Groundbreaking Danish research shows that HPV vaccination can reduce precursors to skin cancer
A common disease – 40 % of Danes over the age of 50 develop precursors to skin cancer
Skin cancer is the most common type of cancer in the world. Approximately 40 % of Danes over the age of 50 develop actinic keratosis which is a precursor to skin cancer. In severe cases a patient can have more than a hundred lesions, and this is a burden on the individual as well as society and economics. Therefore, there’s an urgency to find more efficient, lean and lasting treatments. With the new research results we are a step closer to realizing this.
Connection between HPV and skin cancer
There are more than 200 Human papillomaviruses (HPV) which infect skin and mucosa, and the connection between HPV and cancer is well-known, e.g., an extensive vaccination program against the Alfa type HPV, which can cause cervical cancer, has resulted in a huge decrease in cases of that type of cancer. There is also a handful of cases where Alfa-type HPV vaccination has worked in treating skin cancer, even though HPV of the Beta-type is the predominant in skin.
Using Alfa HPV-vaccination in skin cancer treatment has been controversial, as earlier there has been no research to provide evidence of the effect. However, as the Danish researchers previously had observed that Alfa HPV vaccination resulted in a decrease of actinic keratosis in a small group of severely affected patients, their hypothesis was that the vaccination could be used to prevent skin cancer.
To confirm or reject their hypothesis they established the VAXAK study as an interdisciplinary collaboration led by Postdoc Emily Wenande and Professor Merete Hædersdal, both from the Danish Research Center for Skin Cancer.
The VAXAK study – double-blind, randomized clinical trial
To ensure that neither patients nor researchers consciously or unconsciously influenced the trial results the VAXAK trial was performed as a double-blind, randomized sham-controlled clinical trial.
70 trial participants with severe cases of actinic keratosis were split in two groups each getting three injections. One group was injected with the approved Alfa HPV vaccination while the other group was injected with a saline solution. Neither participants nor researchers knew who got what.
Vaccination resulted in a 10-18 % reduction in the actinic keratosis
The participants’ skin was examined over the next 12 months, and the researchers saw a reduction in the actinic keratosis of 10-18 % in the trial group that received the vaccination compared to the group that received the saline solution.
New avenues of research for HPV and skin cancer
Postdoc Emily Wenande explains about the study: ”We had no guarantee this would work, so it was a bit of a gamble. Now we have evidence of high quality from a controlled scientific trial, and that is amazing. It opens new HPV oriented avenues for research in the prevention and treatment of skin cancer. Perhaps even a new paradigm.
We don’t know yet exactly why it works. There are several sub types of HPV. In the trial we used a vaccination for HPV Alfa, which we see in mucosa. Still, we saw an effect in skin where the Beta type is predominant. Whether this is due to cross reactivity or an unspecified effect of the vaccination on the immune system, we don’t know. It opens for some exciting questions regarding the interaction between viruses, cancer and our immune system. Aspects we must examine further.”
Treatment of skin cancer from within with an injection
”In the long term the perspective is really interesting,” Emily continues, ”When it comes to actinic keratosis and skin cancer, often we treat patients again and again because new lesions appear. And as the skin damage caused by the sun often appears in parts of the skin that are visible to others, multiple treatments can result in huge consequences for the patient both as regards looks, function, resources, and well-being.
Imagine if instead we could provide an injection which from the inside could prevent people from developing skin cancer. We could relieve both patient and society of a great burden. The effect of a possible HPV Beta type vaccination would probably be even more extensive compared to what we have seen now. I expect a Beta HPV vaccination is on its way.”
An international platform for the research results
Last week the Danish research project was published in the internationally renowned medical journal, JAMA Dermatology. Professor Merete Hædersdal from the Danish Research Center for Skin Cancer comments on the acceptance of the article about the VAXAK study to JAMA Dermatology: ”We are very proud. In terms of dermatology this is one of the most prestigious journals. It’s a recognition of our work and the fact that we live up to our mission of contributing to the development of new and improved treatments for the benefit of all.”
Continous monitering of the trial participants
The study does not end with the published results. The researchers monitor the trial participants for the next ten years, because the next interesting question is whether the HPV vaccinantion not only reduces the precursors to skin cancer but also reduces reduces the participants' risk of developing actual skin cancer.
