Researchers from the Netherlands have reported that topical Aldara® (imiquimod 5% cream) was effective treatment for human papillomavirus (HPV) related vulvar intraepithelial neoplasia. The details of this study appeared in the April 3, 2008 issue of the New England Journal of Medicine.[1]
Vulvar intraepithelial neoplasia are pre-malignant skin lesions usually associated with HPV infection. The usual treatment is surgical, though this approach carries a high recurrence rate (presumably because HPV is not eradicated).
Aldara is a topical immune response modifier that has been used to treat other skin lesions. Previous studies have shown that Aldara was highly effective in treating actinic keratosis (a sun induced pre-cancerous condition of the skin), cutaneous squamous cell carcinoma in situ, and superficial basal cell carcinomas.
In the current study, 52 patients with grade 2-3 intraepithelial neoplasia (50 with HPV DNA) were randomly allocated to receive Aldara or placebo administered twice weekly for 16 weeks. Forty-seven patients had grade 3 intraepithelial neoplasia. The average lesion size was approximately 5 centimeters, and the average duration of lesions was five years. Approximately 70% of patients in both groups had received from one to more than five previous treatments, usually surgery.
- At 20 weeks 81% of patients in the Aldara group had a greater than 25% reduction in lesion size compared with none in the control group.
- Nine patients in the Aldara group had complete disappearance of skin lesions, and five had a greater than 75% reduction in size.
- HPV was cleared in 17 Aldara patients and in two control patients.
- Response was associated with an increase in CD1a+ dendritic cells, CD8+ T-cells, and CD94+ natural killer cells.
- Pain and pruritus were reduced in Aldara-treated patients
These authors suggest that Aldara should be first-choice treatment for vulvar intraepithelial neoplasia.
Comments: These results suggest that surgery can be avoided in many patients with vulvar intraepithelial neoplasia.
Related News:
Efficacy of Aldara® (Imiquimod) for Treatment of Low-Risk Nodular Basal Cell Carcinoma Defined (11/27/2007)
Imiquimod Cream Reverses Sun Induced Pre-cancerous Skin Lesions (11/26/2002)
Aldara™ Cream (Imiquimod) Effective for Cutaneous Squamous Cell Carcinoma in Situ (05/31/2006)
Imiquimod Cream Reverses Sun Induced Pre-cancerous Skin Lesions (11/26/2002)
Reference:
[1] Van Seters M, van Beurden M, ten Kate FJW, et al. Treatment of vulvar intrepithilial neoplasia with topical imiquimod. New England Journal of Medicine. 2008;358:1465-1473.
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