Topical imiquimod treatment for human papillomavirus infection in patients with and without cervical/vaginal intraepithelial neoplasia

Lin, Cheng Tao; Qiu, Jian Tai; Wang, Chin Jung; Chang, Shuenn Dyh; Tang, Yueh‐Bih; Wu, Pei-Ju; Jung, Shih Ming; Huang, Ching-Shui; Chou, Hung Hsueh; Jao, Mei Shan; Lai, Chyong‐Huey

doi:10.1016/j.tjog.2012.09.006

Cited by 40 publications

(56 citation statements)

References 29 publications

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“…Both VIN and VAIN are HPV-related neoplasia and the pathophysiology is comparable to CIN. Previous studies have investigated the effect of imiquimod in CIN and showed the adverse effects to be well-tolerated [4,5]. Currently, a non-randomised study comparing the effectiveness of imiquimod treatment with large loop excision of the transformation zone (LLETZ) is being performed in the Netherlands (TOPIC-3) [6].…”

Section: Introductionmentioning

confidence: 99%

Systemic adverse events in imiquimod use for cervical intraepithelial neoplasia – A case series

Wouters

Hendriks

Koeneman

et al. 2019

Case Reports in Women's Health

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Treatment for cervical intraepithelial neoplasia (CIN) often consists of an excisional procedure. However, less invasive treatment methods have been explored, such as topical treatment with imiquimod cream. Imiquimod has been proven to be effective in the regression of vulvar intraepithelial neoplasia (VIN) and vaginal intraepithelial neoplasia (VAIN). Previous studies have investigated the effect of imiquimod in CIN and showed well tolerated adverse effects. During a current study in the Netherlands, a number of adverse events have occurred. This case series presents a selection of these. Gynaecologists should be aware of the possible adverse effects of topical treatment with imiquimod cream.

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Section: Introductionmentioning

confidence: 99%

Systemic adverse events in imiquimod use for cervical intraepithelial neoplasia – A case series

Wouters

Hendriks

Koeneman

et al. 2019

Case Reports in Women's Health

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“…A 57% complete response rate was reported during median follow‐up of 18.4 months, which is in line with our results of complete histological regression rate of 70% in a shorter follow‐up period. Two retrospective studies with self‐administered imiquimod cream comprised mainly of VAIN 1 patients, with regression rates of 86% ( n = 42) and 54% ( n = 26), respectively . The study by Lin et al .…”

Section: Discussionmentioning

confidence: 99%

Randomised trial on treatment of vaginal intraepithelial neoplasia—Imiquimod, laser vaporisation and expectant management

Tainio

Jakobsson

Louvanto

et al. 2016

Intl Journal of Cancer

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Vaginal intraepithelial neoplasia (VAIN) is associated with human papillomavirus (HPV) infection. The most common treatment modality is laser vaporisation, but recurrences are common. Imiquimod is an immune response modulator which is used for the treatment of external condylomas and other HPV-related genital neoplasias. The aim of the study was to evaluate the efficacy and tolerability of vaginally administered imiquimod in comparison with laser vaporisation and expectant management of high-grade VAIN. This proof of principle pilot study was a prospective 16-week randomised trial. We enrolled 30 patients with histologically confirmed VAIN 2 or 3 into three study arms: vaginally administered imiquimod, laser vaporisation and expectant management. Follow-up colposcopy visits included high-risk human papillomavirus (hrHPV) testing, cytology and punch biopsies. At baseline 77% (n = 20/26) of the patients were hrHPV positive. HPV clearance was significantly higher in the imiquimod arm (63%, n = 5/8) than in the laser arm (11%, n = 1/9) (p = 0.05) or in the expectant management arm (17%, n = 1/6) (p = 0.138). At baseline 25 patients (83%) had VAIN 2 and five (17%) had VAIN 3. None of the lesions progressed during the follow-up. Histological regression (≤VAIN 1) was observed in 80% (n = 8/10) of patients in the imiquimod arm, 100% (n = 10/10) of the laser arm (p = 0.474) and 67% (n = 6/9) of the expectant management arm (p = 0.628). Vaginal imiquimod appears to be as effective as laser treatment in high-grade VAIN.

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“…23,24 The use of Imiquimod for the treatment of CIN2/3 or VIN2/3 has shown limited clinical benefits and topical application was more or less well tolerated depending on the study. [25][26][27] Why therapeutic vaccines have shown limited efficacy against HPV associated neoplasia Multiple reasons could explain the limited success of therapeutic vaccines against HPV-induced neoplasia to date. Numerous clinical trials have shown induction of T cell responses against E6 and E7, but the magnitude of the response induced against HPV antigens might have been insufficient to clear HPV infected or transformed cells.…”

Section: Clinical Evaluation Of Immunotherapeutic Interventions Againmentioning

confidence: 99%

Moving forward with human papillomavirus immunotherapies

Çuburu

Schiller

2016

Human Vaccines & Immunotherapeutics

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Persistent human papillomavirus (HPV) is the primary etiologic agent of cervical cancer and causes a significant number of vulvar, penile, anal and oropharyngeal cancers. The development of highly effective HPV therapeutic vaccines is a reasonable goal given the recent advances in basic and applied immunology. A number of vaccine strategies designed to induce systemic T cell responses have been tested in clinical trials against high grade cervical or vulvar high grade neoplasia and cancers, but with limited success. In line with the emerging trend to focus more on the epithelial context of HPV infection and premalignant disease, it might be advantageous to develop vaccination strategies that promote trafficking of HPV-specific T cells into lesions and overcome the local immunosuppressive environment. The development of more biologically relevant animal models would improve the preclinical evaluation of therapeutic vaccine candidates. Finally, persistent infection and low grade lesions may prove to be easier targets for therapeutic vaccines, and these vaccines would likely be commercially viable in high income countries and valuable components in screen and treat programs in low resource settings.

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Topical imiquimod treatment for human papillomavirus infection in patients with and without cervical/vaginal intraepithelial neoplasia

Abstract: The tolerability of intravaginal self-administered imiquimod is confirmed. Its efficacy in the treatment of women with persistent HPV infection and normal cytology warrants further randomized, controlled trials to determine appropriate dosages and scheduling.

Cited by 40 publications

References 29 publications

Systemic adverse events in imiquimod use for cervical intraepithelial neoplasia – A case series

Systemic adverse events in imiquimod use for cervical intraepithelial neoplasia – A case series

Randomised trial on treatment of vaginal intraepithelial neoplasia—Imiquimod, laser vaporisation and expectant management

Moving forward with human papillomavirus immunotherapies

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