HPV Infections Clinical Trial
Official title:
Crossover Vaccination of Women Previously Randomized Into Protocol 04-C-N191(NCI)/IC-200403(INCIENSA)
Background:
- National Cancer Institute Protocol 04-C-N191, also known as the Costa Rica Vaccine Trial,
was a double-blind controlled study of the effectiveness of an experimental human
papillomavirus (HPV) vaccine in preventing cervical cancer in young women in Costa Rica.
Costa Rica was part of the first large study to show the association between HPV and cervical
cancer, and the study contributed greatly to the understanding of this association. The women
who have participated in the vaccine trial in Costa Rica are reaching the end of the
follow-up period offered in the vaccine trial protocol, and as a result they are being
offered the chance to have complementary vaccinations against HPV, hepatitis A, and hepatitis
B.
Objectives:
- To offer participants in the Costa Rica Vaccine Trial the vaccine that they did not
receive during the masked portion of the trial (HPV vaccine or hepatitis A vaccine) and
hepatitis B vaccination.
- To collect information about exposure to known and suspected risk factors for HPV
infection and cervical cancer from women who are receiving vaccination against HPV at
crossover.
Eligibility:
- Women who participated in National Cancer Institute Protocol 04-C-N191.
Design:
- All participants will be offered vaccination against hepatitis B.
- Women who received the hepatitis A vaccine during the trial will be offered vaccination
against HPV.
- Women who received the HPV vaccine during the trial will be offered vaccination against
hepatitis A.
- Appropriate vaccinations (including a combined hepatitis A and hepatitis B vaccine) will
be available to reduce the number of injections that participants will be asked to
receive.
- All vaccines will be given according to the manufacturer's specifications for
appropriate length of time between vaccine doses.
Since the mid 1980 s, the Division of Cancer Epidemiology and Genetics of the National Cancer
Institute in collaboration with investigators in Costa Rica has conducted studies regarding
cervical cancer and HPV infection. The first effort was a case control study where Costa Rica
was one of the Latin American countries included, and it was the first large epidemiological
study to show the association between HPV and cervical cancer. The second study, consisting
of a 10,049 women population-based cohort, the Guanacaste cohort, was carried out from 1993
until 2004, and has greatly contributed to the understanding of the natural history of HPV
infection and its relationship with precancerous cervical lesions.
The profound knowledge of the natural history of HPV infection and cervical neoplasia in
Guanacaste, Costa Rica together with the promising results of the different HPV vaccine
trials led the National Cancer Institute, in collaboration with investigators in Costa Rica,
to launch a community-based randomized phase III clinical trial to evaluate the efficacy of a
virus-like particle HPV vaccine (henceforth referred to as the Costa Rica Vaccine Trial
(CVT)).
The main objectives of the Costa Rica Vaccine Trial were to evaluate the efficacy of the
candidate vaccine to prevent persisting HPV-16/18 infections and related histopathologically
confirmed CIN2+ lesions among the according to protocol subcohort and the overall population
enrolled in the study. In contrast, the objectives of this protocol are aimed at offering
beneficial complementary vaccination to women enrolled in the trial with an additional
objective to collect biological specimens from women receiving the HPV-16/18 vaccine to
complement the information obtained during the masked phase of the trial. As an additional
objective, we propose to collect information regarding exposure to known and suspected risk
factors for HPV infection and cervical cancer and biological specimens during this crossover
phase that will complement those collected during the masked phase of the Costa Rica Vaccine
Trial.
Collection of risk factor information and biological specimens during this crossover phase
will be restricted to women receiving vaccination against HPV 16/18 at crossover. These
samples will permit a more complete and comprehensive evaluation of the vaccine
immunogenicity. Also, those specimens will allow for ancillary analyses and studies (e.g.,
natural history of HPV infection acquisition/clearance) and to assist ongoing efforts to
evaluate the longer-term impact of HPV-16/18 vaccination.
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