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HPV vaccine trial may take place in India
Newsdesk HPV vaccine trial may take place in India The World Health Organization (WHO) has initiated talks with Indian scientists and health officials about starting clinical trials investigating the efficacy of Human papillomavirus (HPV) vaccination in India. At a closed meeting organised by WHO and the Indian Council of Medical Research to discuss possibilities of clinical studies in India a broad consensus was agreed (Sept 18–19, 2002, New Delhi, India). India has about 16% of the global annual incidence of cervical cancer, and with an estimated 100 000 new cases in 2001, this type of cancer is currently the most common malignancy among Indian women. Participants at the meeting agreed that a vaccine against HPV could be an effective strategy in reducing the burden of cervical cancer in India and
other developing countries because there are no effective screening programmes in place. Delegates also concluded that because the most prevalent high-risk HPV types in India are 16 and 18, that India should opt for a bivalent vaccine (based on viral-like particles) that would be effective against both types. However, John Schiller (National Cancer Institute, MD, USA) cautions: “Although there are high expectations that HPV vaccines will be safe and effective in preventing cervical cancers, they are not ideal for widespread distribution in developing countries because they are expensive to produce and difficult to distribute as young women have to be given three injections over 6 months.” Furthermore, clinical studies in India will have to wait until the issue of
study endpoints for the vaccine trials has been resolved by the US Food and Drug Administration. There are also many ethical issues that will need further discussion before initiating such a trial. Some experts at the closed meeting also felt that strategies other than vaccination might be more suitable for poor countries in Africa and Asia. Rengaswamy Sankaranarayanan of the International Agency for Research on Cancer, Lyon, France says: “Health education on primary prevention methods and encouraging 30–40-yearold women to have simple clinical tests to detect cervical cancer early, such as visual inspection with acetic acid, seem to be the most feasible prevention strategies in low-resource, high-risk countries.” Dinesh C Sharma
BLM gene carriers at risk for colorectal cancer
THE LANCET Oncology Vol 3 November 2002
http://oncology.thelancet.com
lymphoma earlier than their Blm+/+ wildtype littermates when exposed to murine leukaemia virus. Furthermore, lung cells cultured from BlmCin/+ mice showed more micronuclei than normal cells, indicating decreased ability to repair DNA damage (Science 2002; 297: 2051–53). When BlmCin/+ mice were mated with animals known to develop intestinal adenomas (ApcMin/+ mice) the progeny developed twice the number of gastrointestinal tumours. “Some tumours from the double heterozygous mice were characterised by a loss of only part of chromosome 18, showing a change in the way the second allele of Apc is mutated”, Groden explains. She says molecular epidemiology and population studies are powerful tools for identifying genetic risk factors for particular tumour types. Gruber, comments, however, that DNA analysis is not currently recommended because screening in heterozygotes hasn’t been shown unequivocally to reduce morbidity or mortality. Courtesy of J Groden
Ashkenazi Jewish ancestry increases the Medical Center, Horev, Israel), who risk of Bloom’s syndrome (BS), which coordinated the sample population. predisposes to many types of cancer. “These papers emphasise two Researchers have now discovered that themes in current cancer research”, says carriers of the mutated Blm/BLM gene Bert Vogelstein (Johns Hopkins Unihave a three-times-average risk of versity, MD, USA). “First, several genes developing intestinal cancer (Science 2002; 297: 2013). Apc Min/+; Blm BS is caused by inactivating T germline mutations in both copies of the BLM gene, which N +/+ encodes a DNA helicase. About 1 Apc Min/+; in 100 Ashkenazi Jews carry one Blm+/T particular mutant allele of the gene. “We know that haploid N sufficiency is a mechanism of other forms of colorectal cancer, but this research highlights the Comparison of tumours from ApcMin mice. fact that it may be a general mechanism for inherited susceptibility are associated with moderate but signiffor [BS]”, says lead author Stephen icant cancer risk. Such findings will Gruber (University of Michigan, USA). eventually allow more accurate preResearchers in Israel and USA have diction of individuals in greatest need combined data from 1244 BS cases and of surveillance. Second, the work illu1839 controls of Ashkenazi Jewish strates the value of mouse models for ancestry. Those with colorectal cancer human diseases, particularly cancers.” were more than twice as likely to carry In a related study, Joanna Groden BLMAsh. “We are saying, possibly for (University of Cincinnati, OH, USA) the first time, that the carrier is in found that BlmCin/+ mice with a null danger”, says Gad Rennert, (Carmel allele of the BLM gene developed
Kathleen Nelson
649
For personal use. Only reproduce with permission from The Lancet Publishing Group.
other developing countries because there are no effective screening programmes in place. Delegates also concluded that because the most prevalent high-risk HPV types in India are 16 and 18, that India should opt for a bivalent vaccine (based on viral-like particles) that would be effective against both types. However, John Schiller (National Cancer Institute, MD, USA) cautions: “Although there are high expectations that HPV vaccines will be safe and effective in preventing cervical cancers, they are not ideal for widespread distribution in developing countries because they are expensive to produce and difficult to distribute as young women have to be given three injections over 6 months.” Furthermore, clinical studies in India will have to wait until the issue of
study endpoints for the vaccine trials has been resolved by the US Food and Drug Administration. There are also many ethical issues that will need further discussion before initiating such a trial. Some experts at the closed meeting also felt that strategies other than vaccination might be more suitable for poor countries in Africa and Asia. Rengaswamy Sankaranarayanan of the International Agency for Research on Cancer, Lyon, France says: “Health education on primary prevention methods and encouraging 30–40-yearold women to have simple clinical tests to detect cervical cancer early, such as visual inspection with acetic acid, seem to be the most feasible prevention strategies in low-resource, high-risk countries.” Dinesh C Sharma
BLM gene carriers at risk for colorectal cancer
THE LANCET Oncology Vol 3 November 2002
http://oncology.thelancet.com
lymphoma earlier than their Blm+/+ wildtype littermates when exposed to murine leukaemia virus. Furthermore, lung cells cultured from BlmCin/+ mice showed more micronuclei than normal cells, indicating decreased ability to repair DNA damage (Science 2002; 297: 2051–53). When BlmCin/+ mice were mated with animals known to develop intestinal adenomas (ApcMin/+ mice) the progeny developed twice the number of gastrointestinal tumours. “Some tumours from the double heterozygous mice were characterised by a loss of only part of chromosome 18, showing a change in the way the second allele of Apc is mutated”, Groden explains. She says molecular epidemiology and population studies are powerful tools for identifying genetic risk factors for particular tumour types. Gruber, comments, however, that DNA analysis is not currently recommended because screening in heterozygotes hasn’t been shown unequivocally to reduce morbidity or mortality. Courtesy of J Groden
Ashkenazi Jewish ancestry increases the Medical Center, Horev, Israel), who risk of Bloom’s syndrome (BS), which coordinated the sample population. predisposes to many types of cancer. “These papers emphasise two Researchers have now discovered that themes in current cancer research”, says carriers of the mutated Blm/BLM gene Bert Vogelstein (Johns Hopkins Unihave a three-times-average risk of versity, MD, USA). “First, several genes developing intestinal cancer (Science 2002; 297: 2013). Apc Min/+; Blm BS is caused by inactivating T germline mutations in both copies of the BLM gene, which N +/+ encodes a DNA helicase. About 1 Apc Min/+; in 100 Ashkenazi Jews carry one Blm+/T particular mutant allele of the gene. “We know that haploid N sufficiency is a mechanism of other forms of colorectal cancer, but this research highlights the Comparison of tumours from ApcMin mice. fact that it may be a general mechanism for inherited susceptibility are associated with moderate but signiffor [BS]”, says lead author Stephen icant cancer risk. Such findings will Gruber (University of Michigan, USA). eventually allow more accurate preResearchers in Israel and USA have diction of individuals in greatest need combined data from 1244 BS cases and of surveillance. Second, the work illu1839 controls of Ashkenazi Jewish strates the value of mouse models for ancestry. Those with colorectal cancer human diseases, particularly cancers.” were more than twice as likely to carry In a related study, Joanna Groden BLMAsh. “We are saying, possibly for (University of Cincinnati, OH, USA) the first time, that the carrier is in found that BlmCin/+ mice with a null danger”, says Gad Rennert, (Carmel allele of the BLM gene developed
Kathleen Nelson
649
For personal use. Only reproduce with permission from The Lancet Publishing Group.