In NEJM this week, researchers across the US teamed up to test a combination treatment of the gp100 peptide melanoma vaccine and interleukin-2. Stimulating an immune response against cancer with vaccines is still a challenge and the researchers hypothesized that adding interleukin-2 might improve outcomes. The team conducted a randomized phase 3 trial involving 185 patients with stage IV or locally advanced stage III cutaneous melanoma, and patients were randomly assigned to receive interleukin-2 alone or gp100 followed by interleukin-2. The group receiving combination treatment had a significant improvement in overall clinical response — 16 percent — compared with the interleukin group at 6 percent, as well as longer progression-free survival and median overall survival, the researchers write.
Also in NEJM this week, readers respond to a February NEJM article on the efficacy of quadrivalent HPV vaccination in males. The study concluded that vaccination "prevents infection with HPV-6, 11, 16, and 18 and the development of related external genital lesions in males 16 to 26 years of age" at a rate of 90.4 percent. Two researchers in Germany wrote to say that although the vaccine is significantly efficacious in the four strains of HPV it is designed to protect against, efforts should be made to create a vaccine that guards against HPV-42 and 61 as well, which can show up in men who have sex with men. In an editorial accompanying the study, the author suggested that targeted vaccination in males might be more effective than universal vaccination, as men who have sex with men are particularly at high risk of infection. In response, however, two researchers in India say that HPV vaccines are most effective when administered at an early age, before a child can articulate his sexual preferences. Universal vaccination would be more "practical" and would generate herd immunity, the authors write.