Treatment of Vulvar Intraepithelial Neoplasia with Topical Imiquimod

• Published in: The New England journal of medicine Vol. 358; no. 14; pp. 1465 - 1473
• Main Authors: van Seters, Manon, van Beurden, Marc, ten Kate, Fiebo J.W, Beckmann, Ilse, Ewing, Patricia C, Eijkemans, Marinus J.C, Kagie, Marjolein J, Meijer, Chris J.M, Aaronson, Neil K, KleinJan, Alex, Heijmans-Antonissen, Claudia, Zijlstra, Freek J, Burger, Matthé P.M, Helmerhorst, Theo J.M
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 03.04.2008
• Subjects: Administration, Topical; Adult; Aged; Aminoquinolines - administration & dosage; Aminoquinolines - adverse effects; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - adverse effects; Antiviral agents; Biological and medical sciences; Biopsy; Carcinoma in Situ - drug therapy; Carcinoma in Situ - pathology; DNA, Viral - isolation & purification; Family medical history; Female; Follow-Up Studies; General aspects; Human papillomavirus; Humans; Medical sciences; Middle Aged; Papillomaviridae - genetics; Papillomaviridae - isolation & purification; Papillomavirus Infections - drug therapy; Pharmacology. Drug treatments; Quality of Life; Surgery; Vulvar Neoplasms - drug therapy; Vulvar Neoplasms - pathology; Immunomodulator; Medicine; Local administration; Treatment; Imiquimod; Antiviral; Vulva; Intraepithelial neoplasia
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa072685

The efficacy of local treatment of vulvar intraepithelial neoplasia with imiquimod, an immune-response modifier, was tested in a double-blind, randomized trial. As compared with placebo, imiquimod cream was effective in reducing or eliminating the lesion, relieving symptoms, and clearing the lesion of human papillomavirus. Imiquimod cream was effective in reducing or eliminating vulvar intraepithelial neoplasia, relieving symptoms, and clearing the lesion of human papillomavirus. Surgery, the treatment of choice for vulvar intraepithelial neoplasia, removes all visible lesions, with the aim of relieving symptoms and preventing vulvar cancer. 1 However, there are limitations to surgery. The percentage of lesions with positive surgical margins ranges from 24 to 68%. 2 , 3 Recurrences are common, because surgery does not eliminate human papillomavirus (HPV), the cause of most vulvar intraepithelial neoplasia. 4 , 5 Progression is not influenced by radical excision, 4 , 6 and surgery can mutilate the vulva, thereby causing psychosexual distress. 7 – 10 Thus, alternative treatments are needed. Vulvar intraepithelial neoplasia is caused by HPV, 11 which has prompted the use of imiquimod . . .