MedicalResearch.com Interview with:
Dr. Jeffrey Rapaport MD, PA
Emeritus head of Dermatology
Teaneck’s Holy Name Hospital.
Dr. Rapaport discusess a case recently reported in JAMA: In 2016:
A 97-year-old female patient was suffering from multiple squamous cell carcinomas varying from small to incredibly large in size on both of her legs. She was injected with the HPV vaccine commonly known as Gardasil, which is also used to treat warts and oral papilloma. She was first injected in her arm, and then after a period of six weeks, the vaccine was directly injected into her tumors. It was observed that this treatment eventually killed off almost all the tumors on her legs. According to recent press coverage, she is now looking forward to celebrating her 100th birthday in fall 2018.
MedicalResearch.com: What is the background for this study?Is HPV thought be a trigger for some cutaneous squamous cell carcinomas?
Response: The link between skin cancers and HPV vaccinations has normally been investigated in patients who have received organ transplants. Due to the immune-suppressant drugs these patients must take, it is incredibly common to find cases of skin cancer in patients who have undergone transplants. The relaxed immune system, which would normally eliminate cancers caused by the HPV virus, would open the floodgates for multiple skin tumors to emerge. In this case of the 97 year old, I would assume her immune system was healthy. There is, however, growing evidence that receiving multiple vaccines for the HPV virus is necessary even in patients with healthy immune systems. So, regardless of immune health, I believe we need to expand the frequency of the HPV vaccine, even beyond the current three-tiered system for women below 26 and men below 21.
MedicalResearch.com: Might HPV vaccine be useful in transplant patients or in patients with multiple keratoacanthomas?
Response: In terms of Keratoacanthomas, research began in Europe in the 1970s, but there was no discovery of HPV DNA in a Keratoacanthoma in the United States until 1989. The research was expedited by new DNA hybridization techniques. In a study conducted in 1989, DNA for HPV -16 was found in all 8 of the keratoacanthomas in question, including the control group.
We now know that HPV protein can modify the cellular response to UV exposure, contributing to a high-frequency of cancers resulting from sun exposure in HPV-infected individuals.
MedicalResearch.com: What are the main findings?
Response: The research is still rather raw. What we do know is that Doctor Anna Nichols of the University of Miami Sylvester Comprehensive Medical Center injected her patient twice in the arm with Gardasil over the course of 6 weeks, and then injected each tumor directly with the same vaccine. It’s been reported that all of these tumors disappeared.
MedicalResearch.com: What are your responses to this research?
Response: If you take any vaccine and inject it into a skin cancer, whether it be HPV, measles, etc… you will elicit an immune response. Think about the yearly flu vaccine. Once it is injected, your arm becomes sore, and you feel week. Many people report cold-like symptoms after receiving a vaccine for this purpose. Frequently injecting a vaccine directly into a tumor will generate an immune response regardless of which vaccine it is. This can possibly raise some doubts regarding the specific role HPV plays in skin cancer development, treatment, and prevention as opposed to vaccines in general.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Research between viruses and cancers must be expanded as a whole, especially with an eye toward common, everyday substances that lower an individual’s immunity towards viruses. It’s recently been released that one of the most common cancers associated with the HPV virus are oropharyngeal. Although the general trend right now is to assume that cannabinoids and marijuana usage is beneficial for the human body, there has been research that cannabinoids bond to certain receptors in immune-regulatory cells, causing a decrease in the body’s ability to resist certain types of viruses that cause skin cancers. As the general population becomes more and more accustomed to the idea that marijuana usage is harmless, and even beneficial, I believe that we must have more research on the relationship between marijuana usage and skin cancers in the coming years.
MedicalResearch.com: Is there anything else you would like to add?
Response: I believe there is a value to injecting vaccines into individuals with normal immune systems as well as those that are immune-depressed. I also believe that we need to continue vaccinating people throughout life–we should dose individuals with vaccines past their youth. This, of course, should be coupled with further research.
Nichols AJ, Gonzalez A, Clark ES, et al. Combined Systemic and Intratumoral Administration of Human Papillomavirus Vaccine to Treat Multiple Cutaneous Basaloid Squamous Cell Carcinomas. JAMA Dermatol.2018;154(8):927–930. doi:10.1001/jamadermatol.2018.1748
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