Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K39/12—Viral antigens
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P15/00—Drugs for genital or sexual disorders; Contraceptives
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P17/00—Drugs for dermatological disorders
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P17/00—Drugs for dermatological disorders
  • A61P17/12—Keratolytics, e.g. wart or anti-corn preparations
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
  • A61P31/12—Antivirals
  • A61P31/20—Antivirals for DNA viruses
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P37/00—Drugs for immunological or allergic disorders
  • A61P37/02—Immunomodulators
  • A61P37/04—Immunostimulants
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
• • C—CHEMISTRY; METALLURGY
  • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
  • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
  • C12N7/00—Viruses; Bacteriophages; Compositions thereof; Preparation or purification thereof
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K2039/545—Medicinal preparations containing antigens or antibodies characterised by the dose, timing or administration schedule
• • C—CHEMISTRY; METALLURGY
  • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
  • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
  • C12N2710/00—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA dsDNA viruses
  • C12N2710/00011—Details
  • C12N2710/20011—Papillomaviridae
  • C12N2710/20034—Use of virus or viral component as vaccine, e.g. live-attenuated or inactivated virus, VLP, viral protein
• • C—CHEMISTRY; METALLURGY
  • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
  • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
  • C12N2710/00—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA dsDNA viruses
  • C12N2710/00011—Details
  • C12N2710/20011—Papillomaviridae
  • C12N2710/20071—Demonstrated in vivo effect

Definitions

• the invention relates to treating cancer or benign tumors and, more particularly, to a method for treatment, or reducing the incidence of recurrence, of skin cancer or tumors comprising administration of a vaccine, including local administration of the vaccine as a therapeutic agent.
• Skin cancer consists of three main types, namely, basal-cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma, and is the most common form of cancer globally. Understandably, there have been ongoing studies for many years searching for effective methods to treat, and possibly cure, these types of skin cancer.
• BCC basal-cell carcinoma
• SCC squamous cell carcinoma
• melanoma melanoma
• HPV human papillomavirus
• SCC squamous cell carcinoma
• Vaccines have been developed and shown to prevent cervical cancer in women and other conditions caused by or associated with HPV infection.
• GARDASIL® is a commercially available vaccine having activity against HPV (types 6, 11, 16, and 18).
• GARDASIL® 9 is another commercially available vaccine marketed for prevention of HPV (types 16, 18, 31, 33, 45, 52, and 58). GARDASIL® is indicated for use in girls and boys from ages 9-26; GARDASIL® 9 is also indicated for use in girls from ages 9-26, and in boys from ages 9-15. [0006] Other vaccines have been produced, as well, for treating subtypes of HPV, particularly HPV16 and HPV18.
• preventive vaccines are typically administered for systemic action, being injected into a patient subcutaneously or intramuscularly (e.g., deltoid), remote from any particular target, such as the cervix. Moreover, they are generally accepted to be effective prior to exposure to HPV and are not commonly known to be effective for treatment after exposure to, or infection with, HPV.
• preventive vaccines include, for example, an improved vaccine composition as described in Chinese Pat App. No. 101890160 (CN'160) comprising certain LI proteins of HPV (as in GARDASIL®), and additional HPV-specific components.
• Preventive vaccines comprising HPV-type 16 and 18 proteins are also suggested to provide cross-protection against other HPV types, as described in US Pub. No. 2005/0287161.
• Vaccines used for treatment are described.
• these therapeutic vaccines require more than viral-specific components, such as HPV LI proteins that comprise the commercially available preventive vaccines, such as GARDASIL®.
• US Pub. No. 2007/0218074 describes the use of a vaccine composition comprising host-cell peptides from an HPV-infected cell.
• the host-cell peptides e.g., the early antigens, E6 or E7, that present on the surface of cells infected with HPV, are fragments of host-cell proteins.
• the criticality of the polypeptides E6 or E7 in a vaccine used in treating certain cancer types is described in Development of HPV vaccines for HPV- associated head and neck squamous cell Carcinoma, Devaraj, et al., Crit Rev Oral Biol Med. 2003;14(5):345-62.
• Another vaccine which includes a host-cell protein (BAX) is described in US Pat. No. 8,399,610.
• Yet another vaccine composition comprising other or additional antigens in combination with HPV-16 peptides, is a vaccine composition described in US Pub. No. 2011//0070252 which additionally requires Trojan antigen.
• US Pub. No. 2011/0110979 discloses therapeutic use of an HPV vaccine comprising E6 or E7 polypeptides (peptide fragments from host cells infected with HPV).
• E6 and E7 are crucial to induce transformation into HPV-infected cells, and states that a vaccine composition which does not include E6 or E7 would not be expected to work on cells that do not have E6 or E7, i.e., cells such as BCC that are not infected with HPV.
• the method described in the US'979 publication additionally requires an immunostimulant or adjuvant.
• HPV vaccines comprising only HPV antigens (being free of host-cell peptides), to a previously unimmunized patient, or an adult patient aged 27 or greater, to eliminate or reduce the incidence of recurrence of cancer, benign tumor or other skin lesion, has not been previously described.
• the limitations and disadvantages of the above uses of vaccines can be overcome by the use of a method in accordance with the subject invention. There is a need in the medical and health fields for safe and efficacious skin cancer treatments which are convenient for the patient as well as the health practitioner.
• the subject invention concerns a method for treating a patient having cancer, benign tumor, or a human papilloma virus-related (HPV-related) lesion, said method comprising the steps of:
• the second dose of HPV vaccine is administered about two months after administering the first dose and the third dose of HPV vaccine is administered about six months after administering the first dose.
• the HPV vaccine can be selected from HPV quadrivalent (types 6, 11, 16, and 18) recombinant vaccine comprising HPV LI proteins and HPV multivalent (types 16, 18, 31, 33, 45, 52, and 58) recombinant vaccine comprising HPV LI proteins, and preferably is free or substantially free of host-cell early antigen, e.g., E6 or E7.
• the method does not comprise or is without administering an additional or other immunostimulant or adjuvant.
• the size of the cancer or HPV-related lesion can be substantially reduced, or completely eliminated.
• the incidence of recurrence of the cancer or HPV-related lesion can be reduced.
• the method can be effective in treating or reducing the incidence of recurrence of a cancer, benign tumor, or HPV-related lesion such as squamous cell carcinoma, basal cell carcinoma, melanoma, verruca vulgaris, or condyloma accuminata.
• Each dose of HPV vaccine administered in the above method steps is preferably 0.5 ml.
• the method can further comprise establishing a positive diagnosis of cancer, benign tumor, or HPV infection prior to administering the first dose of HPV vaccine.
• An alternative embodiment of the method according to the subject invention comprises treating a patient having cancer, benign tumor, or a human papilloma virus-related (HPV-related) lesion, wherein the method comprises administering a dose of an HPV vaccine directly to the cancer, tumor, or lesion or an area immediately surrounding the tumor or lesion.
• HPV-related human papilloma virus-related
• This alternative embodiment of the method according to the subject invention can further comprise the steps of :
• ⁇ optionally, administering a third dose of the HPV vaccine directly to the tumor or lesion or an area immediately surrounding the tumor or lesion about five months to about seven months after administering the first dose.
• the second dose of HPV vaccine can be administered about two months after administering the first dose and the third dose of HPV vaccine can be administered about six months after administering the first dose.
• the size of the cancer, tumor, or HPV-related lesion can be substantially reduced or completely eliminated.
• the incidence of recurrence of the cancer, tumor, or HPV-related lesion can reduced.
• the preferred dose of each administration of HPV vaccine, if any, is 0.5 ml.
• the method according to any embodiment of the invention can be used for treating cancer, benign tumor, or HPV-related lesion, including, but not limited to, a benign tumor associated or unassociated with HPV infection, squamous cell carcinoma, basal cell carcinoma, melanoma, verruca vulgaris, and condyloma accuminata.
• the method can further comprise establishing a positive diagnosis of cancer, benign tumor, or HPV infection prior to administering the first dose of HPV vaccine.
• the direct or local administration of the vaccine is administered by injection, and more preferably the method does not comprise administering an additional or other immunostimulant or adjuvant, with, during or following the administration of the vaccine.
• the present invention is directed to a method of treating cancer, benign tumor, and particularly skin cancer, such as squamous cell carcinoma (SCC), or a skin lesion associated with human papilloma virus (HPV) infection.
• One embodiment of a method according to the subject invention comprises the administration of an HPV vaccine, such as an HPV quadrivalent (types 6, 11, 16, and 18) recombinant vaccine, to a patient that has not been previously immunized with an HPV vaccine, or to an adult patient aged 27 or older.
• an HPV vaccine such as an HPV quadrivalent (types 6, 11, 16, and 18) recombinant vaccine
• the dosing regimen can be in accordance with the conventionally accepted dosing series for a vaccine.
• HPV vaccines are typically administered using a dosing regimen comprising a first dose, a second dose about two months following the first dose, and a third dose about six months following the first dose.
• the method embodiments of the present invention have surprisingly been found to have beneficial results in treating, or minimizing the occurrence, recurrence, and/or progression of, cancer lesions or benign tumors that are not associated with HPV infection, such as basal-cell carcinoma (BBC) or melanoma.
• BBC basal-cell carcinoma
• the subject method can increase, i.e. boost a patient's immune response that may manifest clinically as increased surveillance in skin cells to decrease the likelihood of development and progression of abnormal skin cells that produce the skin cancer, particularly, but not exclusively, SCC.
• the method of the invention can interfere with inherent functional activities of viral and virus-like proteins by other mechanisms. This interference would include the complete or partial functional inactivation of viral and virus -like materials altered or activated by exogenous and/or environmental agents such as ultraviolet light.
• the HPV vaccine employed in the subject method contains purified inactive viral or virus-like proteins, such as the commercially available GARDASIL®, which is an HPV quadrivalent (types 6, 11, 16, and 18) recombinant vaccine or GARDASIL® 9, an HPV multivalent (types 16, 18, 31, 33, 45, 52, and 58) recombinant vaccine.
• a vaccine useful in accordance with this embodiment of the subject method is preferably free of host-cell peptide, polypeptide, or protein, such as the early antigens, E6 or E7, which are fragments of host-cell peptides that present on the surface of an HPV-infected cell.
• the vaccine can be administered for treating cancerous or benign tumors, including cancer lesions not associated with HPV infection, cancer (tumors or lesions) associated with HPV infection, benign tumors not associated with HPV infection, or noncancerous HPV-related lesions in an unimmunized patient.
• the vaccine can be administered to reduce the incidence of recurrence of cancer, a benign tumor, or an HPV-related lesion in an unimmunized patient.
• the vaccine can be administered to treat cancer, benign tumor, or an HPV-related lesion, or reduce the incidence of recurrence thereof, in an adult patient aged 27 or greater.
• one preferred embodiment of the invention comprises a method for the treatment of cancer, benign tumor or HPV-related lesion, in a patient that is unimmunized, or an adult patient aged 27 or older, comprising the steps of:
• a typical total dose for each administration according to the method of the subject invention is about 0.5 ml of the vaccine.
• the above method of treatment can be efficacious for treating skin cancer in the patient, and particularly squamous cell carcinoma, wherein a skin cancer lesion is reduced in size or eliminated following the three administrations of the vaccine.
• the treatment method according to the subject invention can also reduce the incidence of recurrence of benign tumors or cancer tumors or lesions, including skin cancer, in the patient.
• the method can also be effective to reduce the size or eliminate an HPV- associated, but non-cancerous, lesion, such as warts, including genital warts, e.g., verruca vulgaris or condyloma accuminata
• HPV quadrivalent types 6, 11, 16, and 18
• Further unexpected results of the subject method of treatment comprise reducing the size of, eliminating, or reducing the incidence of recurrence of skin lesions that are not associated with HPV infection, such as basal cell carcinoma or melanoma.
• the method is carried out without the administration of an additional or other immunostimulant or adjuvant either with, during, or following the treatment method of the invention.
• Another embodiment in accordance with the subject invention comprises administering an HPV vaccine administered to a patient by direct or local administration, e.g., injection, into a skin lesion or surrounding area of the lesion.
• This direct administration method can be useful in patients suffering from cancer, particularly skin cancer.
• This embodiment of the method can also be useful for treating non-cancerous (benign) tumors, or non-cancerous lesions associated with HPV, such as warts, e.g., verruca vulgaris or condyloma accuminata.
• the dosing regimen can comprise a single administration or more than one administration.
• a three-administration dosing series as above, can be followed.
• a physician can administer a subsequent dose as needed (prn) following an initial dose directly into or surrounding the lesion. Divided dosing of the vaccine for any particular single time point is considered to be a single administration.
• This direct-administration embodiment of the invention can have beneficial results in treating, or minimizing the occurrence, recurrence, and/or progression of, cancer lesions or tumors such as basal-cell carcinoma (BBC) or melanoma, or non-cancerous (benign) tumors that are not associated with HPV infection,.
• cancer lesions or tumors such as basal-cell carcinoma (BBC) or melanoma, or non-cancerous (benign) tumors that are not associated with HPV infection,.
• any effective HPV vaccine can be employed for administration directly to a cancer or HPV-related lesion.
• this embodiment of the subject method can comprise direct administering into or surrounding a lesion a vaccine comprising purified inactive viral or virus-like proteins, such as the commercially available GARDASIL®, which is an HPV quadrivalent (types 6, 11, 16, and 18) recombinant vaccine or GARDASIL® 9, an HPV multivalent (types 16, 18, 31, 33, 45, 52, and 58) recombinant vaccine.
• GARDASIL® is an HPV quadrivalent (types 6, 11, 16, and 18) recombinant vaccine or GARDASIL® 9
• HPV multivalent types 16, 18, 31, 33, 45, 52, and 58
• a vaccine useful in accordance with this embodiment of the subject method can include host-cell peptides, polypeptides, or proteins, such as the early antigens, E6 or E7 or exclude or be free of host-cell peptides, polypeptides, or proteins, such as the early antigens, E6 or E7.
• the vaccine can be administered for treating cancer, a benign tumor, or HPV-related lesion in a patient of any age, whether an unimmunized patient or a patient previously immunized with an HPV vaccine.
• the vaccine can be directly or locally administered into or surrounding a lesion or tumor to reduce the incidence of recurrence of cancer, benign tumor, or an HPV- related lesion in a patient.
• the vaccine can be administered to treat cancer, benign tumor, or an HPV-related lesion, or reduce the incidence of recurrence thereof, in a patient up to 26 years old or, alternatively, an adult patient aged 27 or greater.
• one preferred embodiment of the invention comprises a method for the treatment of cancerous or non-cancerous tumor or lesion in a patient comprising the step of administering to the patient a dose of an HPV recombinant vaccine directly to the lesion, tumor, or non-cancerous HPV-related lesion.
• the method can comprise the following optional steps:
• a typical total dose for each direct or local administration according to the method of the subject invention is about 0.5 ml of the vaccine.
• Each 0.5 ml dose can be administered, e.g., by intralesional injection, as a bolus of the entire 0.5 ml or can be administered as a divided dose as a plurality of 0.1-0.2 ml partial administrations into the lesion, an area surrounding the lesion, or both.
• the above direct or local administration method of treatment can be efficacious for treating skin cancer in the patient, and particularly squamous cell carcinoma, wherein a skin cancer lesion is reduced in size or eliminated following the three administrations of the vaccine.
• the direct or local administration treatment method according to the subject invention can also reduce the incidence of recurrence of cancer, including skin cancer, in the patient.
• the direct or local administration method can also be effective to reduce the size or eliminate a benign tumor, whether or not associated with HPV infection, or an HPV- associated, but non-cancerous, lesion, such as warts, including genital warts, e.g., verruca vulgaris or condyloma accuminata.
• the direct or local administration method can also be effective to reduce the incidence of recurrence of a benign tumor, whether or not associated with HPV infection, or an HPV-associated, but non-cancerous, lesion, such as warts, including genital warts, e.g., verruca vulgaris or condyloma accuminata
• HPV quadrivalent types 6, 11, 16, and 18
• HPV multivalent types 16, 18, 31, 33, 45, 52, and 58
• Further unexpected results of the subject direct or local administration method of treatment comprise reducing the size of, eliminating, or reducing the incidence of recurrence of skin lesions that are not associated with HPV infection, such as basal cell carcinoma or melanoma.
• the direct or local administration method is carried out without the administration of an additional or other immunostimulant or adjuvant.
• the subject method of treating or reducing the incidence of recurrence of skin cancer comprises administering an HPV vaccine in one or more doses to a patient.
• the method includes administration of a first dose of HPV quadrivalent (types 6, 11, 16, and 18) recombinant vaccine to a patient, a second dose of HPV quadrivalent (types 6, 11, 16, and 18) recombinant vaccine approximately two months thereafter, and a third dose of HPV quadrivalent (types 6, 11, 16, and 18) recombinant vaccine approximately four months after the second dose.
• each dose is 0.5 ml.
• the subject method can be advantageous in that it can be performed using a commercially available HPV quadrivalent (types 6, 11, 16, and 18) vaccine or HPV multivalent (types 16, 18, 31, 33, 45, 52, and 58) recombinant vaccine as a therapeutic agent rather than or in addition to its use as a preventive vaccine.
• HPV quadrivalent types 6, 11, 16, and 18
• HPV multivalent types 16, 18, 31, 33, 45, 52, and 58
• a preventive vaccine is understood to be a vaccine composition administered prior to exposure to or infection with an agent such as human papilloma virus (HPV).
• HPV human papilloma virus
• Preventive vaccines for protection against or prevention of HPV infection and associated cancers are commercially available are therefore known to be safe.
• GARDASIL® is an HPV quadrivalent (types 6, 11, 16, and 18) recombinant vaccine and GARDASIL® 9, is an HPV multivalent (types 16, 18, 31, 33, 45, 52, and 58) recombinant vaccine currently marketed as a preventive vaccine in the United States by Merck & Co., Inc. Whitehouse Station, NJ 08889 USA.
• the vaccine can be readily accessed by a physician or healthcare practitioner.
• an HPV quadrivalent (types 6, 11, 16, and 18) recombinant vaccine or HPV multivalent (types 16, 18, 31, 33, 45, 52, and 58) recombinant vaccine in accordance with the subject method do not require secondary or additional immunostimulants or adjuvants.
• HPV quadrivalent (types 6, 11, 16, and 18) or HPV multivalent (types 16, 18, 31, 33, 45, 52, and 58) recombinant vaccines are free, or substantially free, of host-cell peptides, polypeptides, or proteins, such as the antigens, E6 or E7.
• the unexpected result of treating cancer, benign tumor, or HPV-related skin lesions, including skin cancers that are associated with HPV infection or skin cancers that are not associated with HPV infection can be achieved using the subject method as described herein.
• SCC squamous cell carcinoma
• Patient 1 was administered three 0.5ml doses, including a first 0.5ml dose, a second 0.5ml dose two months later, and a third 0.5ml dose four months after the second dose.
• a follow-up exam three months after administration of the third dose of HPV quadrivalent (types 6, 11, 16, and 18) recombinant vaccine, Patient 1 had experienced zero recurrences of skin cancer, including both SCC and BCC types, during the three month period.
• Prior to commencement of the treatment method Patient 1 had more than 300 distinctive occurrences of skin cancer during his lifetime.
• Patient 2 was administered three 0.5ml doses of HPV quadrivalent (types 6, 11, 16, and 18) recombinant vaccine, including a first 0.5 ml dose, a second 0.5ml dose two months later, and a third 0.5ml dose four months after the second dose.
• HPV quadrivalent types 6, 11, 16, and 18
• Patient 3 was administered three 0.5ml doses of HPV quadrivalent (types 6, 11, 16, and 18) recombinant vaccine, including a first 0.5ml dose, a second 0.5ml dose two months later, and a third 0.5ml dose eight months after the second dose.
• HPV quadrivalent types 6, 11, 16, and 18
• the method of treatment described herein serves to effectively increase, i.e. boost, the patient's immune surveillance in skin cells in order to decrease the likelihood of a development of abnormal skin cells that produce the skin cancer.
• the method of the present invention has been shown to treat and prevent recurrence of SCC, and to significantly reduce recurrence of BCC. It is also possible that the increase in immune surveillance, as a result of the treatment method, will concomitantly decrease the incidence of malignant melanoma.
• the method of treatment for eliminating or reducing the incidence of recurrence of skin cancer includes administering the HPV quadrivalent (types 6, 11, 16, and 18) recombinant vaccine in the form of an injection directly into the cancerous tissue or an area of tissue immediately surrounding the cancerous tissue.
• HPV quadrivalent types 6, 11, 16, and 18

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