prevention of HPV-related diseases in both sexes.Future adoption of 9vHPV will depend on factors including market price, costeffectiveness data, use of a two-dose schedule, and safety and efficacy monitoring in real-life programs.

A Retrospective Cohort Study of Young Women Spontaneously Choosing to Be Vaccinated against HPV: Outcomes from Their First Cervical Cancer Screening Test

“…The great majority of the women included in our study were vaccinated with the 4vHPV vaccine; since the 9vHPV vaccine potentially further expands, by 75% or more, the protective efficacy for high-grade preneoplastic cervical lesions [ 20 ], it might be speculated that its use will increase the cost:benefits of cervical screening in vaccinated women.…”

Universal cervical cancer control through a right to health lens: refocusing national policy and programmes on underserved women

“…The widescale implementation of the nonavalent vaccine -US Food and Drug Administration (FDA) approved in 2014 -will be another crucial step towards stopping HPV transmission. The vaccine offers protection to 9 genotypes, of which 7 oncogenic (versus 2 high-risk HPV types in the previously approved vaccines), and is clinically proven to prevent HPV-related diseases in both sexes [31].…”

Purification and Characterization of Antibodies in Single-Chain Format against the E6 Oncoprotein of Human Papillomavirus Type 16

“…Three different prophylactic vaccines are now available to prevent infections from 2 to 7 HR HPV genotypes [10, 11]. In spite of their prevention efficacy and long-term protection, a real reduction of CC incidence will not occur before some decades [12].…”