A recent observational study in Minnesota (Jirakulaporn, et al. Capecitabine for skin cancer prevention in solid organ transplant recipients. Clin Transplant Nov,2010) has shown that continuous use of a drug named capecitabine may reduce the occurrence of new non-melanoma type skin cancers in solid organ transplant patients.
Organ transplant recipients are at significantly increased risk of non-melanoma skin cancer due to their need for lifelong immuno-suppressive medications. This seems to be more common in transplant patients using calcineurin inhibitor type medications which can stimulate the growth of atypical keratinocytes (i.e. precancerous skin cells). Transplant recipients can commonly develop dozens of squamous cell carcinomas and/or basal cell carcinomas every year. Further, these tumors often behave very aggressively. As a result, I frequently see these patients for repeat skin cancer excision and Moh’s reconstruction procedures.
Capecitabine (Xeloda) is a 5-fluorouracil (5-FU) precursor (chemotherapeutic medication) commonly used for the treatment of colorectal cancer and metastatic breast cancer. A dermatology group at the University of Minnesota have recently found that capecitabine may have an interesting “side effect:” the secondary prevention of NMSCs in the transplant population. The Minnesota group reported on 15 solid organ transplant recipients, mean age 57 years, with recurrent NMSCs who were placed on low-dose capecitabine for the off-label purpose of preventing further NMSCs. The investigators found the mean number of squamous cell carcinomas per month declined by 0.33, the mean number of actinic keratoses fell by 2.45 per month, and the mean number of basal cell carcinomas dropped by 0.04 per month. All these reductions were statistically significant.
Patients need to be warned, however, that this medication does have potential side effects. Toxicities were deemed manageable and included fatigue in 40% of patients, hand-foot syndrome in 20%, and diarrhea in 20%. Unfortunately, one-third of the subjects needed to discontinue capecitabine use by 1 year. Further studies are required before this can become widely, or routinely recommended.
While studies of capecitabine for the secondary prevention of NMSCs continue, physicians can use several other means to protect transplant and other immunosuppressed patients. These include”:
1) Dermatologic examinations at intervals of every 3 months or less for aggressive surveillance &
2) Regular use of a broad-spectrum sunscreen.