Nicotinamide yields impressive results in skin cancer

Abstract

New research suggests that oral nicotinamide (vitamin B3) reduces the incidence of new non-melanoma skin cancers (basal-cell carcinoma and squamous-cell carcinoma) and premalignant actinic keratoses in highrisk patients. Exposure to ultraviolet radiation has been regarded as the primary causative factor for non-melanoma skin cancers and actinic keratoses; dermatologists recommend use of sunscreens to prevent these disorders. However, even in high-risk patients, adherence to the application of sunscreens is suboptimal. Therefore, in view of the global rise in non-melanoma skin cancers, researchers have sought additional preventive measures for the cancers. Andrew Chen and colleagues did a multicentre, randomised, placebocontrolled phase 3 trial, which aimed to assess the effi cacy of oral nicotinamide (a vitamin with a protective role against ultraviolet radiation) for the chemoprevention of non-melanoma skin cancer. 386 participants with a history of at least two non-melanoma skin cancers in the past 5 years were randomly assigned (1:1) to receive 500 mg of oral nicotinamide twice daily or a placebo, for 12 months. The participants had dermatological assessment at 3-month intervals, for 18 months. Researchers noted a significant 23% (95% CI 4–38; p=0·02) decrease in the rate of new non-melanoma skin cancers in the nicotinamide group at 12 months compared with the placebo group (1·8 mean number of new cancers per patient [total of 336 cancers] vs 2·4 [total of 463 cancers]). The number of cases of actinic keratoses in nicotinamide group was lower by 11% at 3 months (p=0·01), 14% at 6 months (p<0·001), 20% at 9 months (p<0·001), and 13% at 12 months (p=0·001) compared with the placebo group. No signifi cant diff erences in adverse event frequency or type were reported between the nicotinamide or placebo group during the 12-month intervention period. Diona Damian (University of Sydney, Sydney, NSW, Australia), an author of the study, commented, “For patients who already have a track record of non-melanoma skin cancer and are at very high risk of developing further skin cancers, nicotinamide now provides us with an additional means of skin cancer prevention that is ready for immediate translation into clinical practice”. Ronald Rapini (MD Anderson Cancer Center, Houston, TX, USA) said, “I would recommend trying this treatment, as it is harmless and inexpensive”.