Vulvar Cancer clinical trials and treatments

The GROINSS-VII study is looking at using sentinel node mapping to decide whether women need to have any further treatment after surgery for vulval cancer. They are trying to find out whether radiotherapy works as well as removing lymph nodes at stopping vulval cancer from coming back. They hope radiotherapy will cause fewer side effects. They also want to check that it is safe to give no further treatment after surgery if a woman has no cancer cells in her sentinel lymph node. You may be able to join this study if you are going to have an operation to remove an early vulval cancer which measures less than 4 cm across. If the sentinel node has no sign of cancer cells, then you will have no further treatment, but you will be followed up by the trial team. If there are cancer cells in the sentinel lymph node, then instead of having the rest of the lymph nodes in that area removed, you will have radiotherapy for 4 to 5 weeks. Some women will also have cisplatin chemotherapy, to make the cancer more sensitive to radiotherapy.

HPV tests
New tests are being developed to detect the types of human papilloma virus (HPV) that cause cancer. Studies are also going on to find out whether this test should be part of the national screening programme to prevent cervical cancer. This may also prove useful in picking up vulval cancer.

HPV vaccines
HPV vaccines have been developed to stop people from becoming infected with the HPV virus. Other vaccines are being developed that will help your immune system to destroy the virus if you are already infected with it. In future, we hope that the incidence of vulval cancer will go down, as women have this vaccine and HPV infection is prevented. This will take some years, as vulval cancer takes such a long time to develop.

If you have precancerous vulval cells (VIN), it may be linked to HPV infection. So a vaccine that gets rid of the HPV could stop the VIN from developing. This type of treatment is still very experimental. An early stage UK trial of an HPV vaccine for women with VIN has shown some responses, and research is ongoing in this area.

Anti-viral creams for VIN
VIN means you have precancerous cells in the skin of your vulva. It isn't cancer, but if you have this condition, there is a risk that it might go on to develop into a cancer. Doctors are looking at new ways to treat this condition. They are experimental and not yet used as standard treatment. They include:
Imiquimod
Cidofovir
Imiquimod cream is usually used to treat genital warts. It works by stimulating the immune system. This means it uses the body's natural defenses to kill the HPV. It does this by releasing a number of chemicals called cytokines. One of these cytokines is called interferon. Interferon is a protein that is made naturally as part of the body's immune response. It is sometimes used as a cancer treatment. The idea is that the imiquimod makes cells produce more interferon and this helps to kill off the HPV infection. If the HPV is removed, the hope is that the cells affected by VIN will go back to normal. A small Dutch trial of imiquimod has shown quite promising results.

Cidofovir cream (or gel) is quite new and still being investigated as a treatment for VIN. We don't know yet how useful it is.

Photodynamic therapy
Doctors are testing photodynamic therapy as a treatment for VIN and early vulval cancers. For this treatment, you have a chemical injected into a vein that circulates through your body and is absorbed by cancer cells. When the chemical has been taken up by the cells, the doctor shines a bright light on the area of VIN or vulval cancer. The chemical makes the cells very sensitive to light and so the light kills them.

Photodynamic therapy is looking promising. But the treatment is not without its difficulties. If you have a light sensitising drug injected into a vein, all your skin will be at risk of damage just from daylight, until your body has got rid of the drug. So during this time you have to stay in a darkened room, or cover up completely and wear dark glasses if you go out.

Support from another woman with vulvar cancer
Many women have said that getting emotional support when they have gynaecological cancer has helped them to cope. But there is little scientific evidence to back this up. A small study in London has been looking at the difference that this kind of support can make. Women in one group are contacted by a woman who has had similar treatment, and had special training in giving support. The other group go on a waiting list for this kind of support. All women in the study are asked to fill in some questionnaires. The researchers want to find out how helpful this service is for women with gynaecological cancer. This study is no longer recruiting patients and we are waiting for the results.