Gardasil: CHMP Grants Positive Opinion for New Indication, for the Prevention of Anal Cancers and Anal Precancerous Lesions, in the European Union


European Committee for Medicinal Products for Human Use evaluated positively a new indication for the prevention of anal cancers and precancerous lesions for Gardasil

April 30, 2014

Sanofi Pasteur MSD announced today that the European Medicines Agency’s Committee for Medicinal Products for Human Use (CHMP) has given a positive opinion for Gardasil® to be used for the prevention of anal precancerous lesions and anal cancers, causally related to oncogenic Human Papillomavirus (HPV) types 16 and 18.

This new indication is supported by the results of a study showing the high efficacy of Gardasil® against anal precancerous lesions linked to HPV types 6, 11, 16 & 18 (AIN 2/3) which are recognized as immediate precursors of anal cancers[1].

Anal cancer is a rare but serious disease frequently caused by HPV and for which there is no screening,” said Dr Jean-Paul Kress President of Sanofi Pasteur MSD. “This new indication for the quadrivalent HPV vaccine offers for the first time protection from this cancer thanks to a vaccine.”

A CHMP positive opinion is one of the final steps before a variation to the marketing authorisation granted by the European Commission.

Gardasil® is a quadrivalent HPV vaccine, helping to protect people from cervical cancer, genital precancerous lesions and genital warts, with demonstrated protection in real life [2,3,4].  It is Europe’s leading HPV vaccine with 29 million doses distributed in Western Europe and approximately 144 million doses distributed worldwide. The number of doses administered is not known.

Gardasil® is currently licensed from the age of nine years, for the prevention of premalignant genital lesions (cervical, vulvar and vaginal) and cervical cancer causally related to certain oncogenic Human Papillomavirus (HPV) types and genital warts (condyloma acuminata) causally related to specific HPV types.[5]

About anal cancer

Approximately 6,800 new cases of anal cancer are estimated to occur annually in Europe*, among which about 75-80% are attributable to HPV types 16 and 18[6,7,8].  According to population-based studies, anal cancers are more frequent in women than in men, with over 60% of cases occurring in women[6]. In men, the incidence of anal cancer is higher among men who have sex with men (MSM), however a population based study estimated that 53% of male anal cancers in occurred in heterosexual men[8].

The incidence of anal cancer has been continuously increasing over recent decades, both amongst men and women, in industrialized countries in general, and in Europe in particular[8].

Prevention of anal cancer

The efficacy of Gardasil® against anal disease – anal intraepithelial neoplasia (AIN) and anal cancer – was evaluated in a population of 598 men who have sex with men between 16 and 26 years of age. The primary analysis was conducted in the per-protocol efficacy (PPE) population, which consisted of individuals who received all three vaccinations within one year of enrolment, did not have any major deviations from the study protocol, and were naïve to HPV types 6, 11, 16 and 18 when they started the study and remained free of infection from these four HPV types through one month after receiving their last vaccine dose[5].

The efficacy of Gardasil® in reducing the incidence of anal precancerous lesions grades 2/3 (AIN 2/3) related to vaccine HPV types 6, 11, 16 & 18 was 74.9% (95 % CI: 8.8, 95.4) and 86.6% (95 % CI: 0.0, 99.7) for the anal precancerous lesions grades 2/3 (AIN 2/3) related to the 2 oncogenic vaccine HPV types 16 & 18[5]. Median duration of follow-up was 2.15 years.

The CHMP acknowledged the extrapolation of the efficacy of Gardasil® in preventing AIN 2/3 from the MSM population to healthy heterosexual men (HM) and women.

About Gardasil® 

Gardasil®, manufactured by Merck, is a quadrivalent vaccine for protection against cancer of the cervix and other genital diseases caused by the human papillomavirus types 6, 11, 16 and 18: precancerous lesions of the cervix (CIN2/3), precancerous lesions of the vulva (VIN2/3) and vaginal (VaIN2/3) and genital warts (condyloma acuminata).

Launched 2006, it is the most widely used HPV vaccine worldwide with approximately 144 million doses distributed to date. The number of doses administered is not known.

About Sanofi Pasteur MSD

Sanofi Pasteur MSD is a European joint venture formed between Sanofi Pasteur (the vaccine division of Sanofi) and Merck (known as MSD outside the United States and Canada). Combining innovation and expertise, Sanofi Pasteur MSD is the only European pharmaceutical company dedicated exclusively to the development of vaccines. Sanofi Pasteur MSD makes use of the combined expertise resulting from Sanofi Pasteur and Merck’s research to focus on the development of new vaccines inEurope in order to produce the most effective, most acceptable and better tolerated vaccines.

*United Nations European Region


  1. Scholefield JH, Castle MT, Watson NF. Malignant transformation of high grade anal intraepithelial neoplasia. Br J Surg 2005;92:1133-6.
  2. Brotherton JML et al. Early effect of the HPV vaccination programme on cervical abnormalities in Victoria, Australia: an ecological study. Lancet 2011;377:2085-92.
  3. Read TRh et al. The near disappearance of genital warts in young women 4 years after commencing a national human papillomavirus (HPV) vaccination programme. Sex Transm Infect 2011; 87: 544-547.
  4. Markowitz LE et al. Reduction in Human Papillomavirus (HPV) Prevalence Among Young Women Following HPV Vaccine Introduction in the United States, National Health and Nutrition Examination Surveys, 2003-2010. J Infect Dis, 2013; 208[3]: 385-393.
  5. Gardasil SmPC, April 2014.
  6. Forman D, de Martel C, Lacey CJ, Soerjomataram I, Lortet-Tieulent J, Bruni L, et al. Global burden of human papillomavirus and related diseases. Vaccine 2012;30 Suppl 5:F12-23.
  7. de Martel C, Ferlay J, Franceschi S, Vignat J, Bray F, Forman D, et al. Global burden of cancers attributable to infections in 2008: a review and synthetic analysis. Lancet Oncol 2012;13(6):607-15.
  8. De Vuyst H, Clifford GM, Nascimento MC, Madeleine MM, Franceschi S. Prevalence and type distribution of human papillomavirus in carcinoma and intraepithelial neoplasia of the vulva, vagina and anus: a meta-analysis. Int J Cancer 2009;124(7):1626-36.
  9. Brewster DH, Bhatti LA. Increasing incidence of squamous cell carcinoma of the anus in Scotland, 1975-2002. Br J Cancer 2006;95(1):87-90.
  10. Nielsen A, Munk C, Kjaer SK. Trends in incidence of anal cancer and high-grade anal intraepithelial neoplasia inDenmark, 1978-2008. Int J Cancer 2012;130(5):1168-73.
  11.  Daling JR, Madeleine MM, Johnson LG, Schwartz SM, Shera KA, Wurscher MA, et al. Human papillomavirus, smoking, and sexual practices in the etiology of anal cancer. Cancer 2004;101(2):270-80.
  12.  Brewster DH, Bhatti LA. Increasing incidence of squamous cell carcinoma of the anus in Scotland, 1975-2002. Br J Cancer 2006;95(1):87-90.
  13. Robinson D, Coupland V, Moller H. An analysis of temporal and generational trends in the incidence of anal and other HPV-related cancers in Southeast England. Br J Cancer 2009;100(3):527-31.
  14. Goldman S, Glimelius B, Nilsson B, Pahlman L. Incidence of anal epidermoid carcinoma in Sweden 1970-1984. Acta Chir Scand 1989;155(3):191-7.
  15. Nielsen A, Munk C, Kjaer SK. Trends in incidence of anal cancer and high-grade anal intraepithelial neoplasia inDenmark, 1978-2008. Int J Cancer 2012;130(5):1168-73.
  16. van Lieshout A, Pronk A. [Increasing incidence of anal cancer in the Netherlands]. Ned Tijdschr Geneeskd 2010;154:A1163.

Comments 3

  1. VeliAlbertKallio

    This was the only expected outcome which one could see from the onset. It would have been far better to push the quadrivalent vaccine aggressively to eradicate the relevant HPVs (6,11,16,18) from circulation as fast as possible as the wide range of HPV-associated adverse conditions is so large.

    Europeans had from the onset of HPV introduction this moron idea that only teenagers have sex till 20s, that couples stick together from marriage ring to the deathbed. This presupposition was coined by some Pentecostal missionary doctors at the European Commission. In reality, our partners die, or depart. Many men and women may emerge to the wider sexual marketplace first time in their 40’s and 50’s after 20-30 years in a steady relationship and suddenly get kicked into a dirty HPV-infested ass or vagina as their mid-life gift, or after curse to the loss of their previous steady relationship with one sexual partner.

    I suppose the morons in the West, especially the EU, who think either that (1.) partners have everlasting life, or (2.) all widowers are jonining the monastery, and furthermore that (3.) no pathogen carousel exist between vaginal and oral and anal sex to transmit HPVs and illnesses around. European stupidity is just once again proven world-wide.

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