Gardasil Demonstrates Up to 100% Efficacy
- In the Prevention of Cervical Cancer and Other Human
Papillomavirus Related Diseases After an Additional Year of Follow
Up in Large Phase III Clinical Studies Which Included More Than
17,000 Women
New England Journal of Medicine publishes the most comprehensive
and robust clinical data for any Human Papillomavirus vaccine
LYON, France, 10th May2007 – New clinical study results
confirm the high and sustained efficacy of Gardasil® in the
prevention of cervical cancer and other Human Papillomavirus
related diseases that occur before cervical cancer and beyond the
cervix. After three years of follow up in the large phase III
clinical studies FUTURE I and II, which included more than
17,000 women, Gardasil® prevented 98% to 100% of pre-cancerous
and potentially pre-cancerous cervical lesions (CIN 1-3),
pre-cancerous and potentially pre-cancerous vulvar and vaginal
lesions (VaIN 1-3 and VIN 1-3), and genital warts caused by Human
Papillomavirus types 6, 11, 16 and 18. The results were published
today in the New England Journal of Medicine (NEJM). ,
The new three years results substantiate previous phase III results
which demonstrated up to 100% efficacy against the same diseases
after two years of follow up and on which the licensure of
Gardasil® was essentially based. The results also add to other
recently presented three years phase III data. The currently
available phase III results for Gardasil® are the most
comprehensive and robust clinical data presented for any Human
Papillomavirus vaccine. Previously presented data from a phase II
study had shown Gardasil® to be 100% efficacious against
cervical lesions and genital warts after five years of follow up
post-enrolment. ,a)
"The efficacy results on which the licensure of Gardasil® was
based, were already excellent and very reliable. The new data
clearly demonstrate that this high efficacy is likely to persist
for a long time. The gap in development of disease between women in
the placebo and those in the vaccine group continued to widen over
the three years. This means that the precision of the data
continued to increase; even more young women than initially thought
could benefit from Gardasil®," comments Professor Margaret
Stanley of the University of Cambridge, UK.
The virus types 6, 11, 16 and 18 directly targeted by Gardasil®
cause the vast majority of genital Human Papillomavirus diseases.
It is estimated that among Human Papillomavirus diseases in Europe,
they cause 75% of cervical cancer, 95% of vulvar and vaginal
cancers, , 70% of pre-cancerous (CIN2/3) , and 50% of
potentially pre-cancerous cervical lesions (CIN1) , 80% of
pre-cancerous vulvar (VIN2/3) and vaginal lesions (VaIN2/3)5,6, , ,
and 90% of genital warts. ,
In FUTURE I, after three years of follow up, Gardasil®
prevented 100% of Human Papillomavirus types 6-, 11-, 16- and
18-related pre-cancerous and potentially pre-cancerous cervical
lesions (CIN1-3); there was no case observed in the vaccine group
compared to 65 cases in the placebo group. Gardasil® prevented
also 100% of types 6-, 11-, 16- and 18-related pre-cancerous
and potentially pre-cancerous vulvar and vaginal lesions (VIN1-3
and VaIN1-3) and genital warts; no case was observed in the vaccine
group compared to 60 cases in the placebo group.b)
In FUTURE* II, after three years of follow up, Gardasil®
prevented 98% of pre-cancerous cervical lesions
(CIN†2/3) associated with Human Papillomavirus types 16 and
18; one case of CIN3 was observed in the vaccine group compared to
42 cases in the placebo group. b) In a combined analysis, including
almost 17,000 women and recently presented at the 5th International
Conference on Cervical Cancer (ICCC) in Venice, Gardasil®
prevented 99% of pre-cancerous cervical lesions
(CIN†2/3) associated with Human Papillomavirus types 16 and
18; 85 cases were observed in the placebo group compared to the one
case of CIN3 observed in the vaccine group. ,c)
The one case of CIN3 in the vaccine group of FUTURE II involved a
woman who had an infection with Human Papillomavirus type 52 at
baseline and at five follow-up visits. Type16 was detected in
only one of these visits suggesting that this case could have been
type 52-related. To be conservative, this case was nevertheless
included in the group that received the vaccine.
CIN2/3 is the obligate precursor of cervical cancer and the
clinically most relevant endpoint for the US Food and Drug
Administration (FDA) and the World Health Organization (WHO) to
demonstrate efficacy in the prevention of cervical cancer.
In both studies, Gardasil® was generally well tolerated. The adverse events observed were similar to what has been previously reported.
Notes to editors
High efficacy has already led to vaccination of women in the
placebo groups
In light of the high efficacy shown by Gardasil® at licensure,
the Data and Safety Monitoring Board of FUTURE I and II had
recommended that women in the placebo group should be vaccinated
with Gardasil®. The board recommended that the studies should
be terminated as soon as feasible in order to provide the benefits
of vaccination with Gardasil® to these women rapidly. In
Europe, vaccination of women in the placebo groups of FUTURE I and
II has already begun in the United Kingdom, Germany, Sweden,
Norway, Denmark, Finland and Austria. In other countries,
vaccination will start soon with the objective to complete
vaccination before the end of the year 2007. In a similar way,
vaccination of women in many other countries around the world,
including the US, Australia and Canada, has begun or is anticipated
to begin soon.
Protection against additional virus types through cross
protection
In large phase III clinical studies, including more than 17,000
womenb),c), Gardasil® provided benefits against pre-cancerous
(CIN2/3) and potentially pre-cancerous cervical lesions (CIN1)
caused by additional virus types not directly targeted by the
vaccine. The additional virus types cause more than 10% of cervical
cancer and substantial proportions of pre-cancerous and potentially
pre-cancerous cervical lesions. The data have recently been
submitted to the European Medicines Agency (EMEA) and the US Food
and Drug Administration in order to update the marketing
authorisation for Gardasil®.
The burden of cervical cancer and other Human Papillomavirus
diseases
Despite screening for early detection, cervical cancer remains the
second most common cause of death from cancer (after breast cancer)
among young women (15-44 years) in Europe . Around 33,500
women are diagnosed with, and 15,000 women die from cervical cancer
each year (the equivalent of 40 women per day or nearly 2 per
hour).
In addition, hundreds of thousands of women are diagnosed with
other Human Papillomavirus diseases that start before cervical
cancer and go beyond the cervix. These diseases include
pre-cancerous and potentially pre-cancerous cervical lesions7,9, ,
vulvar and vaginal cancer5,6, , pre-cancerous vulvar and vaginal
lesions10,11, , and genital warts.
Cervical cancer is caused by Human Papillomavirus. ,
The virus is very common, with 70% of sexually active people
estimated to become exposed at some point in life. , ,
Genital infections with Human Papillomavirus are very common with
the majority of infections occurring in adolescence or early
adulthood. ,
EU indication of Gardasil®
According to the licence in the EU, Gardasil®, Human
Papillomavirus Vaccine [types 6,11,16,18] (Recombinant, adsorbed),
can be given to children and adolescents 9 to15 years and adult
females 16 to 26 years of age and is indicated for the prevention
of cervical carcinoma (cervical cancer), high grade cervical
dysplasia CIN2/3 (precancerous cervical lesions), high grade vulvar
dysplastic lesions VIN 2/3 (precancerous vulvar lesions) and
external genital warts (condyloma acuminata) caused by Human
Papillomavirus types 6, 11, 16 and 18.
Worldwide availability of Gardasil®
Gardasil® has been developed by Merck & Co., Inc. and
Sanofi Pasteur MSD. In Europe, the vaccine is marketed by Sanofi
Pasteur MSD.
Gardasil® has been approved in 70 countries (many under
accelerated review timelines), including the EU, the US, Canada and
Australia and has met with very broad acceptance. Additional
applications are currently under review with regulatory agencies in
many more countries around the world.
The EU licensed Gardasil® within just 9 months compared to a
usual review time of 13-15 months. After gaining the license in
September 2006 Sanofi Pasteur MSD has made Gardasil® available
in 18 European countries.
Merck is actively working to accelerate the availability of
Gardasil® in the developing world. Clinical trials for the
development of Gardasil® have already included participants
from 33 countries on 5 continents in a variety of settings.
Clinical studies in developing world countries are being initiated
to assess the efficacy of Gardasil® in other environments.
Merck will donate free vaccine to the non-profit organisation
PATH to support demonstration studies to accelerate the
availability of Human Papillomavirus vaccines in the most
impoverished countries. Merck is also working with India's Council
of Medical Research to study Gardasil® in India. Merck will
make our new vaccines, including Gardasil®, available to
developing world countries at dramatically lower prices.
About Sanofi Pasteur MSD
Sanofi Pasteur MSD is a joint venture between sanofi pasteur, the
vaccine division of sanofi-aventis, and Merck & Co., Inc.
Combining innovation and expertise, Sanofi Pasteur MSD is the only
company in Europe dedicated exclusively to vaccines. Sanofi Pasteur
MSD is able to draw on the research expertise of sanofi pasteur and
Merck & Co., Inc., together with their teams throughout the
world, to focus on the development of new vaccines for Europe,
which aim to extend protection to other diseases and perfect
existing vaccines in order to improve the acceptability, efficacy
and tolerability of vaccination.
Contact
Dr. Arne Näveke
Executive Director, Communication Europe
Sanofi Pasteur MSD
Tel +33 4 37 28 40 40
Fax +33 4 37 28 44 04
Clinical study details
a) 551 16-23 year-old women were enrolled and vaccinated in a
randomised, placebo-controlled trial. Subjects received vaccine or
placebo at Day 1, Months 2, and 6. At regular intervals through 3
years, subjects underwent serum anti-HPV testing. A subset
(241 subjects) underwent 2 additional years of follow up. Subjects
who originally received vaccine were given another dose at Month
60, while placebo subjects initiated a 3-dose vaccine regimen.
Anti-HPV responses were measured 1 and 4 weeks post-dose 4
(subjects who originally received vaccine) or post-dose 1 (subjects
who originally received placebo).
b) FUTURE I and II are phase III, prospective, double-blind,
placebo-controlled randomised studies conducted in 16
countries. The women who participated in the trials were aged
16 to 26 and received three doses of either Gardasil® or
placebo at day 1, month 2, and month 6. The primary analyses of
these trials evaluated the efficacy of Gardasil® compared to
placebo in women who were negative to the relevant Human
Papillomavirus types (6, 11, 16 and/or 18) when they started the
study, remained free of infection with the relevant Human
Papillomavirus types through month 7, received all three doses of
Gardasil® within one year and had no protocol violations.
FUTURE I evaluated the incidence of pre-cancerous and
potentially pre-cancerous cervical lesions (CIN 1-3), pre-cancerous
and potentially pre-cancerous vulvar and vaginal lesions (VIN1-3
and VaIN1-3) and external genital warts caused by the Human
Papillomavirus types 6, 11, 16 and 18. FUTURE II evaluated
the prevention of pre-cancerous cervical lesions (CIN 2/3) and
non-invasive cancers (AIS) caused by Human Papillomavirus types 16
and 18.
c) 20,541 women (16-26 years) from the Americas, Europe and
Asia were enrolled in one of four trials. In one trial,
subjects were randomised to either a monovalent Human
Papillomavirus 16 vaccine or placebo. In 3 trials, subjects were
randomised to either Gardasil® (types 6/11/16/18) or
placebo. For all trials, vaccination occurred at day 1, and
months 2 and 6. The primary endpoint was the combined incidence of
Human Papillomavirus types 16/18-related CIN 2/3, AIS, or cervical
cancer. In the Human Papillomavirus 16 vaccine study, only Human
Papillomavirus 16-related cases were considered. Analyses were done
in a per protocol (PP) population (subjects received 3 doses, had
no major protocol violations, were Human Papillomavirus 16/18
seronegative at day 1 and Human Papillomavirus 16/18 DNA negative
Day 1 through month 7). Endpoint counts began at Month 7.
References
Posted: May 2007
