HPV vaccine in the treatment of usual type vulval and vaginal intraepithelial neoplasia: a systematic review

BMC Womens Health. 2019 Jan 7;19(1):3. doi: 10.1186/s12905-018-0707-9.

Abstract

Background: HPV DNA is found in almost 80% of VIN/VaIN. Current management is inadequate, with high recurrence rates. Our objective was to review the literature regarding the role of HPV vaccine in secondary prevention and treatment of VIN/VaIN.

Methods: Database searches included Ovid Medline, Embase, Web of Science, The Cochrane Library and Clinicaltrials.gov . Search terms included HPV vaccine AND therapeutic vaccine* AND VIN OR VAIN, published in English with no defined date limit. Searches were carried out with a UCL librarian in March 2018. We included any type of study design using any form of HPV vaccine in the treatment of women with a histologically confirmed diagnosis of VIN/VaIN. We excluded studies of other lower genital tract disease, vulval/vaginal carcinoma and prophylactic use of vaccines. The outcome measures were lesion response to vaccination, symptom improvement, immune response and HPV clearance.

Results: We identified 93 articles, 7 studies met our inclusion criteria; these were uncontrolled case series. There were no RCTs or systematic reviews identified. Reduction in lesion size was reported by all 7 studies, symptom relief by 5, HPV clearance by 6, histological regression by 5, and immune response by 6.

Conclusions: This review finds the evidence relating to the use of HPV vaccine in the treatment of women with VIN/VaIN is of very low quality and insufficient to guide practice. Further longitudinal studies are needed to assess its use in prevention of progression to cancer.

Keywords: HPV vaccine; Therapeutic vaccine; VAIN; VIN; Vulval disorders; Vulvar intraepithelial neoplasia.

Publication types

  • Systematic Review

MeSH terms

  • Adult
  • Antineoplastic Agents / therapeutic use*
  • Carcinoma in Situ / drug therapy*
  • Carcinoma in Situ / prevention & control
  • Disease Progression
  • Female
  • Humans
  • Middle Aged
  • Papillomavirus Vaccines / therapeutic use*
  • Treatment Outcome
  • Vaginal Neoplasms / drug therapy*
  • Vaginal Neoplasms / prevention & control
  • Vulvar Neoplasms / drug therapy*
  • Vulvar Neoplasms / prevention & control

Substances

  • Antineoplastic Agents
  • Papillomavirus Vaccines