Keratinocyte Carcinomas in Immunocompromised Patients Are Reduced After Administration of the Nonavalent Human Papillomavirus Vaccine

May 2022 | Volume 21 | Issue 5 | Case Reports | 526 | Copyright © May 2022


Published online April 29, 2022

doi:10.36849/JDD.6536

Anna J. Nichols MD PhD,a,b William J. Nahm BA,c Harold Rabinovitz MD,d Tim Ioannides MDa,e

aUniversity of Miami Miller School of Medicine, Miami, FL
bSylvester Comprehensive Cancer Center, Miami, FL
cNew York University Grossman School of Medicine, New York, NY
dMedical College of Georgia at Augusta University, Augusta, GA
eTreasure Coast Dermatology, Port St. Lucie, FL

Abstract
Immunosuppression, as seen in solid organ transplant recipients, is highly associated with the development of keratinocyte carcinomas (KCs). Reducing the level of immunosuppression lowers the incidence of KCs but at the cost of increased potential morbidity and mortality. Recent studies have revealed a greater prevalence of HPV DNA, especially that of β-HPV, in KCs of immunocompromised patients compared to KCs of immunocompetent individuals. A prior report demonstrated that the HPV vaccine was associated with reducing KC incidence in immunocompetent patients. The nonavalent HPV vaccine was administered to two immunosuppressed individuals with histories of multiple prior KCs. Both patients are male, with Patient 1 being a liver transplant recipient who was on tacrolimus for an extended period and Patient 2 having Crohn’s disease and currently being treated with mercaptopurine. The treatment was well tolerated without adverse events and was associated with dramatic reductions in average incidence of KCs/year in both patients. Patient 1 demonstrated an 88% reduction in new KCs/year (87% squamous cell carcinomas (SCCs); 100% basal cell carcinomas (BCCs) post-injection of the intramuscular vaccine and Patient 2 demonstrated a 63% reduction in incidence of KCs/year (30% SCCs; 100% BCCs). Evidence links the β-HPV genera to the development of SCCs and actinic keratoses. The nonavalent HPV vaccine, containing antigens of the α-HPV genera, may also induce humoral immunity to β-HPV due to shared expression of L1 and L2 capsid proteins. The HPV vaccine may be an effective tool in the prevention of KCs in immunosuppressed patients.

J Drugs Dermatol. 2022;21(5):526-528. doi:10.36849/JDD.6536

INTRODUCTION

Immunosuppression, as seen in solid organ transplant recipients (SOTRs), has been highly associated with the development of cutaneous keratinocyte carcinomas (KCs), particularly squamous cell carcinomas (SCCs) and basal cell carcinomas (BCCs).1 Although reducing the level of immunosuppression lowers the incidence of KCs,2 the potential morbidity and mortality associated with such reductions are increased. Strategies to reduce KCs in the setting of immunosuppression include the use of sun protection, acitretin, niacinamide, field therapy treatments, and the switching or reducing of immunosuppressive agents.2-4 However, these options are limited in their efficacy.

Our group was the first to report that the HPV vaccine was associated with a reduction in new KCs in immunocompetent patients.5 There is compelling data that there is increased expression of HPV in cutaneous KCs of immunosuppressed patients as compared to the KCs of immunocompetent patients.6 For these reasons, we offered the nonavalent HPV vaccine to two immunosuppressed individuals with a history of multiple prior KCs. This treatment was associated with a dramatic reduction in the average incidence of KCs per year in both patients. The vaccine was also well-tolerated without adverse events.

CASE REPORTS

Patient 1: A man in his 60s had multiple KCs after his liver transplant in 1995. He was treated with tacrolimus from 1995– 2016. To potentially reduce the number of new skin cancers, the nonavalent vaccine was administered intramuscularly at 0, 2, and 6-months (April, June, and October 2016). Prior to the first intramuscular vaccine at month 0 (April 2015-April 2016), the patient was diagnosed with 9 new KCs (8 SCCs and 1 BCC) and averaged 9 KCs/year (8 SCCs/year; 1.00 BCCs/year). After the first intramuscular vaccine (April 2016-July 2019), he developed 5 new KCs (5 SCCs) at an average of 1.05 KCs/year (1.05 SCCs/ year; 0 BCCs/year). This represents an 88% reduction in new
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