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clinical trial comparing the regression rate after 12 months of histologically confirmed cervical intraepithelial lesions 1 in 2 parallel groups. One group using the vaginal gel Papilocare® for 6 months and one group without any treatment.
Cervical cancer affects 3000 women and causes 1100 deaths every year in France. This type of cancer usually takes about 10 to 15 years to develop and has distinct precursor stages. Persistent infection by Human Papillomavirus is necessary for the development of these lesions.
Currently, when a colposcopy biopsy reveals low grade lesion, it is recommanded to make a new cervical cytology or HPV testing, 12 months later. No treatment is recommended over this period. However 11% of these lesions evolve from low to high grade.
Papilocare® is a vaginal gel that would improve the re-epithelialization of the uterine cervix. Creating a protective film on the cervix, it could induce a favorable environment for regression of the cervical intraepithelial lesions 1 and for clearance of Human Papillomavirus.
The goal of our study is to include 150 women with a histologically confirmed cervical intraepithelial lesions 1. Half of them will be using the vaginal gel Papilocare® for 6 month while the other half will not receive any treatment (as suggested by current recommendations). Each patient will have a cervical cytology and a HPV testing after 6 months and after 12 months. Therefore we will be able to compare the percentage of normalization of cervical cytology and HPV clearance for each group after 6 months and after 12 months.
Patients will visit the Orleans hospital once for the inclusion and twice for follow-ups after 6 months and 12 months.
If the use of Papilocare® really induces a significant regression of low grade lesions, this vaginal gel could be offered as soon as these lesions are histologically identified in order to stop its progress to high grade.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Papilocare group | Experimental | Papilocare® for 6 months according to the following schedule: 1 self-applying single dose per day for 21 days over 28 during the first month, then 1 day over 2 during the following 5 months, with a 7-day break during the menstrual period. (This break must be respected even in menopausal women or women undergoing artificial amenorrhea (amenorrhea induced by certain contraceptives: implant, hormonal IUD, micro-progestogen). |
|
| Control group | No Intervention | No treatment for 12 months. Smear and HPV test will be perform by all patients at 6 and 12 months |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| PAPILOCARE | Device | Papilocare® is a self-administered vaginal gel. Its single-dose cannula contains hyaluronic acid and pre-biotics (Coriolus Versicolor) that would improve the re-epithelialization of the uterin cervix. By creating a protective film on the cervix, this gel could induce a favorable environment for regression of the cervical intraepithelial lesions 1 and for clearance of Human Papillomavirus. The specific approach related to our study would be to apply Papilocare® vaginal gel for 6 months for the treated group. Smear and HPV test will be perform by all patients at 6 and 12 months. |
| Measure | Description | Time Frame |
|---|---|---|
| Cervical cytology normalization after 12 months. | Compare the normalization rate of the cervical cytology in each arm after 12 months. The difference will be considered statistically significant if the treatment group has a normalization rate of 25% or higher. An "unsatisfactory" smear in its realization will have to be repeated within 45 days. | Month 12 |
| Measure | Description | Time Frame |
|---|---|---|
| Cervical cytology normalization after 6 months. | Compare the normalization rate of the cervical cytology in each arm after 6 months. | Month 6 |
| HPV clearance after 6 months | 2) Compare in each arm the rate of transition from a positive HPV testing at inclusion to a negative HPV testing after 6 months. The difference will be considered statistically significant if the treatment group has a clearance rate of 25% or higher. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Helene GBAGUIDI, Dr | CHR ORLEANS | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Centre Hospitalier Régional d'Orléans, France | Orléans | 45000 | France |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 11919208 | Background | Bosch FX, Lorincz A, Munoz N, Meijer CJ, Shah KV. The causal relation between human papillomavirus and cervical cancer. J Clin Pathol. 2002 Apr;55(4):244-65. doi: 10.1136/jcp.55.4.244. | |
| 8463044 | Background | Ostor AG. Natural history of cervical intraepithelial neoplasia: a critical review. Int J Gynecol Pathol. 1993 Apr;12(2):186-92. |
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clinical trial with 2 parallel groups :
Treatment arm : Use of the vaginal gel for the first 6 months, then absence of treatment for the next 6 months until follow-up.
Control arm - Absence of treatment for 12 months.
Inclusion of 150 patients, balanced randomization meaning 75 patients in each arm.
Follow-up after 6 months : a cervical cytology and a HPV testing for each patient + listing how many patients suffer from vaginal discomfort for 6 months.
Follow-up after 12 months : a cervical cytology and a HPV testing for each patient.
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|
| Month 6 |
| HPV clearance after 12 months | 2) Compare in each arm the rate of transition from a positive HPV testing at inclusion to a negative HPV testing after 12 months. The difference will be considered statistically significant if the treatment group has a clearance rate of 25% or higher. | Month 12 |
| Evaluation of tolerance of Papilocare vaginal gel | Compare in each group the number of episodes of vaginal discomfort over the first 6 months. | Month 6 |
| 10667155 | Background | Lousuebsakul V, Knutsen SM, Gram IT, Akin MR. Clinical impact of atypical squamous cells of undetermined significance. A cytohistologic comparison. Acta Cytol. 2000 Jan-Feb;44(1):23-30. doi: 10.1159/000326220. |
| 18630456 | Result | Bansal N, Wright JD, Cohen CJ, Herzog TJ. Natural history of established low grade cervical intraepithelial (CIN 1) lesions. Anticancer Res. 2008 May-Jun;28(3B):1763-6. |
| ID | Term |
|---|---|
| D065310 | Squamous Intraepithelial Lesions of the Cervix |
| D030361 | Papillomavirus Infections |
| ID | Term |
|---|---|
| D002578 | Uterine Cervical Dysplasia |
| D011230 | Precancerous Conditions |
| D009369 | Neoplasms |
| D002577 | Uterine Cervical Diseases |
| D014591 | Uterine Diseases |
| D005831 | Genital Diseases, Female |
| D052776 | Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D000091662 | Genital Diseases |
| D000081483 | Squamous Intraepithelial Lesions |
| D065308 | Morphological and Microscopic Findings |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D015229 | Sexually Transmitted Diseases, Viral |
| D012749 | Sexually Transmitted Diseases |
| D003141 | Communicable Diseases |
| D007239 | Infections |
| D004266 | DNA Virus Infections |
| D014777 | Virus Diseases |
| D014412 | Tumor Virus Infections |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
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