Human Papillomavirus Vaccine in Cutaneous Basaloid Squamous Cell Carcinomas

Squamous cell carcinoma is the second-most-common form of skin cancer. Evidence suggests the human papillomavirus (HPV) plays a role in the development of some types of this skin cancer.

Two years ago, a 97-year-old woman whose right leg was covered with squamous cell tumors went to see dermatologist Anna Nichols, MD, PhD, at Sylvester Comprehensive Cancer Center. Surgery is the standard of care for most patients with skin cancer.

“She was not a candidate for surgery because of the sheer number and size of her tumors. She wasn't a candidate for radiotherapy, again for the same reasons,” said Dr. Nichols, Assistant Professor at the University of Miami (UM) Miller School of Medicine, whose report on this case was published in JAMA Dermatology.

In 2017, a case report by Dr. Nichols showed the quadrivalent HPV vaccine (Gardasil) reduced the number of new basal and squamous cell skin cancers in 2 patients. Tim Ioannides, MD, a voluntary faculty member at UM, suggested using the vaccine as an off-label treatment by directly injecting it into the tumors. Since her patient had no other options, Dr. Nichols offered her the treatment.

“I think we had a really reasonable expectation and good data that this was actually going to, at the very least, do no harm to this patient, and possibly provide some benefit,” said Dr. Ioannides. “To have this type of result in such an advanced patient I think was beyond all our expectations.”

Key Results

The patient was first given two doses of the 9-valent HPV vaccine (Gardasil 9) in her arm, 6 weeks apart. A few weeks later Dr. Nichols directly injected several, but not all, of the patient's tumors. The direct intratumoral injections were given 4 times over 11 months.

“All of her tumors completely resolved 11 months after the first direct tumor injection, and she has had no recurrence,” Dr. Nichols said. “It has been about 24 months now since we started with the treatment.”

These findings suggest that the HPV vaccine may have therapeutic utility for patients with squamous cell carcinomas who are poor surgical candidates, have multiple lesions, or defer surgery.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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