Department of Obstetrics & Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
Indian J Med Res. 2009 Sep;130(3):341-7.
Cervical cancer is the leading cause of cancer mortality among women in worldwide. Some 99 per cent of cervical cancer cases are linked to genital infection with human papillomaviruses (HPVs) comprised of approximately 15 oncogenic genital HPV types. Most HPV infections resolve spontaneously. But, the remainder persist and may then progress to cervical cancer in some women. In high-resource countries, the best way to prevent cervical cancer is to implement organised gynaecological screening programs with appropriate treatment of the detected pre-cancerous lesions. However, in developing countries, this method is not practicable because of cost and complexity of proper screening. Vaccines against HPV infections hold promise to reduce incidence of cervical cancer cost-effectively. Two Prophylactic HPV vaccines have been thus far developed: Gardasil(R), a quadrivalent vaccine targeting HPV-6, -11, -16 and -18) and Cervarix(R), a bivalent vaccine which targets HPV-16 and -18. Both vaccines contain L1 virus-like particles (VLPs) derived from HPV-16 and -18 which are most frequently associated with cervical cancer. The L1-VLP vaccines are HPV type-specific and therefore can effectively prevent infection of a HPV type in question alone. Therefore, the L1-VLP vaccines are hoped to be multivalent for 15 oncogenic HPV types, which comes at a price. Otherwise, costly cytologic screening for cervical cancer is still necessary. The current HPV vaccines thus may not be ultimate strategy and study on new HPV vaccines is needed. Broad-spectrum prophylactic vaccines against all oncogenic HPV types and therapeutic vaccines for clearance of HPV-related cervical lesion are being developed.
宫颈癌是全球女性癌症死亡的主要原因。大约 99%的宫颈癌病例与生殖器感染人乳头瘤病毒 (HPV)有关，HPV 由大约 15 种致癌性生殖器 HPV 类型组成。大多数 HPV 感染会自行消退。但是，其余的 HPV 会持续存在，并可能在某些女性中进展为宫颈癌。在高资源国家，预防宫颈癌的最佳方法是实施组织化妇科筛查计划，并对检测到的癌前病变进行适当治疗。然而，在发展中国家，由于成本和适当筛查的复杂性，这种方法不可行。HPV 感染疫苗有希望以具有成本效益的方式降低宫颈癌的发病率。迄今为止已经开发出两种预防性 HPV 疫苗：Gardasil（针对 HPV-6、-11、-16 和 -18 的四价疫苗）和 Cervarix（针对 HPV-16 和 -18 的二价疫苗）。这两种疫苗都包含源自 HPV-16 和 -18 的 L1 病毒样颗粒 (VLP)，这些病毒与宫颈癌最相关。L1-VLP 疫苗是 HPV 型特异性的，因此可以有效地单独预防特定 HPV 型的感染。因此，L1-VLP 疫苗有望针对 15 种致癌 HPV 型成为多价疫苗，但这需要付出代价。否则，仍需要进行昂贵的宫颈癌细胞学筛查。因此，目前的 HPV 疫苗可能不是最终策略，需要研究新的 HPV 疫苗。正在开发针对所有致癌 HPV 型的广谱预防性疫苗和清除 HPV 相关宫颈病变的治疗性疫苗。
