Nicotinamide: A Chemoprevention for Nonmelanoma Skin Cancer

Aaron Nethercott, Mercer University College of Pharmacy

The sun produces ultraviolet (UV) radiation. This radiation is believed to cause damage to deoxyribonucleic acid (DNA) and decrease immune repair functions in the skin which leads to nonmelanoma skin cancer.  It is also theorized that the oxidative stress of UV radiation decreases the levels of adenosine triphosphate (ATP).  Nicotinamide is a vital part of the coenzymes nicotinamide adenine dinucleotide (NADH) and nicotinamide adenine dinucleotide phosphate (NADPH).  These coenzymes have been found to be essential components of over 200 enzymatic reactions, including the production of ATP.  It is suggested that increasing the levels of ATP nicotinamide can help protect against nonmelanoma skin cancers. [1]

 A phase 3 Randomized Trial of Nicotinamide for skin-cancer Chemoprevention [2]
Design Double-blinded, randomized control, trial (N = 486)
Objective To assess the efficacy of oral nicotinamide for the chemoprevention of nonmelanoma skin cancer in a high-risk population
Study Groups Patients included in the study were those who had had at least two nonmelanoma skin cancers in the last five years. In total 486 patients were screened, 386 patients were randomized.  Of the included patients 193 were in the placebo arm, and 193 were in the nicotinamide arm.
Methods Patients were randomized to take either placebo or 500 mg nicotinamide twice daily for 12 months. The patients were evaluated by a dermatologist every three months for 18 months.
Duration Unknown
Primary Outcome Measure The primary end point was the number of new nonmelanoma skin cancers during the 12-month intervention period.
Baseline Characteristics Placebo Nicotinamide
Age (years) 66.4 ± 11.8 66.4 ± 11.8
Male, n (%) 72 (63) 71 (37)
Mean Nonmelanoma skin cancer in last 5 years (n) 8.2 ± 7.4 7.9 ± 8
Mean Basal-cell carcinomas in the last 5 years (n) 6.1 ± 7.0 5.7 ± 6.9
Mean Squamous-cell carcinomas in the last 5 years (n) 2.1 ± 3.2 2.1 ± 3.5
Results Placebo Nicotinamide
Mean New nonmelanoma skin cancer (n) 2.4 1.8 (P = 0.02)
Adverse Events Common Adverse Events: Not defined
Serious Adverse Events: Not defined
Percentage that Discontinued due to Adverse Events: Not defined
Study Author Conclusions Oral nicotinamide was safe and effective in reducing the rates of new nonmelanoma skin cancers and actinic keratoses in high-risk patients.

Nicotinamide has been shown to reduce the occurrence of nonmelanoma skin cancers in high risk individuals.  Nonmelanoma skin cancers are one of the most common types of cancers among caucasians.  The use of oral nicotinamide has the potential to reduce prevalence of these types of cancers.  However it should be noted that the study didn’t find a significant reduction in other types of skin cancers with the use oral nicotinamide [2].

References

  1. Rolfe HM. A review of nicotinamide: treatment of skin diseases and potential side effects. J Cosmet Dermatol. 2014;13(4):324-8.
  2. Chen AC, Martin AJ, Choy B, et al. A Phase 3 Randomized Trial of Nicotinamide for Skin-Cancer Chemoprevention. N Engl J Med. 2015;373(17):1618-26.
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