Prevention of non-melanoma skin cancers with nicotinamide in transplant recipients: a case-control study

Abstract

Background: Nicotinamide is the precursor of nicotinamide adenine dinucleotide (NAD+), an essential cofactor for adenosine triphosphate (ATP) production. It has recently been reported to be effective in reducing the rates of new non-melanoma skin cancers (NMSCs) and actinic keratosis (AKs). Objectives: We studied the efficacy of oral nicotinamide as treatment for AKs in transplant recipients. Materials & methods: We recruited 38 transplant (eight liver and 30 kidney) patients with single or multiple AKs. Nineteen patients were randomly assigned to Group 1 and took nicotinamide 500 mg/daily (cases); the other 19 patients were randomly assigned to Group 2 without nicotinamide (controls). At baseline, AKs were identified, measured, and photographed for follow-up. Five patients underwent an AK biopsy for histopathology. Statistical analyses were performed using the Student t test. Results: At baseline, no statistically significant differences were observed regarding AK size between the two groups. After six months, among the cases, AKs had significantly decreased in size in 18/19 patients (88%). Among these 18 patients, seven patients (42%) had shown complete clinical regression and no patient developed new AKs. Conversely, among the controls, 91% showed an increase in AK size and/or developed new AKs. Seven pre-existing AKs progressed to squamous-cell carcinoma. Conclusion: Nicotinamide appears to be effective in preventing and treating AKs, although the mechanisms are still unclear. Further studies with a larger sample of organ transplant recipients and a longer follow-up period are needed to further support our conclusions.

Nicotinamide for photoprotection and skin cancer chemoprevention: A review of efficacy and safety

“…High‐dose NAM (at 1 g/d) in solid organ transplant recipients is well tolerated, and the two published reports of NAM in this immunosuppressed population group show no alteration in blood levels of immunosuppressants.…”

“…In contrast, 91% of the control group showed an increase in AKs and/or new AKs. Additionally, within the control group, seven AKs progressed to SCC, whereas no skin cancers were reported in the NAM group.…”

“…Drago et al investigated the effect of NAM 500 mg daily on AKs in solid organ transplant recipients at the University of Genoa. Thirty‐eight patients were recruited (eight liver and 30 kidney transplants), with 19 assigned to NAM 500 mg/d vs controls.…”

Nonmelanoma skin cancer – from actinic keratosis to cutaneous squamous cell carcinoma

“…For nicotinamide, it has been shown that a daily dose of 500 mg BID for twelve months results in a (significant) reduction of AKs (by 13 %) and SCCs (by 30 %) compared to the control group . This trend has been confirmed in immunosuppressed patients .…”

Chemoprevention agents for melanoma: A path forward into phase 3 clinical trials

“…For example, the study of T4 endonuclease reported by Yarosh et al required only 30 patients in a 18 month study to demonstrate a significant reduction in both AKs and KCs 35 . Nicotinamide has also been shown to reduce these lesions in transplant patients 48, 154 . These studies provide invaluable evidence of efficacy in a human system that is supportive of the potential to prevent melanoma.…”