9-Valent HPV Vaccine in Managing Squamous Cell Carcinoma: Case Report
Posted: Thursday, April 23, 2020
In a recent case study published in SKIN–The Journal of Cutaneous Medicine, an immunocompetent 84-year-old woman presented to a university-based outpatient dermatology clinic with more than 20 dome-shaped crusted nodules on her right leg. Histopathologic examination of one of the nodules revealed an invasive squamous cell carcinoma of the keratoacanthoma variant. Since invasive therapy was deemed impractical, the clinicians agreed on a more novel approach of injecting the patient with the 9-valent human papillomavirus (HPV) vaccine. Surprisingly, 10 months after the first dose, the patient’s skin displayed neither clinical nor histologic evidence of any residual cancer.
According to the study authors, Solomon Geizhals, BA, and Mark G. Lebwohl, MD, of the Icahn School of Medicine at Mount Sinai, New York, the patient initially was prescribed an oral retinoid at 25 mg/day for both psoriasis and multiple keratoacanthomas. After 3 months of treatment, the tumors cleared up, and the underlying psoriatic plaque nearly disappeared. However, due to patient complaints of increased skin dryness, cheilitis, and mild hair loss, the dosage was decreased to 10 mg every other day along with concurrent betamethasone dipropionate 0.05% ointment twice daily for 4 weeks and then twice per week. Unfortunately, 5 months later, there was a recurrence of multiple histopathologically confirmed keratoacanthomas. After the patient declined increasing the retinoid dosage or receiving systemic therapy, it was decided to treat her with off-label vaccine therapy.
The investigators noted that recent evidence suggests that HPV, specifically the β-HPV subtypes 5, 8, 15, 17, 20, 24, 36, and 38, contributes to the pathogenesis of squamous cell carcinoma. “Regardless of the exact pathogenesis,” noted the authors, “the growing evidence showing the association between the prevalence of squamous cell carcinoma and HPV infection can potentially help to create new therapeutic avenues in reducing cutaneous malignancy prevalence.”
Disclosure: The study authors reported no conflicts of interest.