Quadrivalent human papillomavirus recombinant vaccine: the first vaccine for cervical cancers.

Gardasil is the first quadrivalent human papillomavirus (HPV)-types 6, 11, 16, 18 recombinant vaccine approved by the FDA on June 8, 2006. It induces genotype-specific virus-neutralizing antibodies and prevents infection with HPV. Various clinical trials demonstrated a reduction in the incidence of vaccine-type-specific persistent infections and of associated moderate- and high-grade cervical dysplasias and carcinomas in situ after its use. Gardasil is currently approved by FDA for prevention of genital warts, cancers and precancerous conditions of cervix and vulva in 9-26 year old females. Three doses of 0.5 ml of gardasil each at 0, 2 and 6 months are given intramuscularly. It is contraindicated in individuals who are hypersensitive to the active substances or to any of the excipients of the vaccine, patients with bleeding abnormalities or patients on anticoagulant therapy and during pregnancy. However, the vaccine, at an estimated $300-500 per course, is too expensive for many women in developing countries. Moreover, question regarding the longevity of the protection by vaccine is still unsolved. Hence, longer studies are required to establish its real status in cancer prevention.

Pure sarcomatous recurrence of clear cell renal carcinoma following radical nephrectomy and dendritic cell vaccination / Recorrência sarcomatosa pura após nefrectomia radical e vacina de células dendríticas no carcinoma renal de células claras

CONTEXT: Sarcomatous differentiation, which represents transformation to high-grade malignancy, can occur in all histogical types of renal malignancy. CASE REPORT: The authors report on the case of a 66-year-old woman with a right renal mass that was shown to be a clear cell carcinoma. She underwent radical nephrectomy and dendritic cell vaccination and, 3.5 years later, she developed retroperitoneal pure sarcomatous recurrence of the tumor. The authors speculate that the vaccination could have played some role in this differentiation or selection of the sarcomatous component of the primary tumor.

CONTEXTO: Diferenciação sarcomatosa, que representa evolução para malignidade de alto grau, pode ocorrer em todos os tipos histológicos de câncer renal. RELATO DE CASO: Os autores relatam o caso de uma mulher de 66 anos, com uma massa no rim esquerdo que se revelou um carcinoma de células renais. Após 3,5 anos da nefrectomia radical seguida de vacinação com células dendríticas, a paciente desenvolveu uma recorrência sarcomatosa pura no retroperitônio. Os autores especulam que a terapia com vacina de células dendríticas pode ter desempenhado algum papel na diferenciação ou seleção do componente sarcomatoso do tumor primário.