Imiquimod in cervical, vaginal and vulvar intraepithelial neoplasia: a review.
Human papillomavirus (HPV) infection is in the vast majority of patients accountable for the development of vulvar, cervical and vaginal intraepithelial neoplasia (VIN, CIN, VAIN); precursors of vulvar, cervical and vaginal cancers. The currently preferred treatment modality for high grade VIN, CIN and VAIN is surgical excision. Nevertheless surgical treatment is associated with adverse pregnancy outcomes and recurrence is not uncommon. The aim of this review is to present evidence on the efficacy, safety and tolerability of imiquimod (an immune response modifier) in HPV-related VIN, CIN and VAIN. A search for papers on the use of imiquimod in VIN, CIN and VAIN was performed in the MEDLINE, EMBASE and Cochrane library databases. Data was extracted and reviewed. Twenty-one articles met the inclusion criteria and were analyzed; 16 on VIN, 3 on CIN and 2 on VAIN. Complete response rates in VIN ranged from 5 to 88%. Although minor adverse effects were frequently reported, treatment with imiquimod was well tolerated in most patients. Studies on imiquimod treatment of CIN and VAIN are limited and lack uniformly defined endpoints. The available evidence however, shows encouraging effect. Complete response rates for CIN 2-3 and VAIN 1-3 ranged from 67 to 75% and 57 to 86% respectively. More randomized controlled trials on the use of imiquimod in CIN, VAIN and VIN with extended follow-up are necessary to determine the attributive therapeutic value in these patients.
Universal Medical Center Utrecht, The Netherlands.
C J
CJ
de Witte
Erasmus MC Cancer Institute, Department of Gynaecology, Rotterdam, The Netherlands.
A J M
AJ
van de Sande
Erasmus MC Cancer Institute, Department of Gynaecology, Rotterdam, The Netherlands.
H J
HJ
van Beekhuizen
Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands.
M M
MM
Koeneman
Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands.
A J
AJ
Kruse
Meander Medical Center Amersfoort, The Netherlands. Electronic address: cg.gerestein@meandermc.nl.
C G
CG
Gerestein
D000634:Aminoquinolines / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002278:Carcinoma in Situ / Q000188:drug therapy / Q000821:virology; D005260:Female; D006801:Humans; D000077271:Imiquimod; D030361:Papillomavirus Infections / Q000188:drug therapy* / Q000821:virology; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000821:virology; D014625:Vaginal Neoplasms / Q000188:drug therapy* / Q000821:virology; D014846:Vulvar Neoplasms / Q000188:drug therapy* / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000188:drug therapy* / Q000821:virology
D000634:Aminoquinolines; D000970:Antineoplastic Agents; D000077271:Imiquimod
Cervix uteri; Imiquimod; Intraepithelial neoplasia; Vagina; Vulva