Could Vitamin B Reduce Skin Cancer Risk?

Certain types of skin cancer can be reduced in high-risk people just by taking a simple, inexpensive vitamin, according to results of a recent clinical trial in Australia.

Participants who took 2 pills a day of nicotinamide—a form of vitamin B3 that is available as an over-the-counter nutritional supplement—had a 23% lower risk of developing non-melanoma skin cancer than those who took placebo pills.
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Senior study author Diona Damian, MBBS, PhD, will present the complete study findings May 30 at the American Society of Clinical Oncology’s 51st annual meeting in Chicago.

“Based on these results, nicotinamide should now be considered for high-risk patients who have already had a number of skin cancers and are very likely to develop more,” says Damian, a dermatology professor at the University of Sydney in Australia. “We would not recommend it at this stage for the general population.”

Damian and her colleagues conducted the phase 3 Oral Nicotinamide to Reduce Actinic Cancer (ONTRAC) study in 2 tertiary treatment centers in Sydney, Australia from 2012 to 2014. The double-blind, randomized control trial focused on non-melanoma skin cancer, particularly basal cell carcinomas and squamous cell carcinomas.  

The study involved 386 people who had 2 or more such skin cancers in the previous 5 years. The average age of the study population was 66, and the mean number of cases was 8 cancers over the past 5 years.

“Nicotinamide seemed to be even more protective in people with the greatest numbers of previous skin cancers; in other words, it may be most effective in the people who need it most,” Damian says.

The patients were randomized to receive either 500 mg of oral nicotinamide or a matched placebo twice a day for 12 months.

The average rate of non-melanoma skin cancer was significantly lower in the group who took nicotinamide—those who took the B3 vitamin developed an average of 1.77 new cancers the year of the study, compared with 2.42 in the placebo group. The nicotinamide group also reported fewer cases of actinic keratosis, rough, scaly patches of skin that may become cancerous.

“UV radiation causes cancer by damaging DNA, suppressing the skin’s immune system and also by depleting cells of energy so that they can’t repair their DNA efficiently,” Damian says. “We have shown that nicotinamide replenishes cellular energy, enhances DNA repair, and reduces the immune suppressive effects of UV radiation.”

This widely accessible, inexpensive supplement presents a new chemopreventive opportunity without the scarring of surgical approaches or the side effects of other treatment options.

Currently, doctors sometimes prescribe retinoids for skin-cancer chemoprevention in the very worst-affected patients, but retinoids have a range of side effects, including dry skin, lips and eyes, changes in blood lipids and liver function, teratogenicity, hair loss, and fatigue

“Nicotinamide had no excess of adverse effects compared to placebo and, so, may be a first-line chemopreventive agent in these people,” Damian says. “The key message for patients, however, is that nicotinamide needs to be taken in conjunction with sunscreens and with sun-sensible behaviors.”

Moving forward, Damian and her colleagues are hoping to study the effects of nicotinamide in organ transplant patients who are chronically immunosuppressed by their medications.

“These people are at extreme risk of skin cancer, and we urgently need chemopreventive options for them,” she says.

—Colleen Mullarkey

Reference

Martin AJ, Chen A, Choy B, Penas PF, Halliday G, Dalziell R, et al. Oral nicotinamide to reduce actinic cancer: A phase 3 double-blind randomized controlled trial. J Clin Oncol. 2015;33(Suppl):9000.