Anti-cancer shots for boys in the pipeline

By Dr. Ananya Mandal, MDFeb 8 2011

The Pharmaceutical Benefits Advisory Committee (PBAC) is deciding on whether to include the human papillomavirus (HPV) vaccine, Gardasil in in the National Immunization Program for boys.

At present Gardasil is administered to girls when they begin high school to prevent cervical cancer. HPV, however, also causes throat cancer, genital and anal warts, and cancer of the penis. About 90 per cent of all anal squamous cell carcinomas are caused by infection with HPV. Anal cancer had increased by about 3.4 per cent annually in men and 1.9 per cent in women since 1982, according to the study published in the journal Vaccine.

Gardasil is approved in Australia for use in boys and men aged nine to 26. Without subsidy, it costs $450 a treatment, and most parents are unaware of the protection it offers boys. According to Professor Andrew Grulich, of the National Centre in HIV Epidemiology and Clinical Research, only few boys from medical families are getting the shots. He said, “The boys who are getting it more than any others are the sons of doctors because doctors are aware of the enormous benefits of this vaccine for boys… There is absolutely no doubt it will prevent most anal cancer, that it will prevent quite a bit of penile cancer, and that it will prevent almost all anal and genital warts.”

Grulich pointed out that HPV was now responsible for majority of cancers in the back of the throat in Australia due to lower rates of smoking, and oral sex growing in acceptability. “Those cancers have been increasing over the last 20 or 30 years. Previously we thought perhaps 20 or 30 percent of those cancers were caused by HPV and now it’s more like 70 percent…It’s really important that this vaccine should be given before the onset of sexual activity because once a man becomes sexually active this virus is so common that he will become infected with it really quite quickly…It should be part of the school vaccination program. It should be given at exactly the same age as girls, and on the same day as the girls are done,” he said.

According to the CSL Limited, which holds the license for the drug in Australia, this is a cost effective submission to the PBAC. If PBAC supports the submission, it will go to the health minister by midyear. Sharon McHale, CSL’s senior director of public affairs is hopeful that males could be included in the immunization program by next year. “The prevalence and severity of HPV disease in males is considerable and justifies a universal vaccination program… A gender-neutral vaccination strategy will have the greatest impact on HPV disease and is in the best interest of public health,” McHale said.