From Medicineworld.org: Immunotherapy for precancerous changes of the cervix
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Immunotherapy for precancerous changes of the cervix
Dr. Daron G. FerrisImmunotherapy for premalignant changes of the cervix.
Whether young women with premalignant changes of the cervix can avoid surgery by using an agent that helps the immune system target the virus responsible is under study at the Medical College of Georgia.
"Infection with human papillomavirus initiates these premalignant changes and this treatment uses that fact to target the lesions," says Dr. Daron G. Ferris, family medicine physician, colposcopist and director of the Gynecologic Cancer Prevention Center at the Medical College of Georgia. "We are telling the immune system to go find HPV and eliminate it. When the immune system attacks the HPV, it also attacks the premalignant changes".
Human papillomavirus is the most common sexually transmitted disease in the country and the major cause of cervical cancer, Dr. Ferris says. Strains that cause cervical cancer get inside cells in the cervix and slowly change them. "In the beginning, women commonly have mild premalignant changes. The good news is, most of the time, these mild changes go away on their own. About 70 percent of the time, we don't have to do any therapy other than following patients closely," Dr. Ferris says.
Unfortunately, cells may also develop moderate to severe changes called cervical dysplasia. "These are true cancer precursors. There is a 30 to 50 percent chance that severe dysplasia will progress to cancer if they are not treated," Dr. Ferris says.
An abnormal Pap smear detects such abnormalities and colposcopy, a technique for examining the cervix for signs of premalignant or malignant cellular changes, typically is performed in follow up. Tests also may be performed to detect the 13 oncogenic strains of HPV.
Patients who have cervical dysplasia may get one of several surgical approaches to remove affected cells and adjacent tissue. "We want to make sure there is only normal, healthy, unexposed skin left after surgery so that when the woman heals, there is no disease left behind," Dr. Ferris says. These approaches, which are 90 percent to 95 percent effective, require removing some of the cervix's mucus-secreting tissue, which can reduce fertility and increase chances of premature delivery.
"We are really excited about the potential of this treatment," says Dr. Ferris, a principal investigator for the study. "If it works, it could mean a lot less surgery for these young women who most doctors would prefer not to operate on." .
The new therapy, classified as gene treatment by the Food and Drug Administration, includes three injections spaced three weeks apart of ZYC101a, an immunotherapeutic agent that contains pieces of dead HPV.
"The drug directs the immune system to attack anything that looks like a portion of HPV. The body identifies the pieces of HPV and makes antibodies to fight them." Much like vaccines that contain dead virus, this immunotherapy cannot transmit disease, Dr. Ferris says.
The hope is HPV and the abnormal cells will be eliminated so cervical tissue can be saved and potential consequences, such as the increased risk of a premature childbirth, can be avoided, Dr. Ferris says. He notes that most abnormal Pap smears are in women in the child-bearing ages of 20 to 40.
MCG is enrolling women age 25 or younger with moderate to severe cervical dysplasia who have still not had surgery. Two-thirds of the women will get the agent and a third will get placebo, says Dr. Eileen D. Dickman, clinical researcher and coordinator of the MCG Gynecologic Cancer Prevention Center, who is coordinating the study at MCG.
All participants will be followed for 12 and one-half months with regular Pap smears and colposcopic examinations, Dr. Dickman says. Women who get placebo will receive a standard surgical therapy after the study if needed. She notes that any of the women who begin to show signs of advancing disease during that year will be pulled out of the study and get surgery.
Three years ago, MCG participated in a study of ZYC101a, which included women of any age with moderate to severe premalignant changes of the cervix, that found it no more protective than placebo in all except the younger women, Dr. Ferris says. That finding prompted this new study.
"We think the immunotherapeutic agent is better at clearing up disease that has not been there for long time," he says. "It also may be that the younger person's immune system is a little more robust and the immunotherapeutic agent has a greater chance of clearing it than in someone who is older".
By Toni Baker
Source: Medical College of Georgia
Did you know?
Immunotherapy for premalignant changes of the cervix. Whether young women with premalignant changes of the cervix can avoid surgery by using an agent that helps the immune system target the virus responsible is under study at the Medical College of Georgia. "Infection with human papillomavirus initiates these premalignant changes and this treatment uses that fact to target the lesions," says Dr. Daron G. Ferris, family medicine physician, colposcopist and director of the Gynecologic Cancer Prevention Center at the Medical College of Georgia. "We are telling the immune system to go find HPV and eliminate it. When the immune system attacks the HPV, it also attacks the premalignant changes".
Medicineworld.org: Immunotherapy for precancerous changes of the cervix
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