Multi‐Year Effect of Human Papillomavirus Vaccination on Recurrent Respiratory Papillomatosis

Abstract

Objective To examine whether human papilloma virus (HPV) vaccination in combination with surgical resection could suppress recurrence for an extended period of time in patients with recurrent respiratory papillomatosis (RRP). Methods In a prospective case series, data of patients who received combination therapy comprising surgery and quadrivalent HPV vaccination (Gardasil; Merck & Co., West Point, PA) were collected. Patients were followed up for RRP from March 2012 to July 2018 in an academic tertiary care center. The patients comprised 16 adults with RRP who were observed for >12 months after HPV vaccination, and whose HPV‐DNA status was tested before and for >12 months after completion of combination therapy. The outcomes of this study were the severity score of larynx disease, tumor incidence rate, and relationship between this rate and HPV‐DNA negative conversion after therapy. Results The severity score of laryngeal disease significantly decreased from before combination therapy to the time of final examination (P = 0.00045). The tumor incidence rate decreased to approximately 20% during the period from 12 to 47 months after HPV vaccination. Regarding HPV‐DNA status in the final test results of each patient, 12 of 16 (75%) patients showed negative conversion; these 12 were significantly less likely to experience recurrence than patients who persistently tested positive for HPV‐DNA during the period between 12 and 47 months after vaccination. Conclusion HPV vaccination prevented recurrence associated with RRP surgery for 4 years in 80% of patients. This may be an effective adjuvant therapy, and HPV‐DNA negative conversion after HPV vaccination might predict prevention of recurrence. Level of Evidence 2 Laryngoscope, 130:442–447, 2020

Long‐term Outcomes of Juvenile Onset Recurrent Respiratory Papillomatosis with Pulmonary Involvement

“…However, the effectiveness of these adjuvant therapies was not analyzed in this population. Recently, intravenous bevacizumab and HPV vaccination were reported to be clinically effective for the treatment of RRP patients 21,22 . Programmed death‐ligand 1 (PD‐L1) blockade with avelumab demonstrated that its administration was safe and clinically effective in patients with laryngeal RRP but not pulmonary RRP 23 .…”

Health Impact and Cost-Effectiveness of Implementing Gender-Neutral Vaccination With the 9-Valent Human Papillomavirus Vaccine in Belgium

“…Based on the model outcomes, vaccinating boys is projected to reduce anal cancer and genital wart incidence in males, and also provide additional protection for females with substantial reductions in the incidence of cervical cancer, precancerous cervical lesions, anal cancer, and genital warts. Although HPV vaccines are not indicated for the prevention of RRP, head and neck cancer, and penile cancer as per label (Gardasil, 2018), there is evidence demonstrating the efficacy of HPV vaccines in reducing persistent HPV infections at these anatomic sites (e.g., persistent external genital infection (Giuliano et al, 2011), persistent oral infection (Herrero et al, 2013;Wilkin et al, 2018), and many countries and international literature considered that HPV vaccines may protect against these diseases, (Takla et al, 2018;Burger et al, 2014;Chesson et al, 2016;Joint committee on Vaccination and Immunization, 2018;Mauz et al, 2018;Boiron et al, 2016;Matsuzaki et al, 2020). Our model suggests GNV with the 9vHPV vaccine is a cost-effective strategy in Flanders (vs. FOV with the 9vHPV vaccine), Wallonia-Brussels (vs. FOV with the 2vHPV vaccine), and the Belgium national catchup program (vs. FOV with the 9vHPV vaccine), with the ICERs being €8,062, €4,179, and €6,127 in the three programs, respectively.…”

How Enhancing Immunity to Low‐Risk HPV Could Cure Recurrent Respiratory Papillomatosis

“…This biologic understanding of how different arms of the adaptive immune system prevent or control existing infection is in conflict with clinical data suggesting that adjuvant administration of the Gardasil preventative vaccine prevents RRP disease recurrence or significantly lengthens the time between surgeries. Several single cohort, retrospective studies suggest a clinical benefit with increased intersurgery interval after adjuvant Gardasil administration 65,68,69 . Of two multicohort studies that reported intersurgery interval in patients with and without adjuvant Gardasil, one reported clinical benefit and the other did not 70,71 .…”