Prophylactic HPV vaccination after conization: A systematic review and meta-analysis

Jentschke, Matthias; Kampers, Johanna; Becker, Jeroen H.; Sibbertsen, Philipp; Hillemanns, Peter

doi:10.1016/j.vaccine.2020.07.055

Cited by 80 publications

(83 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As a consequence of the growing attention on the role of post-LEEP vaccination, three meta-analyses focused on this specific point have been recently published. Interestingly, these manuscripts showed superimposable findings, all in accordance with our data (Bartels et [20]). However, when compared with the most recent one by Jentschke et al our meta-analysis added a new multicenter, retrospective study by Bogani et al [47], with 300 patients selected for the propensity-score matching analysis and a median follow-up of 5 years.…”

Section: Discussionsupporting

confidence: 91%

“…Conversely, it is still controversial whether they are useful even after HPV infection has already occurred. Accumulating data highlighted that potentially HPV vaccines have a role in the adjuvant setting [ 18 , 19 , 20 ]; however, the level A evidence is still lacking.…”

Section: Discussionmentioning

confidence: 99%

“…Enormous attempts are being made to obtain the first therapeutic HPV vaccine [ 15 , 16 , 17 ]. In the meantime, interesting data suggest that the administration of prophylactic HPV vaccine, either shortly before or after surgical treatment for CIN 2+, might reduce the risk of recurrence [ 18 , 19 , 20 ]. The rationale behind the efficacy of HPV vaccine as an adjuvant therapy remains unclear.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Adjuvant HPV Vaccination to Prevent Recurrent Cervical Dysplasia after Surgical Treatment: A Meta-Analysis

et al. 2021

View full text Add to dashboard Cite

Objective: The aim of this meta-analysis was to discuss evidence supporting the efficacy of adjuvant human papillomavirus (HPV) vaccination in reducing the risk of recurrent cervical intraepithelial neoplasia (CIN) 2 or greater after surgical treatment. Methods: A systematic literature search was performed for studies reporting the impact of HPV vaccination on reducing the risk of recurrence of CIN 2+ after surgical excision. Results were reported as mean differences or pooled odds ratios (OR) with 95% confidence intervals (95% CI). Results: Eleven studies met the inclusion criteria and were selected for analysis. In total, 21,310 patients were included: 4039 (19%) received peri-operational adjuvant HPV vaccination while 17,271 (81%) received surgery alone. The recurrence of CIN 2+ after treatment was significantly lower in the vaccinated compared with the unvaccinated group (OR 0.35; 95% CI 0.21–0.56; p < 0.0001). The recurrence of CIN 1+ after treatment was significantly lower in the vaccinated compared with the unvaccinated group (OR 0.51; 95% CI 0.31–0.83; p = 0.006). A non-significant trend of reduction rate of HPV persistence was observed in the vaccinated compared with the unvaccinated cohorts (OR was 0.84; 95% CI 0.61–1.15; p = 0.28). Conclusions: HPV vaccination, in adjuvant setting, is associated with a reduced risk of recurrent CIN 1+ and CIN 2+ after surgical treatment.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Adjuvant HPV Vaccination to Prevent Recurrent Cervical Dysplasia after Surgical Treatment: A Meta-Analysis

et al. 2021

View full text Add to dashboard Cite

show abstract

“…In addition, as part of the participation in the study, but not used for clinical decision-making, clinician-collected cervical samples (Abbott), self-collected vaginal samples (VSS) and urine samples were analyzed for comparative HPV testing at 1st follow-up. The procedure employed a multiplex real-time polymerase chain reaction (PCR) test which detects HPV16, HPV18, as well as other high-risk HPV: 31,33,35,39,45,51,52,56,58,59,66,68. The results of this comparative testing are described in detail in a previous study (25).…”

Section: Methodsmentioning

confidence: 99%

Age, margin status, high‑risk human papillomavirus and cytology independently predict recurrent high‑grade cervical intraepithelial neoplasia up to 6 years after treatment

et al. 2021

View full text Add to dashboard Cite

The present study aimed to identify the factors that independently contribute to disease recurrence among women first-time treated for high-grade cervical intraepithelial neoplasia (CIN) during 4-6 years of follow-up. Overall, 529 of 530 eligible patients participated; these patients all attended a 1st follow-up appointment ~6 months post-conization, at which time high-risk human-papillomavirus (HPV) testing, liquid-based cytology and colposcopy were performed. Full data on margin excision status, other aspects of initial treatment and comorbidity were obtained. At least one subsequent follow-up was attended by 88% of patients. A total of 22 recurrent cases were detected during follow-up. Detected recurrence was the outcome of focus for multiple logistic regression analysis, with odds ratios (OR) and 95% confidence intervals (CI) computed. Four significant independent risk factors were identified: Age 45 years or above (OR=3.5, 95% CI=1.3-9.9), one or both unclear or uncertain margins (OR=5.3, 95% CI=2.0-14.2), positive HPV at 1st follow-up (OR=5.8, 95% CI=2.0-16.8), and abnormal cytology at 1st follow-up (OR=3.9, 95% CI=1.4-11.0). Bivariate analysis revealed that persistent HPV positivity was associated with recurrence (P<0.01). These findings indicated that incomplete excision of the CIN lesion may warrant more intensive subsequent screening, regardless of early post-conization HPV findings. Although early post-conization positive HPV was a powerful, independent predictor of recurrent high-grade CIN, over one-third of the patients with detected recurrence had a negative early post-conization HPV finding. These patients returned for routine screening, at which time, in most cases, HPV status was positive, thus indicating the need for repeated HPV evaluation. Especially during the on-going pandemic, home vaginal self-sampling is recommended. Particular attention is required for women aged ≥45 years. In addition, although not statistically significant, relevant comorbidities, especially autoimmune conditions, warrant consideration in clinical decision-making. Women who have been treated for high-grade CIN are at risk for recurrent disease and progression to cervical cancer; therefore, they require careful, individualized follow-up to avoid these adverse consequences.

show abstract

“…It should be noted that a possible therapeutic benefit of HPV vaccination has been observed for preventing the recurrence of pre-cancerous lesions as well (91)(92)(93)(94). The evidence is compelling for prevention of pre-cancerous cervical lesions in patients who underwent conization for cervical intraepithelial neoplasia (95), but is also growing for other HPV-associated lesions (91,93,94). Karita et al, for instance, are running a clinical trial evaluating whether Gardasil-9 ® (MSD) can reduce the risk of high-grade squamous intraepithelial lesion recurrence by 50% in previously unvaccinated individuals recently treated for anal or vulvar high-grade squamous intraepithelial lesions (NCT03051516) (96).…”

Section: Hpv Vaccinementioning

confidence: 99%

Repurposing Infectious Diseases Vaccines Against Cancer

et al. 2021

View full text Add to dashboard Cite

Vaccines used to prevent infections have long been known to stimulate immune responses to cancer as illustrated by the approval of the Bacillus Calmette–Guérin (BCG) vaccine to treat bladder cancer since the 1970s. The recent approval of immunotherapies has rejuvenated this research area with reports of anti-tumor responses with existing infectious diseases vaccines used as such, either alone or in combination with immune checkpoint inhibitors. Here, we have reviewed and summarized research activities using approved vaccines to treat cancer. Data supporting a cancer therapeutic use was found for 16 vaccines. For 10 (BCG, diphtheria, tetanus, human papillomavirus, influenza, measles, pneumococcus, smallpox, typhoid and varicella-zoster), clinical trials have been conducted or are ongoing. Within the remaining 6, preclinical evidence supports further evaluation of the rotavirus, yellow fever and pertussis vaccine in carefully designed clinical trials. The mechanistic evidence for the cholera vaccine, combined with the observational data in colorectal cancer, is also supportive of clinical translation. There is limited data for the hepatitis B and mumps vaccine (without measles vaccine). Four findings are worth highlighting: the superiority of intravesical typhoid vaccine instillations over BCG in a preclinical bladder cancer model, which is now the subject of a phase I trial; the perioperative use of the influenza vaccine to limit and prevent the natural killer cell dysfunction induced by cancer surgery; objective responses following intratumoral injections of measles vaccine in cutaneous T-cell lymphoma; objective responses induced by human papillomavirus vaccine in cutaneous squamous cell carcinoma. All vaccines are intended to induce or improve an anti-tumor (immune) response. In addition to the biological and immunological mechanisms that vary between vaccines, the mode of administration and sequence with other (immuno-)therapies warrant more attention in future research.

show abstract

Prophylactic HPV vaccination after conization: A systematic review and meta-analysis

Cited by 80 publications

References 24 publications

Adjuvant HPV Vaccination to Prevent Recurrent Cervical Dysplasia after Surgical Treatment: A Meta-Analysis

Adjuvant HPV Vaccination to Prevent Recurrent Cervical Dysplasia after Surgical Treatment: A Meta-Analysis

Age, margin status, high‑risk human papillomavirus and cytology independently predict recurrent high‑grade cervical intraepithelial neoplasia up to 6 years after treatment

Repurposing Infectious Diseases Vaccines Against Cancer

Contact Info

Product

Resources

About