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Acitretin in Preventing Skin Cancer in Patients at High Risk for Skin Cancer

This study has been completed.
National Cancer Institute (NCI)
Information provided by:
Mayo Clinic Identifier:
First received: March 22, 2008
Last updated: May 13, 2011
Last verified: May 2011

RATIONALE: Chemoprevention is the use of certain drugs to keep cancer from forming. The use of acitretin may stop cancer from growing in patients at high risk for basal cell carcinoma or squamous cell carcinoma of the skin.

PURPOSE: This randomized trial is studying how well acitretin works in preventing skin cancer in patients at high risk for skin cancer.

Condition Intervention
Non-melanomatous Skin Cancer Drug: acitretin Genetic: gene expression analysis Genetic: northern blotting Genetic: polymerase chain reaction Genetic: protein expression analysis Other: laboratory biomarker analysis

Study Type: Interventional
Study Design: Allocation: Randomized
Masking: Double-Blind
Primary Purpose: Prevention
Official Title: Chemoprevention Trial of Acitretin Versus Placebo in Patients at High Risk for Basal Cell Carcinoma or Squamous Cell Carcinoma

Resource links provided by NLM:

Further study details as provided by Mayo Clinic:

Primary Outcome Measures:
  • Rate of new non-melanoma skin cancer development

Secondary Outcome Measures:
  • Time to new non-melanoma skin cancer development
  • Gene expression (RAR/RXR, Fos/Jun, and AP-1)
  • HPV DNA detection, sequencing, and quantification

Estimated Enrollment: 130
Study Start Date: February 2003
Study Completion Date: May 2006
Primary Completion Date: May 2006 (Final data collection date for primary outcome measure)
Detailed Description:


  • Determine the chemopreventive efficacy of acitretin, a synthetic retinoid, in patients at high risk for basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) of the skin.
  • Evaluate human papillomavirus (HPV) as a possible etiologic cofactor in the development of cutaneous epidermal dysplasia/carcinoma from skin tissues of patients at high risk for BCC or SCC of the skin.
  • Determine the effect of acitretin on a series of potential surrogate endpoint biomarkers (SEBs), including specific retinoid receptors; the Fos/Jun family of proto-oncogenes and products; the Fos/Jun family of transcription factor complexes known as activating protein 1 (AP-1); and HPV DNA in normal (sun-protected), sun-exposed dysplastic and carcinoma (SCC/BCC) skin specimens.
  • Correlate standard clinical and histopathological dermatologic evaluation with modulation of SEBs.

OUTLINE: This is a multicenter study. Patients are stratified according to age (18-49 years vs 50-59 years vs 60-69 years vs ≥ 70 years), number of skin cancers within the past 5 years (2-5 vs 6-10 vs 11-20 vs 21-30 vs > 30), most recent skin cancer occurrence (< 12 months ago vs ≥ 12 months ago), patient-reported sunburn susceptibility by Fitzpatrick skin type (1 vs 2 vs 3 vs 4 vs 5 vs 6), and assessment of visible skin damage (minimal vs moderate vs extensive). Patients are randomized to 1 of 2 treatment arms.

  • Arm I: Patients receive oral acitretin 5 days a week for 2 years in the absence of unacceptable toxicity.
  • Arm II: Patients receive oral placebo 5 days a week for 2 years in the absence of unacceptable toxicity.

Tissue samples of normal skin, excised squamous cell or basal cell carcinoma, or excised actinic keratoses are obtained at baseline and periodically during study. Tissue samples are analyzed for surrogate endpoint biomarkers, including RARγ, RXRα, Fos/Jun family of proto-oncogenes and products, AP-1 DNA binding activity, and presence, identification, and quantification of HPV DNA. mRNA and protein expression levels of RARγ, RXRα, and Fos/Jun family members are analyzed by northern blotting and/or quantitative polymerase chain reaction (PCR) methods. HPV is analyzed by PCR.

After completion of study treatment, patients are followed every 6 months for up to 5 years.


Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No


  • At high risk for basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) of the skin, defined as a prior history of ≥ 3 nonmelanoma skin lesions

    • All visible BCC or SCC must have been resected prior to study entry


  • Life expectancy > 5 years
  • Alkaline phosphatase ≤ 2.5 times upper limit of normal (ULN)
  • SGOT ≤ 2 times ULN
  • Creatinine ≤ 1.5 times ULN
  • Cholesterol < 250 mg/dL
  • Triglycerides < 2.5 times ULN
  • Not pregnant
  • No history of significant, uncontrolled hyperlipidemia
  • No history of oral retinoid intolerance
  • No history of other significant medical condition that, in the opinion of the physician, would contraindicate retinoid use


  • More than 1 year since prior retinoid therapy
  • At least 4 weeks since prior and no other concurrent use of oral vitamin A supplements, topical retinoids, or other potentially irritating skin preparations

    • Concurrent multivitamin supplements allowed
  • No prior organ transplantation
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT00644384

Sponsors and Collaborators
Mayo Clinic
National Cancer Institute (NCI)
Principal Investigator: Mark R. Pittelkow, MD Mayo Clinic
  More Information

Responsible Party: Mark R Pittelkow, M.D., Mayo Clinic Identifier: NCT00644384     History of Changes
Other Study ID Numbers: CDR0000582327
P30CA015083 ( US NIH Grant/Contract Award Number )
MC02C8 ( Other Identifier: Mayo Clinic Cancer Center )
1153-98 ( Other Identifier: Mayo Clinic IRB )
Study First Received: March 22, 2008
Last Updated: May 13, 2011

Keywords provided by Mayo Clinic:
basal cell carcinoma of the skin
squamous cell carcinoma of the skin

Additional relevant MeSH terms:
Carcinoma, Basal Cell
Skin Neoplasms
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms, Basal Cell
Neoplasms by Site
Skin Diseases
Keratolytic Agents
Dermatologic Agents processed this record on June 23, 2017