Page 136 - Strategies for non-invasive managementof high-grade cervical intraepithelial neoplasia - prognostic biomarkers and immunotherapy Margot Maria Koeneman

Chapter 7
Table 2: Awareness and off-label use of imiquimod as an immunotherapy for VIN, VAIN, and CIN by respondents divided according to hospital type
Total respondent population
(n = 77)
University hospital (n = 12)
Semi-specialized teaching hospital (n = 42)
Non-teaching hospital
(n = 23)
Aware of imiquimod in VIN Aware of imiquimod in VAIN Aware of imiquimod in CIN Applied imiquimod in VAIN Applied imiquimod in CIN
70 (91%) 61 (79%) 45 (58%) 12 (16%) 5 (7%)
12 (100%) 12 (100%) 11 (92%) 4 (33%)
2 (17%)
39 (93%) 36 (81%) 28 (67%) 6 (14%) 2 (5%)
19 (83%) 15 (65%) 6 (26%) 3 (9%)
1 (4%)
CIN, cervical intraepithelial neoplasia; VAIN, vaginal intraepithelial neoplasia; VIN, vulvar intraepithelial neoplasia.
Off-label application of imiquimod in VAIN and CIN
Twelve (16%) and five (7%) respondents had used imiquimod to treat VAIN and CIN lesions, respectively (table 2). Clinical application of imiquimod was more frequent in respondents who performed more than 100 colposcopies yearly and (fellow) gynecologic oncologists or semi- specialized gynecologic oncologists, compared to the total respondent population. Frequency of application and lesion characteristics are displayed in table 3. Most respondents applied it less than 5 times in VAIN and less than 10 times in CIN. Imiquimod was applied in both low grade and high-grade lesions and in both primary and recurrent lesions.
Table 3: Off-label application of imiquimod in VAIN and CIN by the respondents: frequency, lesion characteristics, and treatment success
VAIN (n = 12)
CIN (n = 5)
How often have you applied imiquimod for this indication?
- - -
What was -
-
-
1–5 times 10 6–10 times 1 More than 10 times 1
(were) the lesion grade(s)?
Low-grade lesion(s) (VAIN/CIN 1) 2 High-grade lesion(s) (VAIN/CIN 2–3) 7 Both 3
(83%) 3 (8%) 2 (8%) 0
(16%) 1 (58%) 3 (25%) 1
(33%) 1 (33%) 3 (33%) 1
(75%) 5
(25%) 1 (8%) 0
(60%) (40%) -
(20%) (60%) (20%)
(20%) (60%) (20%)
(100%) (20%)
table continues
Was it a primary or recurrent lesion?
- Primary lesion(s) 4 - Recurrent lesion(s) 4 - Both 4
Was treatment of the lesion(s) with imiquimod successful? (multiple options possible)*
- Yes, lesion regression or complete remission, invasive 9
therapy no longer needed
- No, persistent lesion 3
- No, progressive lesion 1
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