PhD defence Caroline Lotte Pippi Warmels-Muntinga

Keywords: Cervical and vulvar premalignancies, Imiquimod, Immunology, Biomarker

"Understanding response to imiquimod treatment - immunologic, molecular and clinical aspects in cervical and vulvar premalignancies"

If women have a cervical premalignancy it can be removed with a minor surgical procedure called a loop excision (LEEP/LLETZ procedure). One disadvantage of this treatment is that it increases the risk of premature birth in future pregnancies. This is particularly important because many women who undergo a loop excision still wish to have children. An alternative treatment is imiquimod, a cream. This cream is inserted vaginally three times a week for 16 weeks and can also treat the premalignancy. It is effective in approximately 50–70% of women. Because the treatment course is so long and side effects occur regularly, it is important to know before starting treatment which women are likely to respond. This question was investigated in this dissertation. To study this, a large trial called the PRedICT-TOPIC study was established. The results show that women who have high numbers of “good” immune cells before starting imiquimod treatment are more likely to clear the lesion. These immune cells appear to contribute to the elimination of the precancerous condition. The PRedICT-TOPIC study is still ongoing, so the final outcomes will become available in the future.

In addition, interviews were conducted with patients and healthcare professionals about the use of imiquimod, with the aim of improving both the treatment and patient counseling. These interviews revealed that patients would like more information about the side effects they can expect, the best way to apply the cream, and read experiences of others who have undergone imiquimod treatment. As a result, several new patient stories were published on the website of patient organization Stichting Olijf. 

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