We performed a placebo-controlled trial of
CEP-1347, an inhibitor of neuronal apoptotic cell death, in patients with early
Parkinson's disease (PD) to determine whether long-term
therapy would slow disability progression. This also provided an opportunity to monitor
cancer incidence in a large cohort of PD patients followed prospectively including periods before and after patients developed disability requiring dopaminergic
therapy. This was a multicenter study of 806 patients with early PD, without disability requiring dopaminergic
therapy, assigned randomly to placebo or one of three doses of
CEP-1347. Patients were monitored for an average of 1.8 years (1,467 patient-years) with routine
cancer screening evaluations and annual skin examinations by a dermatologist. There was no significant excess of
cancers among patients taking
CEP-1347 compared with placebo for any
cancer type (all P > 0.1). Nonmelanoma
skin cancers were the most common
cancer type observed. The incidence of
melanomas was 20.9 times that predicted in the general population. Most
melanomas occurred in patients who had never taken dopaminergic
therapy. We found no evidence that
CEP-1347 affected
cancer incidence within 2 years of follow-up.
Melanoma occurrence in our PD patients was greater than predicted compared with the general population and was unrelated to dopaminergic
therapy. Clinical surveillance of PD patients for
melanoma may be warranted.