Over the past decade, a substantial body of data has accumulated which implicates the human papillomaviruses (HPVs) in epithelial cancers, especially cervical cancer. More recently, a new family HPV has been identified in skin cancers that are related to those found originally in patients with heritable skin cancer prone condition, epidermodysplasia verruciformis. With the advent of new chemoprevention strategies directed against each of these cancer types, it appears prudent to develop novel secondary endpoint biomarkers (SEBs). Accordingly, a central Theme of this project is to develop HPV-related SEBs in the context of two novel chemoprevention strategies, one of which is expressly directed against HPV infection. Two Phase II chemoprevention clinical trials are planned at the Mayo Clinic and in the North Central Cancer Treatment Group (NCCTG) member institutions, with support for protocol development, data management, and statistical analysis deriving primarily from NCCTG CCOP grants ( i.e. research base and individual institution grants). The first is a randomized pilot evaluation of topical imiquimod, and immunomodulatory agent which has proven to be safe and effective for the treatment of genital warts. This trial will be conducted on patients with recurrent and/or high-grade cervical intraepithelial neoplasia (CIN). For skin cancers. This trial will attempt to reproduce and further substantiate a previous randomized trial in the which a treatment benefit was demonstrated. Broad-range PCR techniques will be used to monitor the type-specific persistence of HPV in cervical specimens after imiquimod therapy. Similar techniques will be used to characterize the potential role of HPV in skin cancers, strategies will also be developed to determine if HPV - specific immune responses can be used as SEBs in CIN related gene expression and AP-1 expression/activity will be developed for the skin cancer chemoprevention project.
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