We are writing to address the conclusions in the letter “Topical Tretinoin, Lung Cancer, and Lung-Related Mortality” by Katz.1 The Veterans Affairs Topical Tretinoin Chemoprevention (VATTC) trial2 was a double-blind study conducted to assess the value of tretinoin, 0.1%, cream in the prevention of nonmelanoma skin cancer. Katz1 concludes that while it is not clear whether tretinoin caused the excess lung-related deaths in VATTC, concern was warranted because a causal link was plausible. Results presented by Weinstock et al2 reveal minor imbalances in morbidity predictors such as age, comorbidities, and smoking status, and the authors conclude that a causal relationship between topical tretinoin therapy and death cannot be inferred. Thus, the supposition by Katz1 is in clear contrast to the conclusions of Weinstock et al.2
Powers W, Shapiro SS, Heremans A. Tretinoin: An Established Long-term Safety Profile. Arch Dermatol. 2009;145(9):1063–1064. doi:10.1001/archdermatol.2009.206
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