Clinical Investigation
Clinical research progress and implications of therapeutic vaccines for cervical cancer and precancerous lesions: a qualitative systematic review
Cai Shan, Miao Ke, Tan Xiaoyu, Cheng Si, Li Dantong, Zeng Xueyang, Yang Yu, Meng Ruogu, Liu Zhike, Li Yan, Li Keli, Sun Feng, Zhan Siyan
Published 2022-07-23
Cite as Chin J Oncol, 2022, 44(7): 743-760. DOI: 10.3760/cma.j.cn112152-20210824-00638
Abstract
ObjectiveTo systematically summarize and analyze the clinical research progress of therapeutic vaccines for cervical cancer or precancerous lesions.
MethodsEnglish databases (PubMed, Embase, Web of Science, Cochrane library, Proquest, and ClinicalTrails.gov) and Chinese databases (SinoMed, CNKI, WanFang, and VIP Database) were systematically searched to collect literature on therapeutic vaccines for cervical cancer or precancerous lesions from inception to February 18, 2021. After screening, we evaluated the risk of bias of included studies, and combed the basic information of the literature, research designs, information of vaccines, study patients, outcome indicators and so on, qualitatively summarized the clinical research progress.
ResultsA total of 71 studies were included in this systematic review, including 14 random controlled trials, 15 quasi-random controlled trials, 4 cohort studies, 1 case-control study, 34 case series studies and 3 case reports. The study patients included women aged 15~79 with cervical cancer or precancerous lesions in 18 countries from 1989 to 2021. On the one hand, there were 40 studies on therapeutic vaccines for cervical precancerous lesions (22 867 participants), involving 21 kinds of vaccines in 6 categories. Results showed 3 marketed vaccines (Cervarix, Gardasil, Gardasil 9) as adjuvant immunotherapies were significant effective in preventing the recurrence of precancerous lesions compared with the conization only. In addition, MVA E2 vaccine had been in phase Ⅲ clinical trials as a specific therapeutic vaccine, with relative literature showing it could eliminate most high-grade precancerous lesions. Therapeutic vaccines for precancerous lesions all showed good safety. On the other hand, there were 31 studies on therapeutic vaccines for cervical cancer (781 participants), involving 19 kinds of vaccines in 7categories, with none had been marketed. 25 studies were with no control group, showing the vaccines could effectively eliminate solid tumors, prevent recurrence, and prolong the median survival time. However, the vaccines effectiveness couldn′t be statistically calculated due to the lack of a control group. As for the safety of therapeutic vaccines for cervical cancer, 9 studies showed that patients experienced serious adverse events after treatments, where 7 studies reported that serious adverse events occurred in patients couldn′t be ruled out as the results of therapeutic vaccines.
ConclusionsThe literature review shows that the literature evidence for the therapeutic vaccines for cervical precancerous lesions is relatively mature compared with the therapeutic vaccines for cervical cancer. The four kinds of vaccines on the market are all therapeutic vaccines for precancerous lesions, but they are generally used as vaginal infection treatments or adjuvant immunotherapies for cervical precancerous lesions, not used for the specific treatments of cervical precancerous lesions. Other specific therapeutic vaccines are in the early stage of clinical trials, mainly phase Ⅰ/Ⅱ clinical trials with small sample size. The effectiveness and safety data are limited, and further research is still needed.
Key words:
Uterine cervical neoplasms; Human papillomavirus; Cervical precancerous lesions; Therapeutic vaccines
Contributor Information
Cai Shan
Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China
Miao Ke
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
Tan Xiaoyu
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
Cheng Si
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
Li Dantong
Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, China
Zeng Xueyang
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
Yang Yu
National Institute of Health Data Science, Peking University, Beijing 100191, China
Meng Ruogu
National Institute of Health Data Science, Peking University, Beijing 100191, China
Liu Zhike
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
Li Yan
National Center for Disease Control and Prevention, Beijing 100050, China
Li Keli
National Center for Disease Control and Prevention, Beijing 100050, China
Sun Feng
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
Zhan Siyan
Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
