Alpha-2-(Difluoromethyl)-dl-ornithine (DFMO), an irreversible inhibitor of
ornithine decarboxylase, has been shown to suppress skin
carcinogenesis in murine models after oral or
topical administration. We designed a randomized, placebo-controlled study using a topical hydrophilic
ointment formulation with or without 10% (w/w) DFMO. Forty-eight participants with moderate-severe
actinic keratoses (AKs) on their forearms (i.e., at least 10 well-circumscribed lesions on the lateral surface) completed a 1-month run-in on placebo
ointment. Before randomization, all lateral forearm AKs were circled, counted, photographed, and skin biopsies were obtained for DFMO and
polyamine levels. Then participants were randomized to receive DFMO
ointment on the right versus the left forearm and placebo hydrophilic
ointment on the contralateral forearm twice daily for 6 months. DFMO was not detected in the blood of any subject, and there were no systemic toxicities. None of a subsample of 17 placebo forearms had measurable concentrations of DFMO, whereas 13 of the corresponding DFMO-treated forearms had high DFMO skin levels. As compared with placebo, the 6-month DFMO treatment caused a 23.5% reduction in the number of AKs (P = 0.001) as well as significant suppression of AK biopsy
spermidine levels (26%; P = 0.04). Seven of the 48 (14.6%) participants experienced severe (2; 4.2%) or moderate (5; 10.4%) inflammatory reactions on their DFMO-treated arms which required dosing modification. Topical DFMO for 6 months can reduce the number of AK lesions and skin
spermidine concentrations in high-risk participants and deserves additional study as a
skin cancer chemopreventive agent.