High-grade squamous intraepithelial lesions (HSIL), encompassing cervical intraepithelial neoplasia grade 2 (CIN2) with p16 positivity and grade 3 (CIN3), are precancerous conditions that require effective intervention. This Phase II study aims to comprehensively evaluate the efficacy, safety, and impact on quality of life of hexaminolevulinate photodynamic therapy (HAL-PDT) with deferred surgery compared to immediate surgical treatment in subjects with HSIL.
This is a prospective, open-label, randomized, controlled, non-inferiority trial. A total of 230 subjects are planned to be enrolled, with 115 subjects allocated to each treatment group (HAL-PDT with Deferred Surgery or Immediate Surgery ).
The primary endpoint is the pathological regression rate at 12 months, defined as histological findings of normal tissue or low-grade squamous intraepithelial lesions (LSIL) via colposcopy-directed biopsy. Key secondary endpoints include Human Papillomavirus (HPV) clearance rates at 6 and 12 months, pathological regression rate at 6 months, quality of life assessed by the EORTC QLQ-CX24 questionnaire, safety profiles (incidence, severity, and duration of AEs and SAEs, as well as their relationship to the study treatments), and the proportion of subjects developing cervical cancer within 12 months.
Voluntarily participate in this clinical study, fully understand the study content, procedures, and potential adverse reactions, and be able to sign the written informed consent form.
Able to complete the study in accordance with the study protocol.
Subject age ≥18 years.
Presence of High-Grade Squamous Intraepithelial Lesion (HSIL) (CIN2 P16 positive/CIN3), specifically: HSIL with histopathological diagnosis of grade II/III (CIN2 P16 positive/CIN3) within 3 months prior to the first treatment.
Cervical adenocarcinoma in situ or other glandular lesions, invasive cervical cancer, or suspected malignant lesions.
CIN2 with P16 negative.
Lesions extending to the vaginal wall, cervical canal, or vaginal fornix, or lesions located on the vulva.
Prior physical or surgical treatment to the cervix resulting in incomplete cervical structure (e.g., cold knife conization), or receipt of physical or surgical therapy for CIN2 or CIN3 after the current histopathological diagnosis.
Parallel
Loop Electrosurgical Excision Procedure (LEEP) or Cold Knife Conization (CKC)
Procedure/SurgerySubjects undergo immediate surgical excision of the cervical lesion via either Loop Electrosurgical Excision Procedure (LEEP) or Cold Knife Conization (CKC), as determined by the investigator based on the subject's individual lesion characteristics, size, and clinical presentation, following standard institutional surgical protocols.
HAL 5% with illumination
Combination productHAL-PDT is a drug-device combination product. The drug is hexaminolevulinate hydrochloride (HAL) 5% ointment. The device is a single-use cervical light delivery device (CL7) with integrated red LEDs. The ointment is applied into the device cup, placed against the cervix for 5 hours of drug absorption, then automatically delivers 125 J/cm² photodynamic therapy for 4 hours and 36 minutes. Total in-situ time is 11-24 hours. Patients remove the device themselves. Treatment regimen: one session every 2 weeks for a total of 6 sessions (Q2W × 6).
Histopathological regression rate at 12 months
Proportion of participants with pathological remission on colposcopy-directed cervical biopsy at 12 months after the first treatment. Pathological remission is defined as histopathological finding of normal tissue or low-grade squamous intraepithelial lesion (LSIL)
Human Papillomavirus (HPV) baseline clearance rate at 6 months
Proportion of participants with clearance of baseline high-risk Human Papillomavirus (HPV) subtypes at 6 months after the first treatment. HPV clearance is defined as undetectable of the same high-risk HPV subtype(s) that were present at baseline.
Pathological remission rate at 6 months
Proportion of participants with pathological remission on colposcopy-directed cervical biopsy at 6 months after the first treatment. Pathological remission is defined as histopathological finding of normal tissue or low-grade squamous intraepithelial lesion (LSIL).
HPV baseline clearance rate at 12 months
Proportion of participants with clearance of baseline high-risk HPV subtypes at 12 months after the first treatment. HPV clearance is defined as undetectable of the same high-risk HPV subtype(s) that were present at baseline.
Quality of life assessed by EORTC QLQ-CX24
Quality of life assessed by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - Cervical Cancer Module (EORTC QLQ-CX24). Scores for each domain are linearly transformed to a 0-100 scale. For global health status and functional domains, a higher score indicates a better outcome (better quality of life/function). For symptom scales, a higher score indicates a worse outcome (more severe symptoms).
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