Abstract
CIN is clearly caused by HPV infection, but the pathogenesis is thought to differ between CIN1 and CIN2/3. A recent morphological definition classifies CIN1 (LSIL) as a lesion indicating HPV infection and CIN2/3 (HSIL) as a neoplastic lesion. No treatment is needed for CIN1 because it has no symptoms and mostly regresses spontaneously. However, CIN2/3 is a precancerous lesion of cervical cancer and is therefore considered to be a candidate for treatment intervention to reduce the risk of cervical cancer. The only treatment available for CIN2/3 at present is surgical treatment. However, it is not clear why a therapeutic drug remains undeveloped for CIN2/3. In this review, we discuss the current progress in drug discovery for CIN2/3.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Sakakibara A, Nakayama T, Uchida H, Odagiri Y, Ito Y, Katayama T, Ueda Y, Higuchi T, Terakawa K, Matsui K, Miyazaki K, Konishi I. Trends and future projections of cervical cancer-related outcomes in Japan: what happens if the HPV vaccine program is not implemented? Int J Cancer. 2022;152:1863. https://doi.org/10.1002/ijc.34391; Online ahead of print.
Yagi A, Ueda Y, Nakagawa S, Ikeda S, Tanaka Y, Sekine M, Miyagi E, Enomoto T, Kimura T. Potential for cervical cancer incidence and death resulting from Japan’s current policy of prolonged suspension of its governmental recommendation of the HPV vaccine. Sci Rep. 2020;10(1):15945. https://doi.org/10.1038/s41598-020-73106-z.
Bruni L. Global estimates of human papillomavirus vaccination coverage by region and income level: a pooled analysis. Lancet Glob Health. 2016;4(7):e453–63.
A global strategy for elimination of cervical cancer—PAHO/WHO. Pan American Health Organization. https://www.paho.org/en/towardshealthier-generations-free-diseases/global-strategy-elimination-cervical-cancer. Accessed 3 May 2022.
Kyrgiou M, Athanasiou A, Kalliala IEJ, et al. Obstetric outcomes after conservative treatment for cervical intraepithelial lesions and early invasive disease. Cochrane Database Syst Rev. 2017;11(11):CD012847. https://doi.org/10.1002/14651858.CD012847.
Inaba K, Nagasaka K, Kawana K, Arimoto T, Matsumoto Y, Tsuruga T, Mori-Uchino M, Miura S, Sone K, Oda K, Nakagawa S, Yano T, Kozuma S, Fujii T. High-risk human papillomavirus correlates with recurrence after laser ablation for treatment of patients with cervical intraepithelial neoplasia 3: a long-term follow-up retrospective study. J Obstet Gynaecol Res. 2014;40(2):554–60. https://doi.org/10.1111/jog.12196.
Chung HC, Ros W, Delord JP, Perets R, Italiano A, Shapira-Frommer R, Manzuk L, Piha-Paul SA, Xu L, Zeigenfuss S, Pruitt SK, Leary A. Efficacy and safety of Pembrolizumab in previously treated advanced cervical cancer: results from the phase II KEYNOTE-158 study. J Clin Oncol. 2019;37(17):1470–8. https://doi.org/10.1200/JCO.18.01265.
Tewari KS, Monk BJ, Vergote I, Miller A, de Melo AC, Kim HS, Kim YM, Lisyanskaya A, Samouëlian V, Lorusso D, Damian F, Chang CL, Gotovkin EA, Takahashi S, Ramone D, Pikiel J, Maćkowiak-Matejczyk B, Guerra AlÃa EM, Colombo N, Makarova Y, Rischin D, Lheureux S, Hasegawa K, Fujiwara K, Li J, Jamil S, Jankovic V, Chen CI, Seebach F, Weinreich DM, Yancopoulos GD, Lowy I, Mathias M, Fury MG, Oaknin A, Investigators for GOG protocol 3016 and ENGOT protocol En-Cx9. Survival with cemiplimab in recurrent cervical cancer. N Engl J Med. 2022;386(6):544–55. https://doi.org/10.1056/NEJMoa2112187.
Loopik DL, Bentley HA, Eijgenraam MN, IntHout J, Bekkers RLM, Bentley JR. The natural history of cervical intraepithelial neoplasia grades 1, 2, and 3: a systematic review and meta-analysis. J Low Genit Tract Dis. 2021;25(3):221–31. https://doi.org/10.1097/LGT.0000000000000604.
Matsumoto K, Oki A, Furuta R, Maeda H, Yasugi T, Takatsuka N, Mitsuhashi A, Fujii T, Hirai Y, Iwasaka T, Yaegashi N, Watanabe Y, Nagai Y, Kitagawa T, Yoshikawa H; Japan HPV And Cervical Cancer Study Group, Predicting the progression of cervical precursor lesions by human papillomavirus genotyping: a prospective cohort study., Int J Cancer 2011;128(12):2898–2910. doi: https://doi.org/10.1002/ijc.25630.
Einstein MH, Kadish AS, Burk RD, Kim MY, Wadler S, Streicher H, Goldberg GL, Runowicz CD. Heat shock fusion protein-based immunotherapy for treatment of cervical intraepithelial neoplasia III. Gynecol Oncol. 2007;106:453–60.
Maldonado L, Teague JE, Morrow MP, Jotova I, Wu TC, Wang C, Desmarais C, Boyer JD, Tycko B, Robins HS, Clark RA, Trimble CL. Intramuscular therapeutic vaccination targeting HPV16 induces T cell responses that localize in mucosal lesions. Sci Transl Med. 2014;6(221):221ra13. https://doi.org/10.1126/scitranslmed.3007323.
Kawana K, Adachi K, Kojima S, Taguchi A, Tomio K, Yamashita A, Nishida H, Nagasaka K, Arimoto T, Yokoyama T, Wada-Hiraike O, Oda K, Sewaki T, Osuga Y, Fujii T. Oral vaccination against HPV E7 for treatment of cervical intraepithelial neoplasia grade 3 (CIN3) elicits E7-specific mucosal immunity in the cervix of CIN3 patients. Vaccine. 2014;32:6233–9. https://doi.org/10.1016/j.vaccine.2014.09.020.
Harper DM, Nieminen P, Donders G, EinsteinMH GF, Huh WK, Stoler MH, Glavini K, Attley G, Limacher JM, Bastien B, Calleja E. The efficacy and safety of Tipapkinogen Sovacivec therapeutic HPV vaccine in cervical intraepithelial neoplasia grades 2 and 3: randomized controlled phase II trial with 2.5 years of follow-up. Gynecol Oncol. 2019;153(3):521–9. https://doi.org/10.1016/j.ygyno.2019.03.250.
Alvarez RD, Huh WK, Bae S, Lamb LS Jr, Conner MG, Boyer J, Wang C, Hung CF, Sauter E, Paradis M, Adams EA, Hester S, Jackson BE, Wu TC, Trimble CL. A pilot study of pNGVL4a-CRT/E7(detox) for the treatment of patients with HPV16+ cervical intraepithelial neoplasia 2/3 (CIN2/3). Gynecol Oncol. 2016;140(2):245–52. https://doi.org/10.1016/j.ygyno.2015.11.026.
Trimble CL, Morrow MP, Kraynyak KA, Shen X, Dallas M, Yan J, Edwards L, Parker RL, Denny L, Giffear M, Brown AS, Marcozzi-Pierce K, Shah D, Slager AM, Sylvester AJ, Khan A, Boderick KE, Juba R, Herring TA, Boyer J, Lee J, Sardesai NY, Weiner DB, Bagarazzi ML. Safety, efficacy, and immunogenicity of VGX-3100, a therapeutic synthetic DNA vaccine targeting human papillomavirus 16 and 18 E6 and E7 proteins for cervical intraepithelial neoplasia 2/3: a randomised, double-blind, placebo-controlled phase 2b trial. Lancet. 2015;386(10008):2078–88. https://doi.org/10.1016/S0140-6736(15)00239-1.
Stratton SL, Spencer HJ, Greenfield WW, Low G, Hitt WC, Quick CM, Jeffus SK, Blackmon V, Nakagawa M. A novel use of a statewide telecolposcopy network for recruitment of participants in a phase I clinical trial of a human papillomavirus therapeutic vaccine. Clin Trials. 2015;12(3):199–204. https://doi.org/10.1177/1740774514566333.
Coleman HN, Greenfield WW, Stratton SL, Vaughn R, Kieber A, Moerman-Herzog AM, Spencer HJ, Hitt WC, Quick CM, Hutchins LF, Mackintosh SG, Edmondson RD, Erickson SW, Nakagawa M. Human papillomavirus type 16 viral load is decreased following a therapeutic vaccination. Cancer Immunol Immunother. 2016;65(5):563–73. https://doi.org/10.1007/s00262-016-1821-x.
Ikeda Y, Uemura Y, Asai-Sato M, Nakao T, Nakajima T, Iwata T, Akiyama A, Satoh T, Yahata H, Kato K, Maeda D, Aoki D, Kawana K. Safety and efficacy of mucosal immunotherapy using human papillomavirus (HPV) type 16 E7-expressing lactobacillus-based vaccine for the treatment of high-grade squamous intraepithelial lesion (HSIL): the study protocol of a randomized placebo-controlled clinical trial (MILACLE study). Jpn J Clin Oncol. 2019;49:877–80. https://doi.org/10.1093/jjco/hyz095.
Park YC, Ouh YT, Sung MH, Park HG, Kim TJ, Cho CH, Park JS, Lee JK. A phase 1/2a, dose-escalation, safety and preliminary efficacy study of oral therapeutic vaccine in subjects with cervical intraepithelial neoplasia 3. J Gynecol Oncol. 2019;30(6):e88. https://doi.org/10.3802/jgo.2019.30.e88.
Choi YJ, Hur SY, Kim TJ, Hong SR, Lee JK, Cho CH, Park KS, Woo JW, Sung YC, Suh YS, Park JS. A phase II, prospective, randomized, multicenter, open-label study of GX-188E, an HPV DNA vaccine, in patients with cervical intraepithelial neoplasia 3. Clin Cancer Res. 2020;26(7):1616–23. https://doi.org/10.1158/1078-0432.CCR-19-1513.
Kojima S, Kawana K, Fujii T, Yokoyama T, Miura S, Tomio K, Tomio A, Yamashita A, Adachi K, Sato H, Nagamatsu T, Schust DJ, Kozuma S, Taketani Y. Characterization of gut-derived intraepithelial lymphocyte (IEL) residing in human papillomavirus (HPV)-infected intraepithelial neoplastic lesions. Am J Reprod Immunol. 2011;66:435–43.
Adachi K, Kawana K, Yokoyama T, et al. Oral immunization with lactobacillus casei vaccine expressing human papillomavirus (HPV) type 16 E7 is an effective strategy to induce mucosal cytotoxic lymphocyte against HPV16 E7. Vaccine. 2010;28:2810–7.
Komatsu A, Igimi S, Kawana K. Optimization of human papillomavirus (HPV) type 16 E7-expressing lactobacillus-based vaccine for induction of mucosal E7-specific IFNγ-producing cells. Vaccine. 2018;36(24):3423–6.
Ikeda Y, Uemura Y, Asai-Sato M, Nakao T, Nakajima T, Iwata T, Akiyama A, Satoh T, Yahata H, Kato K, Maeda D, Aoki D, Kawana K. Safety and efficacy of mucosal immunotherapy using human papillomavirus (HPV) type 16 E7-expressing lactobacillus-based vaccine for the treatment of high-grade squamous intraepithelial lesion (HSIL): the study protocol of a randomized placebo-controlled clinical trial (MILACLE study). Jpn J Clin Oncol. 2019;49:877–80.
Acknowledgments
We thank H. Nikki March, PhD, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2024 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
About this chapter
Cite this chapter
Kawana, K. (2024). Clinical Management of CIN Including Recent Therapeutic Strategies. In: Aoki, D. (eds) Recent Topics on Prevention, Diagnosis, and Clinical Management of Cervical Cancer. Comprehensive Gynecology and Obstetrics. Springer, Singapore. https://doi.org/10.1007/978-981-99-9396-3_7
Download citation
DOI: https://doi.org/10.1007/978-981-99-9396-3_7
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-99-9395-6
Online ISBN: 978-981-99-9396-3
eBook Packages: MedicineMedicine (R0)