Pivotal Trial
This treatment is in the last trial phase before FDA approval.
Prior Safety Data
This treatment has already been tested in at least one earlier human trial.
Ready to participate?
Review the details below, then apply to join this clinical trial.
At a Glance
Age
18 and older
Sex
Any
Trial phase
Phase 3
Study type
Interventional
Purpose
Prevention
Participants needed
396 (estimated)
Sponsor
Women's College Hospital · Other
Who this trial is looking for
This trial is looking for adults who have received an organ transplant and have had at least one skin cancer. Participants will take nicotinamide pills for up to 4 years to see if it helps prevent new skin cancers.
Are You a Good Fit for This Trial?
Must be takingCalcineurin inhibitor
Rules you outAcute rejection episodeActive liver diseaseSevere kidney diseaseSolid organ malignancyHematologic malignancyInvasive melanomaMerkel cell carcinomaMetastatic skin cancer
You may be able to join if
I am at least 18 years old
I had a kidney, liver, heart, or lung transplant at least two years ago
I have had at least one type of skin cancer confirmed by a doctor
I am currently taking immunosuppressive medication
I can come to follow-up visits
You may not be able to join if
I have used nicotinamide or niacin in the past 12 weeks
I have untreated skin cancer right now
I had a kidney transplant rejection in the past 12 weeks
I have serious liver disease
I have severe kidney disease
I have had certain cancers in the past five years
I am pregnant or breastfeeding
I am allergic to nicotinamide or the study capsules
Summarized in plain language from this trial's official eligibility criteria.
The full criteria are further down this page — only the research team can
confirm whether you qualify.
Think this trial could be right for you?
Answer three quick questions written from this study's own rules to see if you may qualify. No account needed to find out.
As patients live longer after receiving an organ transplant, there is a need to reduce the long-term side effects of the drugs used to prevent organ rejection. In particular, long-term use of these drugs increases the risk of skin cancer. Skin cancer is now a leading cause of illness and disfigurement after kidney, liver, heart, and lung transplantation. Given the increased risk and burden of skin…
As patients live longer after receiving an organ transplant, there is a need to reduce the long-term side effects of the drugs used to prevent organ rejection. In particular, long-term use of these drugs increases the risk of skin cancer. Skin cancer is now a leading cause of illness and disfigurement after kidney, liver, heart, and lung transplantation. Given the increased risk and burden of skin cancer in transplant recipients, prevention is critical.
Nicotinamide is a form of Vitamin B3 that has been shown to protect against skin cancer in the general population. However, it is unclear whether nicotinamide is effective among immune-suppressed transplant recipients. Investigators will conduct a clinical trial involving multiple transplant centres in Canada to evaluate whether oral nicotinamide (500 mg twice daily) is effective and safe for preventing skin cancer. Investigators will recruit 396 high-risk adult kidney, liver, heart, and lung transplant patients who have previously had at least one skin cancer. Patients will receive nicotinamide or sham tablets for up to 4 years. The results will inform efforts to improve the long-term health of transplant recipients.
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Eligibility Criteria
Inclusion Criteria:
* Age ≥ 18 years old
* Kidney, liver, heart, or lung transplant at least two years ago
* History of at least one prior histologically-confirmed keratinocyte carcinoma or squamous cell carcinoma in situ
* Currently immunosuppressed with a calcineurin inhibitor-based regimen (cycl…
Inclusion Criteria:
* Age ≥ 18 years old
* Kidney, liver, heart, or lung transplant at least two years ago
* History of at least one prior histologically-confirmed keratinocyte carcinoma or squamous cell carcinoma in situ
* Currently immunosuppressed with a calcineurin inhibitor-based regimen (cyclosporine or tacrolimus)
* Able to attend follow-up visits
Exclusion Criteria:
* Use of nicotinamide or niacin (≥250 mg daily) within past 12 weeks
* Untreated localized skin cancer at baseline (patient can enrol after skin cancer treatment)
* Biopsy-confirmed acute rejection episode within the past 12 weeks
* Active liver disease (high AST \>3 times or bilirubin \>1.5 times)
* Severe kidney disease (estimated glomerular filtration rate \<20 mL/min/1.73 m2)
* Solid organ or hematologic malignancy, invasive melanoma, Merkel cell carcinoma, or metastatic skin cancer within the past five years
* Pregnancy or lactation
* Need for ongoing carbamazepine or primidone
* Allergy to nicotinamide or any ingredient of the vitamin or placebo capsules
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