- 作者：Prof Matti Lehtinen ; PhDa ; matti.lehtinen@uta.fi ; Prof Jorma Paavonen ; MDb ; Prof Cosette M Wheeler ; PhDc ; Prof Unnop Jaisamrarn ; MDd ; Prof Suzanne M Garland ; FRCPAe ; Xavier Castellsagué ; PhDf ; S Rachel Skinner ; PhDg ; Dan Apter ; MDh ; Prof Paulo Naud ; PhDi ; Prof Jorge Salmeró ; n ; PhDj ; Prof Song-Nan Chow ; MDk ; Prof Henry Kitchener ; MDl ; Jú ; lio C Teixeira ; MDm ; James Hedrick ; MDn ; Prof Genara Limson ; MDo ; Anne Szarewski ; PhDp ; Prof Barbara Romanowski ; MDq ; Prof Fred Y Aoki ; MDr ; Prof Tino F Schwarz ; MDs ; Prof Willy A J Poppe ; PhDt ; Prof Newton S De Carvalho ; PhDu ; Maria Julieta V Germar ; MDv ; Klaus Peters ; MDw ; Prof Adrian Mindel ; MDx ; Philippe De Sutter ; MDy ; F Xavier Bosch ; PhDf ; Marie-Pierre David ; MScz ; Dominique Descamps ; MDz ; Frank Struyf ; MDz ; Gary Dubin ; MDaa ; for the HPV PATRICIA Study Group&Dagger ;
- 刊名：Lancet Oncology
- 出版年：2012
- 出版时间：January 2012
- 年：2012
- 卷：13
- 期：1
- 页码：89-99
- 全文大小：485 K
Summary
Background
Cervical intraepithelial neoplasia grade 2 or greater (CIN2+) is the surrogate endpoint used in licensure trials of human papillomavirus (HPV) vaccines. Vaccine efficacy against CIN3+, the immediate precursor to invasive cervical cancer, is more difficult to measure because of its lower incidence, but provides the most stringent evidence of potential cancer prevention. We report vaccine efficacy against CIN3+ and adenocarcinoma in situ (AIS) in the end-of-study analysis of PATRICIA (PApilloma TRIal against Cancer In young Adults).Methods
Healthy women aged 15-25 years with no more than six lifetime sexual partners were included in PATRICIA, irrespective of their baseline HPV DNA status, HPV-16 or HPV-18 serostatus, or cytology. Women were randomly assigned (1:1) to receive an HPV-16/18 AS04-adjuvanted vaccine or a control hepatitis A vaccine via an internet-based central randomisation system using a minimisation algorithm to account for age ranges and study sites. The patients and study investigators were masked to allocated vaccine. The primary endpoint of PATRICIA has been reported previously. In the present end-of-study analysis, we focus on CIN3+ and AIS in the populations of most clinical interest, the total vaccinated cohort (TVC) and the TVC-naive. The TVC comprised all women who received at least one vaccine dose, approximating catch-up populations and including sexually active women (vaccine n=9319; control=9325). The TVC-naive comprised women with no evidence of oncogenic HPV infection at baseline, approximating early adolescent HPV exposure (vaccine n=5824; control=5820). This study is registered with , number .
Findings
Vaccine efficacy against CIN3+ associated with HPV-16/18 was 100 % (95 % CI 85¡¤5-100) in the TVC-naive and 45¡¤7 % (22¡¤9-62¡¤2) in the TVC. Vaccine efficacy against all CIN3+ (irrespective of HPV type in the lesion and including lesions with no HPV DNA detected) was 93¡¤2 % (78¡¤9-98¡¤7) in the TVC-naive and 45¡¤6 % (28¡¤8-58¡¤7) in the TVC. In the TVC-naive, vaccine efficacy against all CIN3+ was higher than 90 % in all age groups. In the TVC, vaccine efficacy against all CIN3+ and CIN3+ associated with HPV-16/18 was highest in the 15-17 year age group and progressively decreased in the 18-20 year and 21-25 year age groups. Vaccine efficacy against all AIS was 100 % (31¡¤0-100) and 76¡¤9 % (16¡¤0-95¡¤8) in the TVC-naive and TVC, respectively. Serious adverse events occurred in 835 (9¡¤0 % ) and 829 (8¡¤9 % ) women in the vaccine and control groups, respectively; only ten events (0¡¤1 % ) and five events (0¡¤1 % ), respectively, were considered to be related to vaccination.
Interpretation
PATRICIA end-of-study results show excellent vaccine efficacy against CIN3+ and AIS irrespective of HPV DNA in the lesion. Population-based vaccination that incorporates the HPV-16/18 vaccine and high coverage of early adolescents might have the potential to substantially reduce the incidence of cervical cancer.
Funding
GlaxoSmithKline Biologicals.