Skin cancer chemoprophylaxis in renal transplant recipients: 5 years of experience using low-dose acitretin

Abstract

Renal transplant recipients have an increased risk of developing skin cancers, which are often multiple and aggressive. Frequently, these tumours develop on a background of widespread epidermal dysplasia. Systemic retinoids are known inhibitors of skin cancer but reports of their use in renal transplant patients are limited. We describe our experience using 0.3 mg/kg daily of acitretin in 16 patients over a 5-year period. Overall, there was a significant reduction in the number of new tumours excised in 12 of 16 patients during treatment compared with the same pretreatment interval. A significant chemoprophylactic effect was shown for up to 4 years of treatment. Patients with five or more tumours prior to acitretin benefited most. Two patients discontinued treatment because of side-effects and two patients developed hyperlipidaemia. Two patients with end-stage graft failure proceeded to haemodialysis. The introduction of low-dose acitretin proved to be a useful strategy in the long-term reduction of skin cancer in renal transplant recipients with multiple skin cancers and extensive epidermal dysplasia.

Low-Dose Retinoids in the Prevention of Cutaneous Squamous Cell Carcinomas in Organ Transplant Recipients

“…However, publications to date have reported treatment for only 2 years or less, with the exception of 1 study in which responses at 5 years in 7 patients were documented. 15 In addition, the adverse effects of systemic retinoids, including mucocutaneous xerosis, alopecia, musculoskeletal complications, increased plasma triglyceride and cholesterol levels, and abnormalities of liver function, may limit their longterm use in OTRs, but this has rarely been examined in patients treated for more than 5 years. In this study we present data concerning the chemopreventive efficacy and side-effects profile of systemic retinoids in a series of 33 OTRs treated for up to 16 years.…”

“…Similar beneficial effects have been documented in a number of uncontrolled series of between 4 and 16 patients treated for less than 6 months to 5 years. 8,10,[14][15][16][17] In the only randomized, placebo-controlled trial, 19 patients received acitretin for 6 months and had significantly fewer SCCs during this time than did 19 placebo-treated patients. 18 Eleven patients completed a randomized crossover trial in which acitretin produced a significant reduction in SCCs compared with no treatment during 12 months.…”

Psoriasis Therapies and the Risk of Cutaneous Malignancy

“…However, one study did demonstrate a significant chemoprotective effect of low-dose (0.3 mg/kg) daily acitretin in renal transplant patients for up to 4 years of treatment 34 . Topical regimens also do not appear efficacious in preventing malignancy.…”

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“…43 When confronted with perpetual development of cutaneous carcinomas, prophylactic systemic retinoids, derivatives of vitamin A, should be considered. [45][46][47] These agents, although not approved by the Food and Drug Administration for this indication, have potent prodifferentiation and tumor-suppressive effects. Unfortunately, systemic retinoids only suppress tumor development, not active skin cancers.…”

“…The role of topical and systemic retinoids continues to be investigated for use in this setting, as well. [45][46][47] The possibili-ties of HPV vaccines and a soluble p53 antigen vaccine as preventative modalities are actively being explored. 53 …”