Desravines N, Miele K, Carlson R, Chibwesha C, Rahangdale L. Topical therapies for the treatment of cervical intraepithelial neoplasia (CIN) 2-3: A narrative review.
Gynecol Oncol Rep 2020;
33:100608. [PMID:
32685652 PMCID:
PMC7356206 DOI:
10.1016/j.gore.2020.100608]
[Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/23/2020] [Accepted: 06/27/2020] [Indexed: 12/18/2022] Open
Abstract
CIN management is currently surveillance or surgical therapy. This review describes current research on medical therapies.
Imiquimod is the most studied with evidence of safety and efficacy.
5-Fluorouracil has also shown promise with two clinical trials showing efficacy as adjuvant and primary treatment.
Antivirals therapies have produced mixed results with cidofovir showing the most potential.
The data remains weak regarding hormonal, herbal and alternative therapies rending it difficult to draw conclusions.
Current management of Cervical Intraepithelial Neoplasia (CIN), caused by high-risk human papillomavirus (hr-HPV), is based on surveillance and surgical therapy. Procedures carry potential risks such as preterm birth, and access remains limited throughout the world. However, there are no medical therapies recommended to promote the clearance of hr-HPV infection or CIN. Ultimately, even if less efficacious than excision procedures, medical therapies have the potential to decrease cervical cancer by eliminating barriers to treatment, such as access to treatment, or serving as an adjunct to surgical treatment in both high- and low-resource settings.
This review describes current research on topical therapies with the potential for self-application for the treatment of HPV or CIN. Therapies included are immune-modulators, anti-proliferative medications, antivirals, hormones, and herbal/alternative therapies. Randomized trials of immune-modulating (imiquimod), anti-proliferative (5-fluorouracil), and anti-viral (cidofovir) therapies have had the most promising results. However, no option has sufficient clinical trial evidence to be recommended as treatment for CIN 2–3 and surgery remains the standard of care.
The research described in this review serves as a guide for the development of future trials in the burgeoning arena of topical therapies for CIN 2–3.
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