Der Onkologe

, Volume 18, Issue 1, pp 20–26

Primäre Prävention des Zervixkarzinoms und dessen Vorstufen

Leitthema
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Zusammenfassung

Die verfügbaren prophylaktischen HPV-Impfstoffe bestehen aus gentechnisch hergestellten DNA-freien Partikeln („virus-like particles“: VLP) der Hochrisiko-HPV-Typen 16 und 18, die mit 70% der Zervixkarzinome und mit einem substanziellen Anteil vulvärer, peniler, perianaler und oropharyngealer Tumore assoziiert sind. Einer der Impfstoffe enthält zusätzlich VLPs der Niedrigrisiko-HPV-Typen HPV 6 und -11 zum Schutz gegen Condylomata acuminata. In klinischen Studien mit einem Beobachtungszeitraum von bis zu 8,3 Jahren zeigte sich gegen Infektionen und Krebsvorstufen (CIN, VIN, VaIN) eine fast 100%ige Wirksamkeit gegen die Impfstoff-HPV-Typen. Wahrscheinlich aufgrund von kreuzneutralisierenden Antikörpern zeigt sich auch ein Schutz gegen verwandte HPV-Typen (z. B. HPV 31, HPV 45). Populationsbasierte Studien in Australien zeigten bereits 3 Jahre nach Impfeinführung einen Rückgang von zervikalen Krebsvorstufen und der Inzidenz von Condylomata acuminata um über 70%. Die Wirksamkeit gegen Zervixkarzinome wird sich frühestens in etwa 10 Jahren erkennen lassen. Zur Reduktion des Risikos der Infektion bei Frauen ist auch die Impfung von Männern sinnvoll. Ein direkter Nutzen für die Männer besteht in der Wirksamkeit des quadrivalenten Impfstoffs gegen Condylomata acuminata.

Schlüsselwörter

Zervixkarzinom Genitalwarzen HPV-Impfung Konisation Zervikale intraepitheliale Neoplasie 

Primary prevention of cervical cancer and premalignant stages

Abstract

The available prophylactic human papillomavirus (HPV) vaccines consist of recombinant virus-like particles (VLP) of high-risk HPV types 16 and 18 which are associated with 70% of cervical cancers as well as a substantial proportion of vulvar, penile, perianal and oropharyngeal tumors. One of the vaccines contains in addition VLPs of low-risk HPV types 6 and 11 for prevention of genital warts (condylomata acuminata). In clinical trials with up to 8.3 years of follow-up the vaccines demonstrated an efficacy of almost 100% against infection and the high-grade intraepithelial lesions (CIN, VIN, VaIN) induced by vaccine HPV types. Protection against related non-vaccine HPV types (e.g. HPV31, HPV45) has also been shown most probably due to cross-neutralizing antibodies. Population-based trials in Australia demonstrated a reduction in cervical dysplasia and in the incidence of genital warts by more than 70% only 3 years after initiation of the vaccination campaign. Prevention of cases of cervical cancer will only be realized approximately 10 years after introduction of the vaccine. Vaccinating males is a reasonable means to reduce the risk of infection in women and also provides them with a direct benefit through the recently documented efficacy of the quadrivalent vaccine against genital warts.

Keywords

Cervical cancer Genital warts HPV vaccination Conization Cervical intraepithelial neoplasia 

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Klinik für GynäkologieLabor Gynäkologische Tumorimmunologie, Charité - Universitätsmedizin Berlin, CCM/CBFBerlinDeutschland

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