Vaccination against HPV-16 oncoproteins for vulvar intraepithelial neoplasia

N Engl J Med. 2009 Nov 5;361(19):1838-47. doi: 10.1056/NEJMoa0810097.


Background: Vulvar intraepithelial neoplasia is a chronic disorder caused by high-risk types of human papillomavirus (HPV), most commonly HPV type 16 (HPV-16). Spontaneous regression occurs in less than 1.5% of patients, and the rate of recurrence after treatment is high.

Methods: We investigated the immunogenicity and efficacy of a synthetic long-peptide vaccine in women with HPV-16-positive, high-grade vulvar intraepithelial neoplasia. Twenty women with HPV-16-positive, grade 3 vulvar intraepithelial neoplasia were vaccinated three or four times with a mix of long peptides from the HPV-16 viral oncoproteins E6 and E7 in incomplete Freund's adjuvant. The end points were clinical and HPV-16-specific T-cell responses.

Results: The most common adverse events were local swelling in 100% of the patients and fever in 64% of the patients; none of these events exceeded grade 2 of the Common Terminology Criteria for Adverse Events of the National Cancer Institute. At 3 months after the last vaccination, 12 of 20 patients (60%; 95% confidence interval [CI], 36 to 81) had clinical responses and reported relief of symptoms. Five women had complete regression of the lesions, and HPV-16 was no longer detectable in four of them. At 12 months of follow-up, 15 of 19 patients had clinical responses (79%; 95% CI, 54 to 94), with a complete response in 9 of 19 patients (47%; 95% CI, 24 to 71). The complete-response rate was maintained at 24 months of follow-up. All patients had vaccine-induced T-cell responses, and post hoc analyses suggested that patients with a complete response at 3 months had a significantly stronger interferon-gamma-associated proliferative CD4+ T-cell response and a broad response of CD8+ interferon-gamma T cells than did patients without a complete response.

Conclusions: Clinical responses in women with HPV-16-positive, grade 3 vulvar intraepithelial neoplasia can be achieved by vaccination with a synthetic long-peptide vaccine against the HPV-16 oncoproteins E6 and E7. Complete responses appear to be correlated with induction of HPV-16-specific immunity.

Publication types

  • Clinical Trial, Phase II
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cancer Vaccines / adverse effects
  • Cancer Vaccines / immunology
  • Cancer Vaccines / therapeutic use*
  • Carcinoma in Situ / therapy*
  • Carcinoma in Situ / virology
  • Female
  • Freund's Adjuvant
  • Human papillomavirus 16* / immunology
  • Human papillomavirus 16* / isolation & purification
  • Humans
  • Middle Aged
  • Oncogene Proteins, Viral / immunology
  • Papillomavirus E7 Proteins
  • Papillomavirus Infections / complications
  • Papillomavirus Infections / immunology
  • Papillomavirus Infections / therapy*
  • Papillomavirus Vaccines / adverse effects
  • Papillomavirus Vaccines / immunology
  • Papillomavirus Vaccines / therapeutic use*
  • Repressor Proteins / immunology
  • T-Lymphocytes / immunology*
  • Treatment Outcome
  • Vaccines, Synthetic
  • Vulvar Neoplasms / therapy*
  • Vulvar Neoplasms / virology
  • Young Adult


  • Cancer Vaccines
  • E6 protein, Human papillomavirus type 16
  • Oncogene Proteins, Viral
  • Papillomavirus E7 Proteins
  • Papillomavirus Vaccines
  • Repressor Proteins
  • Vaccines, Synthetic
  • oncogene protein E7, Human papillomavirus type 16
  • Freund's Adjuvant