- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00847912
CSP #562 - The VA Keratinocyte Carcinoma Chemoprevention Trial (VAKCCT)
The main purpose of this study is to see if 5-fluorouracil (5-FU) skin cream can prevent the growth of new skin cancers on the face and ears. The cost of trying to prevent skin cancer will be compared to the usual cost of treating skin cancer. Participants are being asked to be a part of this study because the participants have been treated for two or more skin cancers within the past five (5) years. At least one of these cancers occurred on the face or ears. Having had two or more skins cancers in the past 5 years makes it likely that participants will develop additional skin cancers in the future.
Exposure to ultraviolet radiation from the sun or artificial sources such as tanning beds is a major cause of basal cell and squamous cell carcinoma of the skin. Using lotions, creams, or gels that contain sunscreens can help protect the skin from premature aging and damage that may lead to skin cancer.
The 5-FU skin cream used in this study is FDA-approved to treat some types of skin cancers and spots that might become skin cancer. However, 5-FU skin cream has never been studied to see if it can prevent skin cancer. This drug is not approved by the FDA for how it will be used in this study.
In this study, one half of the patients will use the 5-FU cream and the other half will use a skin cream that looks identical to the 5-FU cream but does not have 5-FU or any other active drug in it.
Approximately twelve VA medical centers will work together in this study. About one thousand (1000) patients will be in this study. The study is sponsored by the U.S. Department of Veterans Affairs Cooperative Studies Program.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin, both of which are keratinocyte carcinomas (KCs), account for a half of all cancers in the United States, and over 100,000 diagnoses per year in the VA. The standard treatment for these KCs is excision of the lesion, and they cost the US health care system some $2.5 billion annually and about $100 million annually in the VA. There is no proven means to prevent KCs (except perhaps for a modest benefit of intensive daily sunscreen use). An effective prevention strategy would dramatically change the way high-risk patients are managed and could substantially reduce the costs of care. The investigators' preliminary analysis indicates that the savings will be $116 per high-risk patient and will account for a total national savings of over $11 million. These findings imply that the study would pay for itself by the end of 4 years. The investigators hypothesize that topical 5-fluorouracil (5-FU) chemoprevention will prevent skin cancer surgeries and will be cost-saving. To test this the investigators propose a randomized controlled trial of 5-FU compared to a vehicle control to the face and ears in a high-risk population.
In the study, 1000 Veterans at high-risk of skin cancer defined as at least 2 KCs in the prior 5 years, at least one of which was on the face or ears, will be randomized to 5-FU or a vehicle control cream, and followed for 2 to 4 years. The primary endpoint will be surgery for any KC on the face and ears. The investigators will also assess the cost of care, quality of life, the side effects associated with treatment, and the prevalence and number of actinic keratoses, a skin cancer precursor and itself a cause of morbidity and cost. By targeting patients at high-risk, the study focuses on high-cost patients for whom this treatment could both improve outcomes (cancers and quality of life) and reduce costs.
Study Type
Enrollment (Actual)
Phase
- Phase 4
Contacts and Locations
Study Locations
-
-
California
-
Palo Alto, California, United States, 94304-1290
- VA Palo Alto Health Care System, Palo Alto, CA
-
San Diego, California, United States, 92161
- VA San Diego Healthcare System, San Diego, CA
-
-
Colorado
-
Denver, Colorado, United States, 80220
- VA Eastern Colorado Health Care System, Denver, CO
-
-
Florida
-
Bay Pines, Florida, United States, 33744
- Bay Pines VA Healthcare System, Pay Pines, FL
-
Miami, Florida, United States, 33125
- Miami VA Healthcare System, Miami, FL
-
-
Georgia
-
Decatur, Georgia, United States, 30033
- Atlanta VA Medical and Rehab Center, Decatur, GA
-
-
Illinois
-
Hines, Illinois, United States, 60141-5000
- Edward Hines Jr. VA Hospital, Hines, IL
-
-
Massachusetts
-
Boston, Massachusetts, United States, 02130
- VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA
-
-
Minnesota
-
Minneapolis, Minnesota, United States, 55417
- Minneapolis VA Health Care System, Minneapolis, MN
-
-
North Carolina
-
Durham, North Carolina, United States, 27705
- Durham VA Medical Center, Durham, NC
-
-
Pennsylvania
-
Philadelphia, Pennsylvania, United States, 19104
- Philadelphia VA Medical Center, Philadelphia, PA
-
-
Rhode Island
-
Providence, Rhode Island, United States, 02908
- Providence VA Medical Center, Providence, RI
-
-
Tennessee
-
Nashville, Tennessee, United States, 37212-2637
- Tennessee Valley Healthcare System Nashville Campus, Nashville, TN
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- ADULT
- OLDER_ADULT
- CHILD
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Veteran who is at high risk for developing skin cancer defined as 2 keratinocyte carcinomas in the past 5 years, at least one of which was located on the face or ears
Exclusion Criteria:
- Participants who are unable to speak English
- Participants with KC at randomization
- Participants currently using or having used field therapy for AKs on the face or ears in the past 3 years. The vast majority of these field treatments would have been with 5-FU cream. The investigators will allow recent use of therapies that are applied to individual AK lesions (e.g. cryotherapy), but not those that were used on an entire area (field) in the study treatment area Participants currently using or having used systemic 5-fluorouracil or oral capecitabine (Xeloda) within the past 3 years Participants with known allergy to sunscreen, triamcinolone and/or 5-fluorouracil.
Exclusions 6-l0: The investigators will exclude the small proportion who get their KCs for special reasons other than ultraviolet radiation exposure (see list below), since that etiologic difference, which is associated with a prognostic difference, could be associated with a biologic difference in response to chemoprevention efforts. These will include:
- Solid organ transplant recipients, such as renal, hepatic, or cardiac transplant patients
- Individuals with genetic disorders associated with very high cancer risk such as:
- basal cell nevus syndrome
- erythrodysplasia verruciformis
- xeroderma pigmentosum
- Arsenic exposure
- PUVA (Psoralen plus UVA) treatment
- Cutaneous T-cell lymphoma
- Prior or current radiation therapy to the face and/or ears.
Additional exclusions (12-15) are:
- Those who, in the opinion of the recruiting investigator, have very high mortality risk at randomization (less than 50% chance of surviving 4 years) due to co morbid illness such as metastatic cancer or COPD.
- For women of childbearing potential an initial pregnancy test and ongoing birth control will be required for participation.
- Patients with known dihydropyrimidine dehydrogenase (DPD) enzyme deficiency by self report or noted in the medical record (they have increased toxicity from systemic 5-FU, although screening for this is not part of dermatologic practice and will not be part of this study).
- Patients on methotrexate (these will constitute about 1% of potentially eligible individuals) because they may have more severe reactions to topical 5-FU.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: PREVENTION
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: QUADRUPLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: Arm 1: 5-fluorouracil
Group assigned to blinded 5-FU (5-fluorouracil) cream applied to face and ears twice daily for maximum of 56 doses
|
Apply thin layer of topical 5-FU 5% cream twice daily to face and ears for 4 weeks.
Treatment to be initiated immediately after randomization.
If unable to tolerate the twice daily 5-FU, they will discontinue the treatment and initiate "cool-down" treatment with triamcinolone 0.1% cream twice daily until the symptoms resolve.
At 3 weeks after stopping 5-FU, if and only if the participant has not received at least the minimum 2 week (28 dose) course, 5-FU treatment will be resumed on a once-daily basis to complete the 56 dose course.
If this is not tolerated, the "cool-down" routine will be followed, but 5-FU will be stopped.
Other Names:
|
PLACEBO_COMPARATOR: Arm 2: Placebo
Group assigned to blinded placebo, vehicle control cream applied to face and ears twice daily for maximum of 56 doses
|
Apply thin layer of vehicle control cream twice daily to face and ears for 4 weeks.
Treatment to be initiated immediately after randomization.
If unable to tolerate the twice daily vehicle control cream, they will discontinue the treatment and initiate "cool-down" treatment with triamcinolone 0.1% cream twice daily until the symptoms resolve.
At 3 weeks after stopping vehicle control cream, if and only if the participant has not received at least the minimum 2 week (28 dose) course, vehicle control cream treatment will be resumed on a once-daily basis to complete the 56 dose course.
If this is not tolerated, the "cool-down" routine will be followed, but vehicle control cream will be stopped.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The Time to Diagnosis of the First Keratinocyte Carcinoma (KC) on the Face or Ears for Which Surgery is Performed
Time Frame: From randomization to last visit prior to end of study date (6/30/2013), assessed up to four years
|
Diagnosis of the first Primary Basil Cell Carcinoma (BCC) or primary Squamous Cell Carcinoma (SCC) on the face or ears that was removed surgically.
|
From randomization to last visit prior to end of study date (6/30/2013), assessed up to four years
|
Hazard Ratio for Surgically Treated KC
Time Frame: date of randomization to last visit before end of study follow up (6/30/2013), assessed up to four years
|
date of randomization to last visit before end of study follow up (6/30/2013), assessed up to four years
|
Collaborators and Investigators
Publications and helpful links
General Publications
- Lee KC, Lew R, Weinstock MA. Improvement in precision of counting actinic keratoses. Br J Dermatol. 2014 Jan;170(1):188-91. doi: 10.1111/bjd.12629.
- Korgavkar K, Firoz EF, Xiong M, Lew R, Marcolivio K, Burnside N, Dyer R, Weinstock MA; VAKCC Trial Group. Measuring the severity of topical 5-fluorouracil toxicity. J Cutan Med Surg. 2014 Jul-Aug;18(4):229-35. doi: 10.2310/7750.2013.13143.
- Pomerantz H, Hogan D, Eilers D, Swetter SM, Chen SC, Jacob SE, Warshaw EM, Stricklin G, Dellavalle RP, Sidhu-Malik N, Konnikov N, Werth VP, Keri J, Lew R, Weinstock MA; Veterans Affairs Keratinocyte Carcinoma Chemoprevention (VAKCC) Trial Group. Long-term Efficacy of Topical Fluorouracil Cream, 5%, for Treating Actinic Keratosis: A Randomized Clinical Trial. JAMA Dermatol. 2015 Sep;151(9):952-60. doi: 10.1001/jamadermatol.2015.0502.
- Chen SC, Hill ND, Veledar E, Swetter SM, Weinstock MA. Reliability of quantification measures of actinic keratosis. Br J Dermatol. 2013 Dec;169(6):1219-22. doi: 10.1111/bjd.12591.
- Pomerantz H, Korgavkar K, Lee KC, Lew R, Weinstock MA; VAKCC Trial Group. Validation of Photograph-Based Toxicity Score for Topical 5-Fluorouracil Cream Application. J Cutan Med Surg. 2016 Sep;20(5):458-66. doi: 10.1177/1203475416643952. Epub 2016 Apr 18.
- Siegel JA, Luber AJ, Weinstock MA; Department of Veterans Affairs Topical Tretinoin Chemoprevention Trial and Department of Veterans Affairs Keratinocyte Carcinoma Chemoprevention Trial Groups. Predictors of actinic keratosis count in patients with multiple keratinocyte carcinomas: A cross-sectional study. J Am Acad Dermatol. 2017 Feb;76(2):346-349. doi: 10.1016/j.jaad.2016.09.020. No abstract available.
- Walker JL, Siegel JA, Sachar M, Pomerantz H, Chen SC, Swetter SM, Dellavalle RP, Stricklin GP, Qureshi AA, DiGiovanna JJ, Weinstock MA. 5-Fluorouracil for Actinic Keratosis Treatment and Chemoprevention: A Randomized Controlled Trial. J Invest Dermatol. 2017 Jun;137(6):1367-1370. doi: 10.1016/j.jid.2016.12.029. No abstract available.
- Pomerantz H, Chren MM, Lew R, Weinstock MA; VA Keratinocyte Carcinoma Chemoprevention (VAKCC) Trial Group*. Validation and comparison of quality-of-life measures for topical 5-fluorouracil treatment: results from a randomized controlled trial. Clin Exp Dermatol. 2017 Jul;42(5):488-495. doi: 10.1111/ced.13089.
- Korgavkar K, Weinstock MA, Lee KC; VAKCC Trial Group. Evaluation of photoaging scales in an elderly male population. J Eur Acad Dermatol Venereol. 2017 Nov;31(11):e489-e490. doi: 10.1111/jdv.14330. Epub 2017 Jun 20. No abstract available.
- Leader NF, Means AD, Robinson-Bostom L, Telang GH, Wilkel CS, Weinstock MA; Veterans Affairs Keratinocyte Carcinoma Chemoprevention Trial group. Interrater reliability for histopathologic diagnosis of keratinocyte carcinomas. J Am Acad Dermatol. 2018 Jan;78(1):185-187. doi: 10.1016/j.jaad.2017.07.024. No abstract available.
- Korgavkar K, Lee KC, Weinstock MA; Veterans Affairs Keratinocyte Carcinoma Chemoprevention (VAKCC) Trial Group. Effect of Topical Fluorouracil Cream on Photodamage: Secondary Analysis of a Randomized Clinical Trial. JAMA Dermatol. 2017 Nov 1;153(11):1142-1146. doi: 10.1001/jamadermatol.2017.2578.
- Means AD, Lee KC, Korgavkar K, Swetter SM, Dellavalle RP, Chen S, Stricklin G, Weinstock MA; Veterans Affairs Keratinocyte Carcinoma Chemoprevention (VAKCC) Trial Group. Development of a Pigmented Facial Lesion Scale Based on Darkness and Extent of Lesions in Older Veterans. J Invest Dermatol. 2019 May;139(5):1185-1187. doi: 10.1016/j.jid.2018.11.017. Epub 2018 Nov 30. No abstract available.
- Beatson M, Means AD, Leader NF, Robinson-Bostom L, Weinstock MA. Characteristics of Keratinocyte Carcinomas and Patients with Keratinocyte Carcinomas Following a Single 2-4 Week Course of Topical 5-fluorouracil on the Face and Ears. Acta Derm Venereol. 2019 Jun 1;99(7):707-708. doi: 10.2340/00015555-3176. No abstract available.
- Beatson M, Siegel JA, Chren MM, Weinstock MA. Effects of increased actinic keratosis count on skin-related quality of life: results from the Veterans Affairs Keratinocyte Carcinoma Chemoprevention (VAKCC) Trial. Eur J Dermatol. 2019 Oct 1;29(5):507-510. doi: 10.1684/ejd.2019.3637.
- Beatson M, Misitzis A, Landow S, Yoon J, Higgins HW 2nd, Phibbs C, Weinstock MA. Predictors of Basal Cell Carcinoma and Implications for Follow-Up in High-Risk Patients in the Veterans Affairs Keratinocyte Carcinoma Chemoprevention (VAKCC) Trial. J Cutan Med Surg. 2021 Jan-Feb;25(1):102-103. doi: 10.1177/1203475420945230. Epub 2020 Sep 3. No abstract available.
- Misitzis A, Stratigos AJ, Beatson M, Mastorakos G, Dellavalle RP, Weinstock MA; Veterans Affairs Keratinocyte Carcinoma Chemoprevention Trial Group. The association of metformin use with keratinocyte carcinoma development in high-risk patients. Dermatol Ther. 2020 Nov;33(6):e14402. doi: 10.1111/dth.14402. Epub 2020 Oct 20.
- Siegel JA, Chren MM, Weinstock MA; Department of Veterans Affairs Keratinocyte Carcinoma Chemoprevention Trial Group. Correlates of skin-related quality of life (QoL) in those with multiple keratinocyte carcinomas (KCs): A cross-sectional study. J Am Acad Dermatol. 2016 Sep;75(3):639-642. doi: 10.1016/j.jaad.2016.05.008. No abstract available.
- Yoon J, Phibbs CS, Chow A, Pomerantz H, Weinstock MA. Costs of Keratinocyte Carcinoma (Nonmelanoma Skin Cancer) and Actinic Keratosis Treatment in the Veterans Health Administration. Dermatol Surg. 2016 Sep;42(9):1041-7. doi: 10.1097/DSS.0000000000000820.
- Weinstock MA, Thwin SS, Siegel JA, Marcolivio K, Means AD, Leader NF, Shaw FM, Hogan D, Eilers D, Swetter SM, Chen SC, Jacob SE, Warshaw EM, Stricklin GP, Dellavalle RP, Sidhu-Malik N, Konnikov N, Werth VP, Keri JE, Robinson-Bostom L, Ringer RJ, Lew RA, Ferguson R, DiGiovanna JJ, Huang GD; Veterans Affairs Keratinocyte Carcinoma Chemoprevention Trial (VAKCC) Group. Chemoprevention of Basal and Squamous Cell Carcinoma With a Single Course of Fluorouracil, 5%, Cream: A Randomized Clinical Trial. JAMA Dermatol. 2018 Feb 1;154(2):167-174. doi: 10.1001/jamadermatol.2017.3631.
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ACTUAL)
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ESTIMATE)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Neoplasms by Histologic Type
- Neoplasms by Site
- Neoplasms, Glandular and Epithelial
- Neoplasms
- Carcinoma
- Carcinoma, Squamous Cell
- Skin Neoplasms
- Skin Diseases
- Neoplasms, Squamous Cell
- Carcinoma, Basal Cell
- Neoplasms, Basal Cell
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Antimetabolites, Antineoplastic
- Antimetabolites
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Fluorouracil
Other Study ID Numbers
- 562
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Skin Diseases
-
West Virginia UniversityMary Babb Randolph Cancer Center at West Virginia University Hospitals; West...RecruitingSkin Cancer | Skin Lesion | Skin Melanoma | Tumor SkinUnited States
-
Paratek Pharmaceuticals IncCompletedInfectious Skin Disease | Bacterial Skin DiseaseUnited States
-
R2 DermatologyCompleted
-
TCI Co., Ltd.Completed
-
Access Business GroupClinical Research LaboratoriesCompleted
-
R2 DermatologyRecruitingSkin LesionUnited States
Clinical Trials on 5-fluorouracil
-
The Netherlands Cancer InstituteCompleted
-
The Netherlands Cancer InstituteCompleted
-
The Cleveland ClinicNational Cancer Institute (NCI)TerminatedActinic Keratosis | Organ or Tissue Transplant; ComplicationsUnited States
-
Chia Tai Tianqing Pharmaceutical Group Co., Ltd.UnknownSquamous Cell Carcinoma of the Head and NeckChina
-
National Cancer Institute (NCI)CompletedStage IV Colon Cancer | Stage IV Rectal Cancer | Recurrent Colon Cancer | Recurrent Rectal Cancer | Adenocarcinoma of the Rectum | Adenocarcinoma of the ColonUnited States
-
Wake Forest University Health SciencesNational Cancer Institute (NCI)TerminatedMucinous Adenocarcinoma of the Rectum | Stage IIA Rectal Cancer | Stage IIB Rectal Cancer | Stage IIC Rectal Cancer | Stage IIIB Rectal Cancer | Stage IIIC Rectal CancerUnited States
-
Peking Union Medical College HospitalRecruitingRectal Cancer | Colon Cancer | Chemotherapy Effect | PTC | Exon MutationChina
-
M.D. Anderson Cancer CenterNational Cancer Institute (NCI)CompletedColorectal Cancer | Metastatic CancerUnited States
-
Singapore National Eye CentreSingapore Eye Research Institute; Nanchang UniversityCompletedGlaucoma | Wound Healing | TrabeculectomySingapore