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HPV genotypes not targeted in vaccines have similar malignant potential
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Precancerous lesions that develop from HPV genotypes not included in vaccines have similar malignant potential as genotypes that are included in vaccines, according to study results.
The findings prompted researchers to recommend multiple approaches to managing cervical cancer risk.
“The first generation of prophylactic vaccines against HPV genotypes 16 and 18 hold promise for preventing grade 2 or greater cervical intraepithelial neoplasia (CIN) lesions or cervical cancer associated with those HPV types,” Suguna Badiga, PhD, of Wallace Tumor Institute at The University of Alabama, Birmingham, and colleagues wrote. “However, the finding that a substantial proportion of CIN ≥ 2 lesions are caused by high-risk HPV genotypes other than type 16 or 18 has begun to be appreciated.”
Nonvaccine HPV genotypes are associated with cervical cancer risk, but that doesn’t necessarily mean that precancerous lesions positive for these genotypes will turn into cancerous lesions. Consequently, it is important to evaluate the malignant potential of these precancerous lesions, Badiga and colleagues wrote.
Researchers studied women who had not received HPV vaccines (n = 371), all of whom were HPV positive and enrolled in two studies funded by the NCI. The researchers categorized each participant according to whether their high-risk HPV was a vaccine or nonvaccine genotype, and they used logistic regression analyses to determine any association between the positive expression of p16INK4A and the risk for CIN 2 or CIN 3.
The specimens with a positive expression of p16INK4A were 5.3 times more likely to be diagnosed as CIN 2, and 16.6 times more likely to be diagnosed as CIN 3. CIN ≥ 2 lesions that did not belong to the bivalent or 9-valent high-risk HPV genotypes had p16INK4A expression similar to lesions that did belong to those HPV types. Overall, 80% of the women in the study were diagnosed with CIN ≥ 2 lesions. Women with CIN ≥ 2 had a younger median age than women with CIN 1 (P < .0001).
“Newly approved vaccines against the most common types of HPV genotypes that cause cervical cancer may represent a significant advancement in the prevention of this disease,” Badiga and colleagues wrote. “However, it is imperative that follow-up screening and nonvaccine-based, primary preventive strategies be adapted to and meshed with one another to manage lesions that develop because of high risk HPV genotypes that are not included in the HPV vaccines.” ‒ by Andy Polhamus
Disclosure: Badiga reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.
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