The risk of an invasive or in situ melanoma diagnosis is continuing to increase, with one recent study estimating the lifetime risk of developing either condition as 1 in 28.1 With this growing risk, the development of chemoprevention strategies against melanoma and other skin cancers is important, especially for those at high risk.

Nicotinamide, a form of vitamin B3 (niacin), is a “promising and well-tolerated” chemopreventive agent for patients at high risk for developing skin cancer, according to the results of a recent review of the agent.2

“Preclinical studies of nicotinamide have demonstrated important anticancer properties including DNA repair and the modulation of inflammation and immune suppression induced by damaging ultraviolet radiation,” Ahmad Tarhini, MD, PhD, director of the Melanoma and Skin Cancer Program at the Cleveland Clinic Taussig Cancer Institute in Ohio, told Cancer Therapy Advisor.

ONTRAC was a phase 3 study that compared nicotinamide with placebo in 386 patients with at least 2 non-melanoma skin cancers in the previous 5 years.3 By 1 year, nicotinamide reduced the rate of new non-melanoma skin cancers by a little less than 25% compared with placebo. This reduction in incidence was consistent for both new basal cell (20%) and squamous cell carcinomas (30%) and for actinic keratosis (AK; 13%).

“Nicotinamide can reduce the rate of non-melanoma skin cancer in high-risk patients who have already had numerous basal cell and squamous cell carcinomas,” said review author Diona L. Damian, PhD, professor of dermatology at the University of Sydney in Australia.

To date, there have not been any adverse effects associated with the use of nicotinamide that cause concern, according to Dr Damian. In the ONTRAC study, for example, there were no significant differences in adverse events between the 2 study arms after the 1-year intervention.

The ONTRAC study did not, however, assess nicotinamide in melanoma and excluded anyone with a history of melanoma in the previous 5 years.

“At this point in time we do not have clinical evidence from well-conducted studies that nicotinamide may affect the incidence or evolution of melanoma,” Dr Tarhini said. “Therefore, at best we can say that it is considered promising.”

Dr Damian agreed, adding that “clinical trials would be needed to determine safety and effectiveness of nicotinamide in reducing melanoma risk in patients at high risk of [the disease].”

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These trials would have to recruit patients at an increased risk for developing melanoma, not just skin cancer. These would be people with previous melanoma or those with genetic susceptibility.

Dr Damian recommended the use of high-dose nicotinamide as a medical treatment only in those people at “extreme skin cancer risk,” like those with a history of multiple skin cancers.

According to Dr Damian, anyone considering taking high-dose nicotinamide should discuss it first with their dermatologists to check that none of their other medications may interact. Some epileptic drugs, for example, may have a drug-drug interaction with nicotinamide.

References

  1. Glazer AM, Winkelmann RR, Farberg AS, Rigel DS. Analysis of trends in US melanoma incidence and mortality. JAMA Dermatol. 2017;153(2):225-6.
  2. Minocha R, Damian DL, Halliday GM. Melanoma and nonmelanoma skin cancer chemoprevention: a role for nicotinamide? Photodermatol Photoimmunol Photomed. 2017 Jul 5. doi: 10.1111/phpp.12328 [Epub ahead of print]
  3. Chen AC, Martin AJ, Choy B, et al. A phase 3 randomized trial of nicotinamide for skin-cancer chemoprevention. N Engl J Med. 2015;373:1618-26. 

This article originally appeared on Cancer Therapy Advisor