Opportunities to improve immune-based prevention of HPV-associated cancers

Abstract

Immunization of adolescent girls with VLP vaccines, made of L1 proteins from the most medically significant high risk HPV types, is a major strategy for prevention of cervical cancer plus other HPV-associated cancers. Maximal population impact, including through herd immunity, requires high vaccination coverage. However, protection of unvaccinated women requires secondary prevention through cytology screening. Unfortunately in countries with the highest incidence/mortality due to cervical cancer HPV vaccination (or cytology screening) is not sufficiently available. Vaccination programme costs and a lack of accessibility of the populations for immunization remain significant hurdles. Several approaches could increase effective implementation of HPV vaccination. 1) Use of a single immunization of the current VLP vaccines. 2) Vaccination bundled with other paediatric vaccines with lower dosage to facilitate delivery, improve coverage and reduce costs through established logistics. 3) Local manufacture with lower cost systems (e.g. bacteria) for VLP or capsomer based vaccine production and utilization of additional protective epitopes (e.g L2) for increasing breadth of protection. However, all the latter need appropriate clinical validation. Gender neutral vaccination and extending routine vaccination strategies to women up to age 30 years in combination with at least one HPV screening test can also hasten impact on cancer incidence.

High Prevalence of Cervical High-Risk Human Papillomavirus Harboring Atypical Genotypes in Human Immunodeficiency Virus -Infected and -Uninfected First-Generation Adult Immigrant Women Originating from Sub-Saharan Africa and Living in France

“…In addition, only 20% of study women were exclusively infected by high-risk HPV genotypes not targeted by the Gardasil-9® vaccine, suggesting that at least 80% of genital HPV infections in this sample of first-generation immigrant women living in France would be a priori prevented by the vaccination with Gardasil-9® vaccine. Ongoing clinical trials such as HPV-FASTER study already suggest that extending routine vaccination strategies to women up to age 30 years in combination with greater access to primary molecular HPV screening can hasten impact on cancer incidence [ 55 – 57 ]. Note that catch-up HPV prophylactic vaccination could be proposed even in HIV-infected women, in whom better immunogenicity is seen when HIV viral replication is controlled, and when there is no overt immunodeficiency [ 58 , 59 ].…”

Use of patient navigators to increase HPV vaccination rates in a pediatric clinical population

“…Human papillomavirus (HPV) vaccination can reduce HPV-related cancers significantly if a high proportion of the population receives the vaccine before exposure to the virus ( Stern and Roden, 2019 ). To achieve this, the Advisory Committee on Immunization Practices (ACIP) recommends vaccination at 11–12 years of age, although it is permitted as young as age 9 and up to age 45 ( Petrosky et al, 2015 ).…”

Serum and cervicovaginal IgG immune responses against α7 and α9 HPV in non-vaccinated women at risk for cervical cancer: Implication for catch-up prophylactic HPV vaccination

“…The prophylactic vaccination of young girls below 14 years with the safe and very effective Gardasil-9 1 vaccine (Merck & Co. Inc., Kenilworth, NJ, USA) containing VLPs from HPV-6 and HPV-11, as well as two α7 (HPV-18 and HPV-45) and five α9 (HPV-16, -31, -33, -52 and -58) HR-HPV, constitutes actually one of the main strategies against cervical cancer [10][11][12][13][14][15][16][17][18]. In addition to the secondary prevention measures, sexually active adult women more than 15 years may also be eligible for catch-up HPV vaccination [10,[19][20][21][22].…”

“…Taken together, African immigrant adult women living in Europe, particularly those infected with HIV, appear to be at very high risk of developing cervical cancer and the catchup HPV vaccination in these women constitutes therefore a very promising complementary strategy for the prevention of cervical cancer [20][21][22]. However, it is still unclear whether catch-up HPV vaccination of immigrant women who are sexually active since a while at time of vaccine introduction would be feasible and beneficial.…”