Predicting Response In Cervical Intraepithelial Neoplasia to Topical Imiquimod Treatment
Catharina Ziekenhuis Eindhoven
410 participants
Jun 1, 2022
OBSERVATIONAL
Conditions
Summary
Imiquimod is a good non-invasive treatment option for women with cervical high-grade squamous intraepithelial neoplasia (cHSIL), especially those with a possible (future) pregnancy wish. Complete response to imiquimod occurs in 55-73% of patients, however side-effects of imiquimod are common and can be extensive. Therefore, biomarkers which can predict response to imiquimod therapy are warranted, to increase therapy efficacy and to avoid side effects in patients who will not respond. This prospective, multi-center cohort study aims to validate the potential of immune related biomarkers to predict the clinical response of patients with primary cHSIL to imiquimod, aims to explore the value of these immune biomarkers in recurrent/residual cHSIL to predict treatment responses for imiquimod and aims to explore their potential in spontaneous regression of cHSIL (CIN2).
Eligibility
Inclusion Criteria3
- Primary cHSIL lesions (e.g. CIN3 or CIN 2), histologically confirmed by diagnostic biopsy Nota bene: In case of CIN 2, expectative management must be discussed according to the Dutch national guideline with the patient, if the patient prefers imiquimod therapy the patient can be treated with imiquimod and enrolled in the study, if the patient prefers expectative management they can be enrolled in the observational CIN 2 group.
- Recurrent or residual cHSIL lesions after initial LLETZ treatment (e.g. CIN2 or CIN3), histologically confirmed by diagnostic biopsy
- Age of 18 years or older
Exclusion Criteria10
- Concomitant diagnoses of VAIN (vaginal intraepithelial neoplasia e.g. vaginal HSIL)
- PAP (Papanicolaou) 4 cytology as indication for the baseline colposcopy at study entrance
- Adenocarcinoma in situ (AIS) diagnosis
- Previous imiquimod therapy for cHSIL
- Previous cervical malignancy
- Current malignant disease
- Immunodeficiency (including HIV/AIDS and immunosuppressive medication)
- Pregnancy
- Legal incapability
- Insufficient knowledge of the Dutch language
Interventions
Imiquimod 5% will be administered in the evening by either a vaginal applicator or administered on a vaginal tampon for three times a week during 16 weeks. Treatment efficacy will be evaluated after 20 weeks, by colposcopy with diagnostic biopsies, and at 6 months after completion of imiquimod therapy with cytology and if indicated histology.
A vaginal swab will be taken from all patients at inclusion (before start of imiquimod), at colposcopy 20 weeks after start of imiquimod and at 6 months after completion of imiquimod treatment during follow-up appointment.
Expectative management of CIN 2 when preferred by the patient. Follow-up 6 months after baseline colposcopy with cytology and if indicated histology.
A vaginal swab will be taken from all patients at inclusion and at 6 months after inclusion during follow-up appointment.
Locations(15)
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NCT05405270