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교차 예방 효과를 포함한 자궁경부암 예방 백신들의 효과에 대한 최신 지견

Efficacy of human papillomavirus vaccines including cross protection: A review of recent evidence

박태철|박종섭|김찬주
대한산부인과학회 (Korean Soceity of Obstetrics and Gynecology)|2010.02|Obstetrics & Gynecology Science|제53권 제02호|pp. 103-118

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자궁경부암Cervical cancerVaccineHPVCervical intraepithelial neoplasiaCross protectionCIN예방 백신4가백신2가백신교차면역Quadrivalent vaccineBivalent vaccine
주제분류산부인과학

초록

두 종류의 자궁경부암 예방 백신 (HPV vaccines)의 면역원성은 여러 임상 2상, 임상 3상 연구에 의하여 수만 명의 여성에서 탁월한 효과가 증명이 되었다. 현재 임상에서 사용되고 있는 두 종류의 자궁경부암 예방 백신은 모두 자궁경부암의 약 70%에서 발견이 되는 HPV-16, HPV-18형의 감염에 대한 예방을 목적으로 하고 있다. 이에 최근 나온 HPV 예방 백신을 이용한 무작위 임상-대조군 연구들을 분석하여 이들 예방 백신의 임상적 효과와 안전상, 면역원성에 대하여 정리하여 보았다. Bivalent HPV vaccine, quadrivalent HPV vaccine 모두 성적 접촉이 이루어지기 전의 소녀들에게 접종이 이루어질 경우, 탁월한 면역 원성과 각각 목적으로 하는 HPV형에 대하여 거의 완벽한 방어 효과와 안전성을 보였다. 최근의 논문 결과들에 의하면 이들 백신은 HPV-16, HPV-18형과 비슷한 항원 구조를 가지는 HPV형에 대하여 교차 예방 효과도 보이고 있다. Quadrivalent vaccine은 HPV-31형에 의한 cervical intraepithelial neoplasia (CIN) 2/3, adenocarcinoma in sutu에 대한 예방 효과가 있으며, bivalent HPV vaccine은 HPV-31, HPV-33, HPV-45형의 감염 및 이들 아형에 의한 CIN2 이상의 자궁경부 병변에 대하여 상당한 효과가 보고되었으며, 현재, 국내 뿐만 아니라 오스트렐리아와 이스라엘에서는 26세 이상의 여성에 대하여 등록이 되어 있다. 이들 두 예방 백신에 대하여 임상 권고안이 국내에서는 이미 대한 부인종양콜포스코피 학회에 의하여 제시되어 있다. HPV 예방 백신이 장기적으로 자궁경부암의 예방에 상당한 효과가 있을 것으로 기대되고 있으나, 백신 투여를 받는 여성이 늘어나는 시기에는 국내 자궁경부 검진 권고안에 대하여도 새로운 정립이 필요하며, 26세 이상이나 남성 등 특수 군에 대한 예방 효과를 분석하여 자궁경부암 예방 백신의 권고안도 지속적인 개정이 필요하게 된다.

Abstract

The efficacy and immunogenicity of human papillomavirus (HPV) vaccines has proven excellent in several phase 2 and phase 3 trials involving tens of thousand women. Two versions of HPV vaccine had been developed, both target HPV 16 and HPV 18, which involve approximately 70% of cervical cancer. We have summarized the recent review of all randomized controlled trials in which vaccines against HPV were compared with placebo regarding efficacy, safety, and immunogenicity. Both vaccines have an excellent safety profile, are highly immunogenic, and have atributed complete type specific protection against persistent infection and associated lesions in fully vaccinated girls and young women. Data strongly suggest that both vaccines can have a variable level of cross protection against HPV types genetically and antigenically-closely related to vaccine types. Demonstration of cross protection against combined endpoints [cervical intraepithelial neoplasia (CIN) 2/3 and adenocarcinoma in situ] for HPV-31 has been reached for the quadrivalent vaccine. Bivalent HPV vaccine showed significant type-specific cross-protection against CIN2+ associated with HPV-31, HPV-33, and HPV-45. The bivalent vaccine is also registered for above age 26 in Australia, Israel and Korea. In our country, we have already set up the clinical guideline of both vaccines. Although these prophylactic vaccination is likely to provide important gains in the prevention of cervical cancer, we should have need to establish the new screening guideline in post-vaccination period and to make next version of vaccination-guidelines related of specific subgroups of patients who would benefit from the vaccine (women older than 26 years, boys, and men).

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