Topical imiquimod can reverse vulvar intraepithelial neoplasia: A randomised, double-blinded study

Mathiesen, Ole; Buus, Sanne K.; Cramers, M

doi:10.1016/j.ygyno.2007.06.003

Cited by 98 publications

(92 citation statements)

References 17 publications

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“…In this study, treatment by 8 weeks of imiquimod followed by vaccination gave a lesion response rate of 63% at week 52. This compares very favourably with imiquimod alone treatment of 16 weeks assessed as histological regression to VIN1 or better as 64% soon after treatment (Le et al, 2007) or with no VIN at 2 months after treatment as 81% (Mathiesen et al, 2007) or 69% (van Seters et al, 2008).…”

Section: Discussionmentioning

confidence: 84%

Phase II trial of imiquimod and HPV therapeutic vaccination in patients with vulval intraepithelial neoplasia

et al. 2010

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BACKGROUND: Vulval intraepithelial neoplasia (VIN) is a premalignant condition, which is frequently associated with type HPV16 infection, and multifocal disease has high rates of surgical treatment failure. METHODS: We report a phase II clinical trial of the topical immunomodulator, imiquimod, for 8 weeks, followed by 3 doses (weeks 10, 14 and 18) of therapeutic human papillomavirus (HPV) vaccination (TA-CIN, fusion protein HPV16 E6E7L2) in 19 women with VIN grades 2 and 3. Histology and HPV testing of biopsies were performed at weeks 0, 10, 20 and 52. Intralesional infiltration of T-cell subsets and lymphocyte proliferation for HPV systemic immune responses were also assessed. RESULTS: Lesion response (complete regression of VIN on histology) was observed in 32% (6 out of 19) of women at week 10, increasing to 58% (11 out of 19) at week 20 and 63% (12 out of 19) at week 52. At this time, 36% (5 out of 14) of lesions showed HPV16 clearance and 79% (15 out of 19) of women were symptom free. At week 20, after treatment with imiquimod and vaccination, there was significantly increased local infiltration of CD8 and CD4 T cells in lesion responders; in contrast, nonresponders (persistent VIN by histology) showed an increased density of T regulatory cells. After vaccination, only lesion responders had significantly increased lympho-proliferation to the HPV vaccine antigens. CONCLUSION: The therapeutic effect of treatment depends on the differential immune response of responders and non-responders with affect locally and systemically.

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Section: Discussionmentioning

confidence: 84%

Phase II trial of imiquimod and HPV therapeutic vaccination in patients with vulval intraepithelial neoplasia

et al. 2010

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“…Follow-up of patients treated with imiquimod is still relatively short; long-term effects cannot yet be established. The results of imiquimod are promising, especially in smaller lesions [69] but large randomized controlled trials are needed to obtain data on the long-term effects [70][71][72] and to compare with other treatment modalities like surgery in small lesions. Considering the side effects of imiquimod, its use should be restricted to motivated patients.…”

Section: Treatmentmentioning

confidence: 99%

Prevention, identification and treatment of vulvar squamous (pre)malignancies: a review focusing on quality of care

Einden¹,

Avoort

Hullu

2013

Expert Review of Anticancer Therapy

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Vulvar squamous cell carcinoma, its precursor lesions (usual and differentiated vulvar intraepithelial neoplasia) and lichen sclerosus are rare diseases that may have a large impact on the lives of affected women and their partners. Proper identification is vital, but the lesions are sometimes difficult to diagnose because of their rarity and variety of symptoms. High quality of care and proper treatment is important in order to minimize the morbidity and mortality caused by these lesions. This review gives an outline of the latest insights regarding the current evidence in this area and unresolved issues. Additionally, it highlights the improvements that should be made in order to optimize prevention and identification of (pre-)malignant vulvar lesions and to increase the quality of care for these patients.

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“…[31][32][33] In 2004, the International Society for the Study of Vulvovaginal Disease proposed a new classification system for VIN to more accurately identify women at risk of neoplastic progression. 31 The 2004 International Society for the Study of Vulvovaginal Disease classification will be used throughout this review.…”

Section: Vulvar Intraepithelial Neoplasiamentioning

confidence: 99%

“…Trials with topical imiquimod and 5-fluorouracil have yielded promising results, but long-term results are uncertain with frequent recurrences. 32,[48][49][50][51] Imiquimod is a topical immune modulator. It acts by stimulating local cytokine production and cellmediated immunity.…”

Section: Vulvar Intraepithelial Neoplasiamentioning

confidence: 99%

Benign Vulvar Dermatoses

Rodríguez¹,

Leclair²

2012

Obstetrical &Amp; Gynecological Survey

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Topical imiquimod can reverse vulvar intraepithelial neoplasia: A randomised, double-blinded study

Cited by 98 publications

References 17 publications

Phase II trial of imiquimod and HPV therapeutic vaccination in patients with vulval intraepithelial neoplasia

Phase II trial of imiquimod and HPV therapeutic vaccination in patients with vulval intraepithelial neoplasia

Prevention, identification and treatment of vulvar squamous (pre)malignancies: a review focusing on quality of care

Benign Vulvar Dermatoses

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