Showing posts with label HPV nanovalent. Show all posts
Showing posts with label HPV nanovalent. 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.

Thursday, March 23, 2017

ASCO issues first global resource stratified guidelines for HPV vaccination for the prevention of cervical cancer.


ASCO today issued first guidelines on primary prevention of cervical cancer that can be used by physicians around the globe as it is tailored according to region, social and economic settings and healthcare resources available. The guidelines were published online in Journal of Global Oncology. [1]


HPV Vaccine 
The guidelines offer four levels of recommendations: basic, limited, enhanced and maximal based on the country’s healthcare circumstances and were developed by experts from multiple disciplines representing various countries across the globe.

The final recommendations were based on modified guidelines from WHO, CDC, and Canadian guidelines. 

Virtually all cervical cancers are caused by HPV infections and coverage with HPV vaccines in the female population could reduce up to 90% of cervical cancer incidence worldwide based on current vaccine availability and HPV worldwide distribution.

According to WHO “A large majority (around 85%) of the global burden occurs in the less developed regions, where it accounts for almost 12% of all female cancers.”  It further states that “Two HPV vaccines are now being marketed in many countries throughout the world - a bivalent and a quadrivalent vaccine. Both vaccines are highly efficacious in preventing infection with virus types 16 and 18, which are together responsible for approximately 70% of cervical cancer cases globally.”


Courtesy:elbiruniblogspotcom.blogspot.com


Currently, there are three prophylactic HPV vaccines approved and recommended in the United States, Europe, and many regions and countries: the bivalent (2vHPV; against HPV 16 and 18), quadrivalent (4vHPV; against HPV 6, 11, 16, and 18), and nine valent (9vHPV; against HPV 6, 11, 16, 18, 31, 33, 45, 52 and 58).




Although these guidelines specifically mention cervical cancer, vaccination also protects against other HPV-related cancers, such as other anogenital and potentially oropharyngeal cancers.

Vaccination strategy for girls.

So, in all resource settings two doses of HPV vaccines are recommended for girls age 9 to 14 years, with an interval of at least 6 months and possibly up to 12 to 15 months.

In maximal and enhanced settings, if the girls have reached age 15 or more and received the first dose before the age of 15 they may complete the series before age 26. If they did not receive any dose before 15 years than they should receive 3 doses and the series can be complete till 26 years of age.

In basic and limited resource setting, girls who received single dose can received additional dose between 15 to26 years if enough resources still exist for two dose vaccination among girls between 9-14years of age.

Vaccination strategy for boys.

In Basic settings boy’s vaccination is not recommended, while in limited, enhanced and maximal settings boys can receive vaccination if more than 50% of target female population are immunized, resources and infrastructure exist for boy's vaccination.. The same age related strategy should be applied as girls. This prevents the noncervical human papillomavirus–related cancers and diseases.

Vaccination strategies in special populations: These recommendations are uniform in all resource settings.

Women who are immunocompromised or HIV positive should be immunized according to the age group, but they should receive 3 doses.

Vaccines is not recommended in pregnant women nor women receiving treatment of cervical cancer precursor lesions (cervical intraepithelial neoplasia grade ≥ 2; eg, conization, loop electrosurgical excision process, or cryotherapy; all resource settings).

The latest vaccine coverage data by CDC shows that Six out of 10 teen girls (63 percent) and five out of 10 teen boys (50 percent) in the United States have started the HPV vaccination series (i.e., received at least one dose of HPV vaccine), according to data from the 2015 National Immunization Survey-Teen (NIS-Teen).[2]

The full text of the ASCO recent guidelines can be accessed here.

American Society of Clinical Oncology (ASCO) have released new resource stratified, evidence based global screening guidelines for secondary prevention of cervical cancer which can be accessed here.

The American Society of Clinical Oncology (ASCO) has issued recommendation on managing invasive cervical cancer which can be accessed here.




[1] http://ascopubs.org/doi/full/10.1200/JGO.2016.008151
[2] https://www.cdc.gov/hpv/hcp/vacc-coverage.html