Showing posts with label CIN. Show all posts
Showing posts with label CIN. Show all posts

Friday, October 12, 2018

FDA broadens the age range of Gardasil 9 to cover individuals 27 through 45 years old


The US Food and Drugs Administration (FDA) extended the use of Merck’s cervical cancer vaccine Gardasil 9 to include men and women aged 27 through 45 years.

"Today's approval represents an important opportunity to help prevent HPV-related diseases and cancers in a broader age range," Peter Marks, MD, Ph.D., director of the FDA's Center for Biologics Evaluation and Research, says in a news release.

"The Centers for Disease Control and Prevention has stated that HPV vaccination prior to becoming infected with the HPV types covered by the vaccine has the potential to prevent more than 90% of these cancers, or 31,200 cases every year, from ever developing," Marks says.

 "The CDC has made increasing HPV vaccination rates a public health priority,” said Jacques Cholat, M.D., president, Merck Vaccines, “and today’s recommendation for GARDASIL 9 is an important milestone in the shared effort to help further reduce the burden of HPV-related cancers and diseases.”

According to CDC, every year about 14 million Americans become infected with HPV; about 12,000 women are diagnosed with, and about 4,000 women die from cervical cancer caused by certain HPV viruses. Additionally, HPV viruses are associated with several other forms of cancer affecting men and women. 

FDA first approved Gardasil in 2006, to prevent certain cancers and diseases caused by HPV Types 6, 11, 16, and 18. Gardasil is no longer available in the US. Gardasil 9 received approval in 2014 for use in girls and women 9 through 26 years of age and boys 9 through 15 years of age for the prevention of the cancers and precancerous lesions of cervix, vulva, vagina, and anus caused by HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58.

The approval is based on results of a study involving 3,200 women, aged 27 through 45 years, followed for an average of 3.5 years, Gardasil was 88 percent effective in the prevention of a combined endpoint of persistent infection, genital warts, vulvar and vaginal precancerous lesions, cervical precancerous lesions, and cervical cancer related to HPV types covered by the vaccine.

"The FDA’s approval of Gardasil 9 in women 27 through 45 years of age is based on these results and new data on long-term follow-up from this study," the FDA said.

Similarly, in men aged 27 through 45 years of age, vaccine effectiveness was inferred based on data described above in women, along with efficacy data of Gardasil 9 in younger men aged 16 through 25 years, and immunogenicity data from a clinical trial in which 150 men, 27 through 45 years of age, received a 3-dose regimen of Gardasil over 6 months.

In all the safety and efficacy of Gardasil 9 was evaluated in a total of 13,000 males and females, the most commonly reported side effect being injection site pain, swelling, redness, and headaches.

The FDA granted the Gardasil 9 application priority review status. This program facilitates and expedites the review of medical products that address a serious or life-threatening condition.

Important Information about GARDASIL 9 (Human Papillomavirus 9-Valent Vaccine, Recombinant)

GARDASIL 9 does not eliminate the necessity for women to continue to undergo recommended cervical cancer screening.
Recipients of GARDASIL 9 should not discontinue anal cancer screening if it has been recommended by a health care provider.
GARDASIL 9 has not been demonstrated to protect against disease from vaccine HPV types to which a person has previously been exposed through sexual activity.
GARDASIL 9 has not been demonstrated to protect against diseases due to HPV types other than 6, 11, 16, 18, 31, 33, 45, 52, and 58.
GARDASIL 9 is not a treatment for external genital lesions; cervical, vulvar, vaginal, and anal cancers; or cervical intraepithelial neoplasia (CIN), vulvar intraepithelial neoplasia (VIN), vaginal intraepithelial neoplasia (VaIN), or anal intraepithelial neoplasia (AIN).
Not all vulvar, vaginal, and anal cancers are caused by HPV, and GARDASIL 9 protects only against those vulvar, vaginal, and anal cancers caused by HPV 16, 18, 31, 33, 45, 52 and 58.
Vaccination with GARDASIL 9 may not result in protection in all vaccine recipients.

Wednesday, October 12, 2016

ASCO issues new evidence based recommendations for global cervical cancer screening.

AmericanSociety of Clinical Oncology (ASCO)[i]  releases new resource stratified, evidence based global screening guidelines for secondary prevention of cervical cancer. ASCO called upon multidisciplinary, multinational team of cancer control, public health, oncology, epidemiology, primary care and patient advocacy experts to review the earlier guidelines and formulate recommendations according to the resources available.  

The panel of expert identified 7 existing guidelines, reviewed them and formed the evidence base, along with cost effective analysis and four systematic reviews leading to more than 75% agreement.

The basic aim of the guidelines was utilizing the resources available in countries across the globe to screen the maximum number of women to detect precancerous lesions and treatment and follow-up thereafter.

According to Medscape Surendra S. Shastri, MD, MBBS, co-chair of the ASCO expert panel that developed the guideline and professor of preventive oncology at Tata Memorial Center in Mumbai, India said "Every woman ― no matter where she lives ― should have at least one good cervical cancer screen in her lifetime, but unfortunately, we are not even close to that."

The guidelines were published online October 12 in the Journal of Global Oncology.[ii]

The countries around the world are divided into 4 tier based on available healthcare resources- maximal resources, enhanced resources, limited resources and basic resources. Countries with most resources are in the maximal resource group while countries with very limited resources were labelled as into basic resources group.

The panel then evaluated that what type of screening will be suitable for each tier.

Key Recommendations as published in the Journal of Global Oncology:

Primary Screening

  • Human papillomavirus (HPV) DNA testing is recommended in all resource settings.
  • Visual inspection with acetic acid may be used in basic settings.
  • The recommended age ranges and frequencies in each setting are as follows:
    • Maximal: 25-65 years, every 5 years
    • Enhanced: 30-65 years, if two consecutive negative tests at 5-years intervals, then every 10 years
    • Limited: 30-49 years, every 10 years
    • Basic: 30-49 years, one to three times per lifetime
Exiting Screening

  • Maximal and enhanced: ≥ 65 years with consistently negative results during past ≥ 15 years
  • Limited and basic: ≤ 49 years, resource-dependent; see specific recommendations
Triage

  • In basic settings, visual assessment for treatment may be used after positive HPV DNA testing results.
    • If visual inspection with acetic acid was used as primary screening with abnormal results, women should receive treatment.
  • For other settings, HPV genotyping and/or cytology may be used.
After Triage

  • Women with negative triage results should receive follow-up in 12 months.
  • In basic settings, women should be treated if there are abnormal or positive triage results.
  • In limited settings, women with abnormal results from triage should receive colposcopy, if available, or visual assessment for treatment, if colposcopy is not available.
  • In maximal and enhanced settings, women with abnormal or positive results from triage should receive colposcopy.
Treatment of Women With Precursor Lesions

  • In basic settings, treatment options are cryotherapy or loop electrosurgical excision procedure (LEEP).
  • In other settings, LEEP (if high level of quality assurance) or ablation (if medical contraindication to LEEP) is recommended.
  • Twelve-month post-treatment follow-up is recommended for all settings.
Special Populations

  • Women who are HIV positive or immunosuppressed for other reasons should be screened with HPV as soon as diagnosed and screened twice as many times in a lifetime as the general population.
  • The management of abnormal screening results for women with HIV and positive results of triage is the same as in the general population
  • Women should be offered primary screening 6 weeks postpartum in basic settings and 6 months postpartum in other settings.
  • Screening may be discontinued in women who have received a total hysterectomy for benign causes with no history of cervical dysplasia or HPV. Women who have received a subtotal hysterectomy (with an intact cervix) should continue receiving routine screening.




[i] https://pilotguidelines.atlassian.net/wiki/display/SPCCRG/Secondary+Prevention+of+Cervical+Cancer+Resource-Stratified+Guideline+Home
[ii] http://jgo.ascopubs.org/content/early/2016/10/08/JGO.2016.006577.full#abstract-1