Isotretinoin Rinses May Be Beneficial in Chemoprevention of Recurrent OCSCC

Are oral isotretinoin rinses effective for the prevention of oral cavity squamous cell carcinoma (OCSCC), squamous cell carcinoma (SCC) in situ, and dysplasia?

Bottom line
Oral isotretinoin as chemoprophylaxis for patients treated for oral cavity squamous cell carcinoma, in situ disease, or dysplasia may be beneficial in decreasing recurrence rate.

Background: Over the past three decades, there have been only minor advancements within the field of chemoprevention and chemoprophylaxis. The idea of condemned mucosa and field cancerization ignited an early interest in chemoprevention strategies but, ultimately, an efficacious, well-tolerated agent has yet to be found. The primary aim of this study was to demonstrate the experience of a single group practice with reconstituted oral isotretinoin rinses for the prevention of oral cavity squamous cell carcinoma (OCSCC), squamous cell carcinoma (SCC) in situ, and dysplasia. As irritation is the only side effect, and most insurance companies are willing to cover this drug, this low-risk therapy could prove to be a useful adjunct in the treatment of this patient population.

Study design: Retrospective cohort study.

Setting: JPS Hospital, Fort Worth, Texas.

Synopsis: One hundred forty-three patients were initially enrolled in the study; 18 were excluded due to inability to tolerate therapy. The included patients were classified into four groups. Group 1 included patients with multiple early stage oral cavity lesions following initial resection. Group 2 included patients with SCC in situ after excision. Group 3 included patients with multifocal dysplasia following initial CO2 laser ablation. Group 4 included patients with a history of treated oral cavity SCC with new leukoplakia lesions proven to be dysplastic. Fifty-three patients in the control group did not use post-treatment isotretinoin rinses due to various reasons, whereas 72 patients completed therapy. Minimum use of isotretinoin rinses was 12 months, and minimum follow-up was 24 months. During the follow-up period, all recurrences of carcinoma, in situ disease, and dysplasia were noted and compared with a Fisher test of fit. A Bonferroni correction was applied to increase accuracy and strength of comparison. Using a Bonferroni correction, the significance threshold was 0.0125. By that cutoff, isotretinoin rinses were found to be associated with lower recurrence in groups 1 and 3 (P = .00014, P = .00002, respectively) but not in groups 2 and 4 (P = .4, P = .3846, respectively).

Citation: Kadakia S, Badhey A, Milam M, Lee T, Ducic Y. Topical oral cavity chemoprophylaxis using isotretinoin rinse: A 15-year experience. Laryngoscope. 2017;127:1595–1599.