G. Harvey1, B. Hughes1, C. Christie1, D. Brinkmann2
Imiquimod cream is increasingly being used for the treatment of vulval intraepithelial neoplasia (VIN). Data regarding its effectiveness has been emerging in recent years. However, no data yet exists assessing which patients are most likely to respond to imiquimod. We thus sought to assess the characteristics of women treated with imiquimod for VIN at St Mary’s Hospital (SMH) from January 2011 to July 2017.
47 women were suitable for inclusion in this retrospective case series. Our results showed 61% of all treated patients had initial resolution of VIN after imiquimod treatment (n = 29). In our study, 14 patients were current (n = 12) or ex-smokers (n = 2). Smoking has a known association with VIN. Interestingly, smokers were less likely to respond to imiquimod, with a resolution rate of 38% (including 2 9 ex-smokers). Meanwhile, patients with a background of inflammatory vulval disease (lichen sclerosus or lichen planus) had a higher resolution rate (78%) compared to the total treated group. When assessing response between age groups, the percentage of patients with resolution was 55%–62% in all age groups except for those aged 51 to 60 years (43%).
Our treatment regimen at SMH is application of imiquimod 3–5 times weekly (as tolerated) for a total of 16 weeks. 70% of patients (n = 33) were able to complete the full treatment course. Early cessation of treatment was due to severe vulval inflammation or flu-like symptoms.
Identification of patient characteristics associated with successful response to imiquimod may assist decision making regarding treatment options for VIN in certain patient groups.