Breaking News
September 22, 2018 - BSI accredits Oxehealth’s vital signs measurement software as Class IIa medical device
September 22, 2018 - Evolution of psychiatric disorders and human personality traits
September 22, 2018 - Obesity in early puberty doubles asthma risk for boy’s future offspring
September 22, 2018 - World’s most advanced real-time patient monitoring platform receives key US patent
September 22, 2018 - Study explores connection between sexuality and cognitive status in older adults
September 22, 2018 - LSTM partners with TB Alliance to develop novel TB drug regimens
September 22, 2018 - Annual wellness visits improve delivery of preventive services in elderly population
September 22, 2018 - CHMP provides positive opinion to Cabometyx for previously-treated patients with hepatocellular carcinoma
September 22, 2018 - Hispanic communities with high proportions of Hispanics face more cardiovascular-related death
September 22, 2018 - Vici syndrome – Genetics Home Reference
September 22, 2018 - Single-dose drug can shorten flu symptoms by about a day, studies suggest
September 22, 2018 - AMSBIO launches circulating tumor DNA Reference Standards
September 22, 2018 - Sandalwood mimicking odorant could stimulate hair growth in humans
September 22, 2018 - Overlooked immune cells could play a key role in cancer immunotherapy, claims new study
September 22, 2018 - Study reveals prevalence of diagnosed type 1 and type 2 diabetes among American adults
September 22, 2018 - Researchers develop fast detection strategy to know type of virus acquired by patients
September 22, 2018 - Global Prevalence of Insufficient Activity 27.5 Percent
September 22, 2018 - Strategies to protect bone health in hematologic stem cell transplant recipients
September 22, 2018 - Brigham Genomic Medicine program unravels 30 medical mysteries
September 22, 2018 - New system harnesses power of bubbles to destroy dangerous biofilms
September 22, 2018 - Inflammation plays crucial role in preventing heart attacks and strokes, study reveals
September 22, 2018 - Calorie dense, nutrient deficient meals common across the world
September 22, 2018 - Researchers develop technology to study behavior of implants without animal testing
September 22, 2018 - First gut bacteria in newborns may have lasting effect on ability to ward off chronic diseases
September 22, 2018 - Detection of BFD virus in parrots in 8 new countries raises concerns for threatened species
September 22, 2018 - Insulin treatment shows great potential against chronic bowel inflammation
September 22, 2018 - ‘Liking Gap’ Might Stand in Way of New Friendships
September 22, 2018 - Simple factors that can avoid harmful side effects in type 2 diabetes
September 22, 2018 - ALSAM Foundation invests additional $2 million for drug discovery and development projects
September 22, 2018 - Study findings may advance discussion of how to effectively curb human-wildlife conflict
September 22, 2018 - Dopamine neurons may involve in conditions ranging from Parkinson’s disease to schizophrenia
September 22, 2018 - Protein C and Protein S Tests: MedlinePlus Lab Test Information
September 22, 2018 - Obesity and diabetes—two reasons why we should be worried about the plastics that surround us
September 22, 2018 - Concern over fussy eating prompts parents to use non-responsive feeding practices
September 22, 2018 - Novel mathematical approach uncovers existence of unsuspected biological cycles
September 22, 2018 - Cancer Research UK invests £14 million to transform London into cancer biotherapeutics hub
September 22, 2018 - Scientists predict how well the body will fight lung cancer by analyzing immune cell shapes
September 22, 2018 - New outbreak of rare eye disease identified in contact lens wearers
September 22, 2018 - Iterum Initiates SURE 2 and SURE 3 Phase 3 Clinical Trials of IV and Oral Sulopenem in Complicated Urinary Tract and Complicated Intra-abdominal Infections
September 22, 2018 - Research finds divide in dental health accessibility between city and regional areas
September 22, 2018 - Premature babies show better brain development when fed breast milk, finds study
September 22, 2018 - Novel system uses AI to detect abnormalities in fetal hearts
September 22, 2018 - UNC scientists reveal new approach to prevent obesity and diabetes
September 22, 2018 - CWRU receives NIH grant to learn how non-coding genes contribute to spread of colorectal cancer
September 22, 2018 - Scientists better understand influenza virus and how it spreads
September 22, 2018 - Scientists to focus on length of time when a person is alive and healthy
September 22, 2018 - Study shows positive financial impacts of Medicaid expansion for low-income Michigan residents
September 22, 2018 - Innovative approach for developing vaccine against most prevalent human malaria parasite
September 22, 2018 - Study sheds light on molecular mechanisms underlying progression of prion diseases
September 22, 2018 - Innovation Fund Denmark supports research project that aims to fight Clostridium difficile diarrhea
September 22, 2018 - Survey estimates caregiving costs for family members
September 22, 2018 - Inhibiting NF-kB improves heart function in a mouse model of Duchenne muscular dystrophy
September 22, 2018 - Introducing new EMR system may affect several aspects of clinic workflow
September 22, 2018 - Study finds why some human genes are more popular with biomedical researchers
September 22, 2018 - Finding epigenetic signature appears to predict inflammation risk in serious type of IBD
September 22, 2018 - Researchers develop light-based technique to measure very weak magnetic fields
September 22, 2018 - UAB researchers study dysfunction of the immune system associated with NSAID carprofen
September 22, 2018 - QIAGEN and DiaSorin launch automated, CE-marked workflow for high-throughput TB screening
September 22, 2018 - EFS checklist provides user-friendly tool for evaluating feeding skills in preterm infants
September 22, 2018 - Family history in blacks, Latinos associated with higher risk of AFib
September 22, 2018 - Researchers identify new genetic disorder in a human patient
September 22, 2018 - Cardiac MR With Contrast Feasible in Developing World
September 22, 2018 - Daily low-dose aspirin doesn’t reduce heart-attack risk in healthy people
September 21, 2018 - Children with asthma found to be disadvantaged in education and future occupation
September 21, 2018 - Interaction of chemical slurry and ancient shale in fracking wastewater causes radioactivity
September 21, 2018 - Scientists use mice to study transmission of Lyme disease bacteria by infected ticks
September 21, 2018 - Researchers find that sample size is key factor determining accuracy of study results
September 21, 2018 - Study shows how the drive to eat overpowers the brain’s signal to stop
September 21, 2018 - 30 Million Americans Now Have Diabetes
September 21, 2018 - Thousands of breast cancer gene variants engineered and analyzed
September 21, 2018 - The current fellowship interview process is cumbersome — Stanford researchers have a better idea
September 21, 2018 - Progenitor cells for human bone and cartilage have been identified
September 21, 2018 - Study reveals new therapeutic target for pediatric tumor-associated intractable epilepsy
September 21, 2018 - SLU’s College professor receives NIH grant to develop I-TEST project
September 21, 2018 - DermTech completes enrollment in clinical study to assess DNA damage and reversal
September 21, 2018 - Grieving patients treated with talk therapy have lower risk of suicide and psychiatric illness
September 21, 2018 - NIH and FDA call for eliminating involvement of RAC in human gene therapy experiments
September 21, 2018 - New system uses algorithm to convert 2D videos into 3D printed ‘motion sculptures’
September 21, 2018 - Sea squirt model reveals key molecules in dopaminergic neuron differentiation
September 21, 2018 - Effective management of neonatal abstinence syndrome requires coordinated ‘cascade of care’
A Little Dab’ll Do Ya to Prevent Squamous Cell Carcinoma

A Little Dab’ll Do Ya to Prevent Squamous Cell Carcinoma

image_pdfDownload PDFimage_print

Action Points

  • Topical fluorouracil (5%, applied twice daily to the face and ears for up to four weeks) reduced the risk of squamous cell carcinoma (SCC) requiring surgery by 75% in the first year after use, in a randomized trial of 932 veterans at high risk for keratinocyte carcinoma (SCC and basal cell carcinoma).
  • Note that risk of BCC was similar in the first year in the fluorouracil group and in controls, and there was no difference in risk of either SCC or BCC over the full four-year trial period.

A randomized trial of 932 veterans at high risk for keratinocyte carcinoma showed that topical fluorouracil, 5%, applied twice daily to the face and ears for up to four weeks, reduced the risk of squamous cell carcinoma (SCC) requiring surgery by 75% in the first year after use (risk ratio 0.25, P=0.002), researchers found.

Risk of basal cell carcinoma (BCC), however, was similar at about 10% in the first year in the fluorouracil group and in controls, reported Martin A. Weinstock, MD, PhD, of Providence Veterans Affairs Medical Center in Rhode Island, and colleagues online in JAMA Dermatology.

There was no difference in risk of keratinocyte carcinoma in year 1 and the risk of either SCC or BCC was not reduced over the full four-year trial period. Moreover, patients reported a high rate of severe or moderate adverse effects during treatment.

Nevertheless, most participants said they would repeat the treatment if it was shown to be conclusively effective in preventing skin cancer. These findings suggest a possible role for the annual use of topical fluorouracil chemoprevention in special high-risk populations, including patients who have received transplants, the investigators said.

In the United States, keratinocyte carcinoma accounts for about three-quarters of all cancers, and incidence is rising.

“It is reasonable at this point to consider the use of a standard and perhaps annual course of topical fluorouracil, 5%, to the face and ears for the reduction of SCC risk in high-risk populations, and potentially for a reduction in need for Mohs surgery,” Weinstock and colleagues wrote. “Topical fluorouracil is the first agent we know of that demonstrates extended post-treatment effects in SCC chemoprevention.”

No “rebound” effect of increased SCCs was observed in the fluorouracil group in year 2 or subsequently. However, the investigators did note a large 49% reduction in the number of fluorouracil group participants who had Mohs surgery treatments for BCCs and keratinocyte carcinoma compared to controls.

More study is also required to better define the effect of fluorouracil on BCC risk, including BCC that requires Mohs surgery, they said.

For the the Veterans Affairs Keratinocyte Carcinoma Chemoprevention Trial, participants were recruited from May 2009 through September 2011, and followed through June 2013. Almost all were male (98%) with a median age of 70 years.

Treatment and control groups were matched for demographic characteristics, military service periods, sunburn, Fitzpatrick skin type, sun protection use during the study, and medical histories, including at least two prior BCCs or SCCs.

In addition to the fluorouracil treatment, participants also received a 30 SPF sunscreen and received education about skin cancer, sunscreen, and sun safety.

Median follow-up was 2.8 years and 97% of participants in each group were followed for at least one year after randomization.

In the first year, 95 of 299 participants (32%) developed BCC and 25 of 108 participants (23%) developed SCC including five participants (1%) in the fluorouracil group and 20 (4%) in the control group.

The only difference in BCC risk was seen in year 2 of the study, the study authors report. Notably, this risk was higher in the fluorouracil group (87 versus 59 tumors; P=0.01).

There were no differences in BCC risk in years 1, 3, or 4 and the only difference in SCC risk was the significant decrease seen in year 1.

Among 27 participants in the control group, 36 underwent Mohs treatment for BCCs and 14 participants in the fluorouracil group underwent Mohs for 17 BCCs (RR 0.51, P=0.045). Five patients in the control group and three in the fluorouracil group were treated for SCCs requiring Mohs surgery.

In year 1, the RR for keratinocyte carcinoma was 0.51 (P=0.02) and there were no differences between groups over the 4-year study period.

Weinstock and colleagues acknowledged the adverse effects of fluorouracil and consequently evaluated participants’ completion of the medication course, the occurrence of adverse events, and patients’ attitudes toward using the drug in the future.

A total of 85% of fluorouracil participants (397 of 468) and 96% of controls completed at least 28 doses of the study medication. However, only 31% of those taking fluorouracil group completed 56 doses compared to 81% of controls.

After 2 weeks, 92% of participants in the fluorouracil group reported erythema, and 61% had mild-to-moderate crusting.

After six months, 21% in the fluorouracil group retrospectively rated treatment adverse effects as “severe,” 40% as “moderate,” 25% as “mild,” and 14% as “none.” At the six-month check-in, 76% of controls reported no adverse effects.

When surveyed at six and 12 months, 87% of fluorouracil group participants said they would repeat treatment if it was shown to be effective in reducing future skin cancers.

“This trial demonstrates a proactive approach that is effective,” the study authors point out. Although annual application may be needed since the effect appears to last for only a year, clinical experience indicates there may be fewer adverse effects with the second and third application, they noted. This may be due to improvement in keratinocytic dysplasia following application to sun-damaged areas.

More study is needed to more precisely define the groups that would most benefit, they added.

A randomized study has shown that daily ingestion of a large dose of nicotinamide (NNA) can reduce the risk of SCC and BCC by 23%. However, this beneficial effect disappears as soon as dosing stops, Weinstock and colleagues said. Notably, the results indicated that nicotinamide may simultaneously increase the risk of the most aggressive types of BCC and SCC.

Study limitations include the potential unblinding of participants (but not investigators) due to the adverse effects of treatment as well as potential limited generalizability to women and younger individuals.

This study was supported by the U.S. Department of Veterans Affairs. Lead study author Weinstock reported relationships with AbbVie, Castle, and Celgene. One co-author reported a relationship with Pfizer. Other study authors declared they had no potential conflicts of interest.

2018-01-04T16:30:00-0500

Tagged with:

About author

Related Articles