The Use of the Quadrivalent Human Papillomavirus Vaccine (Gardasil) as Adjuvant Therapy in the Treatment of Recurrent Respiratory Papilloma

Young, David; Moore, Michael J.; Halstead, Lucinda A.

doi:10.1016/j.jvoice.2014.08.003

Cited by 65 publications

(45 citation statements)

References 47 publications

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“…Another prime target population for vaccination would be pregnant women with clinically obvious HPV genital disease at some time during pregnancy, as their risk of having a child with RRP is 1/400. We suggest that our data, together with other published data17, 18, 19, 20, 21 support the need for a large multi‐center, adequately powered, randomized, and placebo‐controlled trial of vaccination in RRP patients which would definitively answer the question.…”

Section: Discussionsupporting

confidence: 73%

Recurrent respiratory papillomatosis (RRP)–time for a reckoning?

Goon

Scholtz²,

Sudhoff³

2017

Laryngoscope Investig Oto

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ObjectivesRecurrent respiratory papillomatosis (RRP) is a rare disease, but one with severe morbidity and occasional mortality. The aetiological agent is human papillomavirus (HPV), and HPV types 6 and 11 account for over 90% of all cases. In the active phase of the disease, patients require multiple hospital admissions for surgical removal or ablation of these benign tumors, which are likely to obstruct the airways if left unchecked. Long‐term sequelae include scarring of the vocal cords, change in voice timbre, or even muteness if a tracheostomy is required. The aim of this study was to determine if adjuvant vaccination with the quadrivalent HPV L1 vaccine (Gardasil™) would decrease numbers of surgical treatments post‐vaccination.MethodsA prospective pilot study following a cohort of 12 RRP patients, all of whom gave fully informed consent to participate. All patients had their papillomas typed and if they were found to have types 6 or 11, were vaccinated at the time of first surgical treatment in the hospital, according to the manufacturer's protocols. Patients were followed up closely with 3 or 6 month follow‐up visits. Standard surgical treatments were given and were not affected by whether they participated in the study.ResultsWe found a >7‐fold decrease in the incidence rates of papillomatosis requiring surgical intervention from the pre‐vaccination period (47.44/1000 patient‐months) compared to the post‐vaccination period (6.71/1000 patient‐months).DiscussionSurgical treatments for RRP are robust markers for papillomata which require treatment because of the dangers of obstruction of the airway. Despite the small size of this cohort (due to the rarity of this disease), the data suggests that adjuvant use of quadrivalent HPV L1 vaccine imparts significant benefit to this group of patients. A large multi‐center randomized placebo controlled trial is required to definitively establish whether this hypothesis is true and can become the new standard of therapy.Level of Evidence3b

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Section: Discussionsupporting

confidence: 73%

Recurrent respiratory papillomatosis (RRP)–time for a reckoning?

Goon

Scholtz²,

Sudhoff³

2017

Laryngoscope Investig Oto

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“…However, the vaccine trials indicate that vaccination does not treat existing infection or disease. Despite case reports and retrospective reviews temporally associating vaccination with disease remission, there is currently no randomized trial evidence that vaccination is useful therapeutically in RRP patients . Rather, RRP may now be prevented via vaccination of females, therefore dramatically reducing the chance of infant exposure to HPV6/11.…”

Section: Introductionmentioning

confidence: 99%

“…Despite case reports and retrospective reviews temporally associating vaccination with disease remission, there is currently no randomized trial evidence that vaccination is useful therapeutically in RRP patients. [14][15][16][17] Rather, RRP may now be prevented via vaccination of females, therefore dramatically reducing the chance of infant exposure to HPV6/11. In Australia, a quadrivalent vaccine program (for females aged 12-26 years) commenced in 2007 and achieved high coverage.…”

Section: Introductionmentioning

confidence: 99%

Juvenile recurrent respiratory papillomatosis: 10‐year audit and Australian prevalence estimates

et al. 2016

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“…35 In this study, the MVA E2 vaccine proved to be a relatively safe treatment, in that none of the patients experienced any serious adverse events. In a recent clinical trial, there was a decrease in recurrences of RRP in patients vaccinated with Gardasil, but recurrences did occur within in a short time.…”

Section: Discussionmentioning

confidence: 64%

MVA E2 therapeutic vaccine for marked reduction in likelihood of recurrence of respiratory papillomatosis

Beltran

Ledezma²

2019

Head & Neck

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Background Recurrent respiratory papillomatosis (RRP) or laryngeal papillomatosis is a disease caused by papillomavirus infection. Methods In this phase I/II clinical trial, we evaluated the efficacy of the modified vaccinia Ankara (MVA) E2 virus in the treatment of RRP. Twenty‐nine patients (18 female and 11 male) underwent injection of MVA E2 directly into the borders of the vocal cords where lesions were seen and were monitored by direct laryngoscopy. The immune response was assessed by the determination of CD3+, CD4+, and CD8+ lymphocytes counts. The presence of papillomavirus was determined by polymerase chain reaction analysis. Results Lesions were completely eliminated in 13 patients (44.8%). In 16 patients (55.2%), lesions recurred between 6 and 18 months after treatment; these patients received a second round of treatment with MVA E2, and they are not seen with new recurrences. Conclusion The MVA E2 vaccine has excellent potential for generating complete regression of RRP lesions.

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The Use of the Quadrivalent Human Papillomavirus Vaccine (Gardasil) as Adjuvant Therapy in the Treatment of Recurrent Respiratory Papilloma

Cited by 65 publications

References 47 publications

Recurrent respiratory papillomatosis (RRP)–time for a reckoning?

Recurrent respiratory papillomatosis (RRP)–time for a reckoning?

Juvenile recurrent respiratory papillomatosis: 10‐year audit and Australian prevalence estimates

MVA E2 therapeutic vaccine for marked reduction in likelihood of recurrence of respiratory papillomatosis

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