The Effects of 5% Imiquimod Cream on High-Grade Vulval Intraepithelial Neoplasia

Todd, Richard W.; Etherington, Ian J.; Luesley, David

doi:10.1006/gyno.2001.6539

Cited by 70 publications

(33 citation statements)

References 8 publications

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“…Patients frequently either stopped treatment or applied the cream less often. These results are in agreement with those of Todd et al, 16 who reported that 11 of the 13 patients whom they followed up (2 patients were lost to follow-up) developed local adverse effects. In the other published studies, topical intolerance was frequently reported but rarely led to treatment withdrawal.…”

Section: Commentsupporting

confidence: 83%

“…However, the authors did not fully define the term extensive. Todd et al, 16 Jayne and Kaufman, 17 and van Seters et al 18 also did not specify the extent of the lesions in their patients. In future studies, response to treatment should be assessed according to the vulvar area initially involved.…”

Section: Commentmentioning

confidence: 99%

“…24 As far as topical treatment is concerned, flulike symptoms did not occur with a significant frequency in the controlled trials concerning AGWs. 9 Among the studies concerning VIN treatment with imiquimod, only Todd et al 16 mentioned flulike symptoms in 2 of the 13 patients whom they followed up. These symptoms could result from imiquimod-induced cytokine release by responding cells within the lesion 25 and/or in the bloodstream.…”

Section: Commentmentioning

confidence: 99%

“…In the published studies on imiquimod-treated VIN, follow-up for recurrence after complete remission was performed in only 10 of 52 patients (Table 2). [13][14][15][16] Additional studies are needed to determine if, compared with other treatments, imiquimod reduces the recurrence rate of undifferentiated VIN as observed in the treatment of AGWs. Indeed, according to the literature, recurrence rates of AGWs treated with 5% imiquimod vary from 13% to 19%, 19,20 whereas recurrence rates of those treated with podophyllin vary from 30% to 70% and from 58% to 70% with topical fluorouracil.…”

Section: Commentmentioning

confidence: 99%

See 3 more Smart Citations

Treatment of Undifferentiated Vulvar Intraepithelial Neoplasia With 5% Imiquimod Cream

Wendling

Saïag²,

Berville-Levy³

et al. 2004

Arch Dermatol

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Section: Commentsupporting

confidence: 83%

Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

See 2 more Smart Citations

Treatment of Undifferentiated Vulvar Intraepithelial Neoplasia With 5% Imiquimod Cream

Wendling

Saïag²,

Berville-Levy³

et al. 2004

Arch Dermatol

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“…Il s'agit d'un traitement topique, n'ayant pas d'action antivirale directe, mais qui agit comme immunomodulateur local, modifiant et stimulant la production d'interféron ␣ et de cytokines. Les taux de réponses sont variables, entre 30 et 50%, et les taux de récidives chez les patientes ayant répondu au traitement se situent entre 30 et 50% [21,22] .…”

Section: Traitement Non Classique Des Vinunclassified

Diagnostic et prise en charge des néoplasies intraépithéliales vulvaires et des cancers invasifs de la vulve

Sauthier¹,

Petignat²

2007

Gynäkol Geburtshilfliche Rundsch

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Medical interventions for high grade vulval intraepithelial neoplasia

Pepas¹,

Kaushik²,

Bryant³

et al. 2011

Cochrane Database of Systematic Reviews

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Background Vulval intraepithelial neoplasia (VIN) is a pre-malignant condition of the vulval skin; its incidence is increasing in women under 50 years. VIN is graded histologically as low grade or high grade. High grade VIN is associated with infection with human papilloma virus (HPV) infection and may progress to invasive disease. There is no consensus on the optimal management of high grade VIN. The high morbidity and high relapse rate associated with surgical interventions call for a formal appraisal of the evidence available for less invasive but effective interventions for high grade VIN. Objectives To evaluate the effectiveness and safety of medical interventions for high grade VIN. Search methods We searched the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 3), MEDLINE and EMBASE (up to September 2010). We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. Selection criteria Randomised controlled trials (RCTs) that assessed medical interventions, in adult women diagnosed with high grade VIN. Data collection and analysis Two review authors independently abstracted data and assessed risk of bias. Where possible the data were synthesised in a meta-analysis. Main results Four trials met our inclusion criteria: three assessed the effectiveness of topical imiquimod versus placebo in women with high grade VIN; one examined low versus high dose indole-3-carbinol in similar women. Meta-analysis of three trials found that the proportion of women who responded to treatment at 5 to 6 months was much higher in the group who received topical imiquimod than in the group who received placebo (relative risk (RR) = 11.95, 95% confidence interval (CI) 3.21 to 44.51). A single trial showed similar results at 12 months in (RR = 9.10, 95% CI 2.38 to 34.77). Only one trial reported adverse events, which were more common in the imiquimod group. One trial found no significant differences in quality of life (QoL) or body image between the imiquimod and placebo groups. Authors’ conclusions Imiquimod appears to be effective, but its safety needs further examination. Its use is associated with side effects which are tolerable, but more extensive data on adverse effects are required. Long term follow-up should be mandatory in view of the known progression of high grade VIN to invasive disease. Alternative medical interventions, such as cidofovir, should be explored.

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The Effects of 5% Imiquimod Cream on High-Grade Vulval Intraepithelial Neoplasia

Cited by 70 publications

References 8 publications

Treatment of Undifferentiated Vulvar Intraepithelial Neoplasia With 5% Imiquimod Cream

Treatment of Undifferentiated Vulvar Intraepithelial Neoplasia With 5% Imiquimod Cream

Diagnostic et prise en charge des néoplasies intraépithéliales vulvaires et des cancers invasifs de la vulve

Medical interventions for high grade vulval intraepithelial neoplasia

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