Adjuvant HPV vaccination lowers risk for high-grade cervical dysplasia recurrence
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Women who received the HPV vaccine after surgical excision for high-grade cervical dysplasia had lower risk for recurrence than women who received placebo or surgery alone, according to results of a systemic review and meta-analysis presented at the virtual Society of Gynecologic Cancer Annual Meeting.
“Our findings are important because they suggest there is a significant association with HPV vaccination at the time of surgical resection for dysplasia and a reduction in the risk for recurrence,” Kimberly L. Levinson, MD, director of gynecologic oncology at Johns Hopkins University School of Medicine, told Healio. “Recurrent cervical dysplasia is concerning for multiple reasons. One concern is for progression to an invasive cancer. [HPV vaccination] also may have significant clinical benefit, as women with recurrent disease require multiple examinations and procedures — many of which could be prevented or decreased with lowered risk for recurrence.”
Levinson and colleagues pooled data from six studies published between 1990 and 2019 that included 2,984 women with cervical intraepithelial neoplasia grade 1 or higher, CIN grade 2 or higher, or HPV 16/18-associated CIN.
Researchers compared recurrence rates of 1,360 women who received HPV vaccination after surgical excision for recurrent cervical dysplasia with those of 1,624 women who received placebo or surgery alone. Follow-up was between 6 months and 48 months.
Overall, 3.3% (n = 99) of women experienced recurrence of CIN grade 2 or higher. However, risk appeared lower among women who received adjuvant HPV vaccination (1.7% vs. 4.7%; RR = 0.34; 95% CI, 0.22-0.55). Researchers also observed lower risk for recurrence among vaccinated women with CIN grade 1 or higher (6.3% vs. 9.7%; RR = 0.67; 95% CI, 0.52-0.85).
Among four studies that assessed recurrence of lesions specific to HPV strains 16/18, nine (0.9%) vaccinated women and 26 (2%) unvaccinated women experienced recurrence of HPV 16/18-associated CIN grade 2.
Moreover, 49 women developed recurrent HPV 16/18-associated CIN grade 1, including 11 (1.1%) who received adjuvant vaccination and 38 (3.1%) who did not.
Researchers observed a statistically significant overall decreased risk for recurrent HPV 16/18-associated CIN grade 2 lesions (RR = 0.41; 95% CI, 0.2-0.85) and CIN grade 1 lesions (RR = 0.35; 95% CI, 0.18-0.67).
“There are currently two ongoing, large, randomized controlled trials that should help to better elucidate the benefit of adjuvant HPV vaccine in this setting,” Levinson told Healio. “Our group has a strong interest in prevention and treatment of cervical cancers, and we will continue to conduct extensive research in this area.” – by Jennifer Southall
Reference:
Lichter K, et al. Abstract 120. Presented at: Society of Gynecologic Cancer Annual Meeting; March 28-31, 2020 (virtual meeting).
Disclosures: Levinson reports no relevant financial disclosures. Please see the abstract for all other authors’ relevant financial disclosures.
Perspective
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Amelia Jernigan, MD
High-grade cervical dysplasia is a preinvasive condition of the cervix. Unfortunately, when women experience recurrence of cervical dysplasia, they often need to consider repeat cervical procedures. Colposcopies, biopsies and repeat cervical tests are associated with financial cost, physical discomfort, stress and emotional suffering. Diagnostic excisional procedures often are diagnostic and therapeutic but come with risk for potential future pregnancies and often become increasingly technically difficult as they are repeated. An effective adjuvant therapy would minimize the risks and costs of diagnostic and therapeutic procedures required to survey and treat women with these recurrences.
The HPV vaccine has been widely documented as a safe and effective strategy to prevent cervical dysplasia and cervical cancer, as well as other cancer types. It is strongly recommended for females and males aged 9 to 26 years, and it is FDA approved for those up to age 45 years.
Lichter and colleagues compiled and analyzed six studies that compared surgical excision alone or followed by adjuvant HPV vaccination. Women who received adjuvant HPV vaccination were significantly less likely than unvaccinated women to experience recurrence. Similar reductions in the risk for recurrence were seen when looking at recurrent dysplasia that included low grade (CIN1+ or worse) and when only looking at cervical dysplasia known to be associated with HPV 16 and 18.
These findings suggest a therapeutic effect of adjuvant HPV vaccination after excisional procedures for the treatment of high-grade cervical dysplasia. Although guidance exists for HPV vaccination in targeted groups — even if they are known to have a history of HPV infection or HPV related disease — these data put to bed any reservations anyone may have had about vaccinating women who were already exposed to HPV. Unlike other diseases — such as chickenpox, where vaccination is not necessary if you have been exposed and cleared of an infection — HPV vaccination can help the body clear an infection that it is having trouble clearing on its own.
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