Chemoprevention of keratinocyte carcinoma and actinic keratosis in solid-organ transplant recipients: Systematic review and meta-analyses

Is the first‐line systemic chemoprevention of nonmelanoma skin cancer nicotinamide or acitretin?

“…In the authors’ opinion, nicotinamide should be considered the first‐line agent because of its low cost, wide accessibility, minimal side effect profile, and inessential laboratory monitoring 1 . Although there is a lack of randomized, controlled trials comparing acitretin and nicotinamide chemoprevention, a systematic review and meta‐analysis determined that there was no significant difference between nicotinamide and acitretin in preventing keratinocyte carcinoma in SOTRs 4 . Based on our experience, we recommend that patients who had two or more NMSC in 1 year or a history of five NMSC take nicotinamide 500 mg BID.…”

“…1 Although there is a lack of randomized, controlled trials comparing acitretin and nicotinamide chemoprevention, a systematic review and meta-analysis determined that there was no significant difference between nicotinamide and acitretin in preventing keratinocyte carcinoma in SOTRs. 4 Based on our experience, we recommend that patients who had two or more NMSC in 1 year or a history of five NMSC take nicotinamide 500 mg BID. If there is no improvement in the rate of NMSC development after 6 months, the patient is switched to acitretin and dosed as previously described (see above).…”

“…Two oral agents that can be used for chemoprevention are nicotinamide and acitretin 3 . Although a recent meta‐analysis determined that there was no significant difference between nicotinamide and acitretin in preventing keratinocyte carcinoma in solid‐organ transplant recipients (SOTRs) and it has been recommended that acitretin is the first‐line oral chemoprevention for NMSC in high‐risk patients, we recommend nicotinamide as the first‐line systemic chemoprevention agent for NMSC in high‐risk patients 2,3,4 …”

“…3 Although a recent meta-analysis determined that there was no significant difference between nicotinamide and acitretin in preventing keratinocyte carcinoma in solid-organ transplant recipients (SOTRs) and it has been recommended that acitretin is the first-line oral chemoprevention for NMSC in high-risk patients, we recommend nicotinamide as the firstline systemic chemoprevention agent for NMSC in high-risk patients. 2,3,4 Nicotinamide Nicotinamide, also known as niacinamide, is a water-soluble vitamin B 3 derivative that prevents NMSC by reducing ultraviolet-associated immunosuppression and enhancing DNA repair. 1,3 A phase 3, double-blind randomized controlled trial that excluded SOTRs demonstrated that the rate of new NMSC was lowered by approximately 23% (P = 0.02) in the group taking nicotinamide 500 mg BID compared to placebo.…”

Is 5-fluorouracil the best candidate for topical chemoprevention of skin cancers in organ transplant recipients?

“…Another crucial confounding variable is concurrent systemic chemoprevention with acitretin, previously demonstrated to be effective in OTRs, 9 which was allowed during the SPOT trial and was more frequent in the 5‐FU group. Further trials should also consider using the core outcome set for AK trials, 10 which aims to homogenize outcome measures across studies to allow comparability and meta‐analyses – with such a core outcome set not being available when the SPOT trial was implemented.…”