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A Randomised phase II multi-centre Trial of topical treatment in women with Vulval Intraepithelial Neoplasia
ISRCTN ISRCTN34420460
ClinicalTrials.gov identifier
Public title A Randomised phase II multi-centre Trial of topical treatment in women with Vulval Intraepithelial Neoplasia
Scientific title
Acronym RT3 VIN
Serial number at source WCTU004; Sponsor ref: SPON CU 245
Study hypothesis VIN is a pre-malignant condition that predominantly affects premenopausal women. VIN has a significant invasive potential, is often highly symptomatic and difficult to manage clinically. Severe distressing symptoms of itching and pain are common and management aims to both relieve symptoms and prevent malignant progression. The precise rate of malignant progression is unknown.

Surgery is often chosen as the treatment for this condition but is associated with high rates of recurrence and may be mutilating. By comparison, recent small studies of new topical treatments have shown promising results that warrant further investigation as an alternative to surgery.

The purpose of this research is to determine whether there is evidence that either of the topical treatments is active, safe and feasible to use and would therefore warrant further investigation in a phase III setting.
Ethics approval To be submitted as of 03/09/2007.
Study design A randomised phase II multi-centre trial.
Countries of recruitment United Kingdom
Disease/condition/study domain Vulval Intraepithelial Neoplasia
Participants - inclusion criteria 1. Women with biopsy proven Vulval Intraepithelial Neoplasia 3 (VIN3) (including visible peri-anal disease not extending into the anal canal)
2. At least one lesion of sufficient size to allow biopsies (greater than or equal to 1 cm2)
3. Informed consent
Participants - exclusion criteria 1. Any patients with impaired renal function
2. Any patient with current anogenital carcinoma or any patient who, in the investigators opinion, is at a high risk of developing invasive disease (patients in whom invasive or microinvasive disease is suspected should have adequate biopsies to exclude this prior to entry)
3. Pregnancy, breast feeding or trying to conceive
4. Active treatment for VIN within the previous four weeks
5. Patients who are under 18 years old
6. Known allergy to either of the topical treatments
7. Unable to comply with protocol treatment
8. Prior failure of imiquimod or cidofovir following treatment 3 times a week for a minimum of 12 weeks
Anticipated start date 01/01/2008
Anticipated end date 01/01/2013
Status of trial Ongoing
Patient information material
Target number of participants 204 (102 in each arm)
Interventions Topical treatment with either imiquimod or cidofovir will be applied by the patient for a maximum of 24 weeks. In both treatments the patient should use as much cream as needed to adequately cover the affected area. Patients will be reviewed every 6 weeks. At each visit the lesion will be assessed. In the absence of complete response, treatment will be continued for a maximum of 24 weeks.

Arm A:
Topical imiquimod will be applied three times a week. A thin layer will be spread over the area at night and the area will be washed using aqueous cream and water the following day. Patients will be advised to avoid contact with the treated area, including avoiding sexual intercourse until the area is washed the next day.

Arm B:
Topical cidofovir will be applied three times a week. A thin layer will be spread over the area at night and the area will be washed using aqueous cream and water the following day. Patients will be advised to avoid contact with the treated area, including avoiding sexual intercourse, until the area is washed the next day.

Patients who are judged to have failed on either topical treatment will be given the opportunity to switch to the alternative trial treatment.
Primary outcome measure(s) Histologically confirmed complete response by 30 weeks after start of treatment.
Secondary outcome measure(s) 1. Symptomatic improvement, assessed at each 6-weekly visit
2. Compliance and side effects, assessed at each 6-weekly visit
3. Viral clearance, assessed 6 weeks after the participants stop treatment
4. Human PapillomaVirus (HPV) type and integration status, assessed 6 weeks after the participants stop treatment
5. Recurrence rate at two years (in 30 week complete responders). This will be assessed 6 monthly for 2 years from the end of treatment visit
Sources of funding Cancer Research UK (C10087/A7736)
Trial website http://www.wctu.org.uk
Publications
Contact name Prof  Alison  Fiander
  Address Department of Obstetrics and Gynaecology
Cardiff University
Heath Park
  City/town Cardiff
  Zip/Postcode CF14 4XW
  Country United Kingdom
Sponsor Cardiff University (UK)
  Address Research and Commercial Division
7th Floor
30-36 Newport Road
  City/town Cardiff
  Zip/Postcode CF24 0DE
  Country United Kingdom
  Tel +44 (0)2920 875834
  Fax +44 (0)2920 874189
  Email DaviesKP2@cf.ac.uk
Date applied 03/09/2007
Last edited 25/09/2007
Date ISRCTN assigned 25/09/2007
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