How it is administered

Decitabine is given as an intravenous (IV) infusion, meaning it is administered directly into a vein. It comes as a sterile, lyophilized powder that is reconstituted and diluted before use. There are two main dosing regimens:

• Three Day Regimen: 15 mg/m² by continuous IV infusion over 3 hours, every 8 hours for 3 days. This cycle is repeated every 6 weeks.
• Five Day Regimen: 20 mg/m² by continuous IV infusion over 1 hour, once daily for 5 days. This cycle is repeated every 4 weeks.

Your healthcare provider will determine the best regimen and dose for you based on your specific condition and response to treatment.

How it works

Decitabine is a nucleoside metabolic inhibitor that works by affecting the DNA of cancer cells. After entering the cell, decitabine is incorporated into the DNA during cell division. It inhibits an enzyme called DNA methyltransferase, which normally adds methyl groups to DNA. By blocking this process, decitabine causes hypomethylation of DNA.

This hypomethylation can reactivate genes that control normal cell growth and differentiation, which may have been turned off in cancer cells. As a result, cancer cells may stop growing or die (a process called apoptosis). Decitabine is particularly effective in rapidly dividing cells, such as those found in certain blood cancers. Non-dividing cells are less affected by this medication.

Overall, decitabine helps restore normal function to genes that are important for controlling cell growth and can lead to the death of abnormal blood cells.

Who Should take it

Decitabine is indicated for adult patients with myelodysplastic syndromes (MDS), including previously treated and untreated, de novo and secondary MDS of all French-American-British subtypes. These include refractory anemia, refractory anemia with ringed sideroblasts, refractory anemia with excess blasts, refractory anemia with excess blasts in transformation, and chronic myelomonocytic leukemia. It is also used for patients with intermediate-1, intermediate-2, and high-risk groups according to the International Prognostic Scoring System (IPSS).

Although the main FDA-approved use is for MDS, decitabine is sometimes used off-label for certain patients with Acute Myeloid Leukemia (AML), especially those who may not tolerate intensive chemotherapy. Your doctor will decide if decitabine is appropriate for your specific diagnosis and health situation.

Who should not take it

There are no absolute contraindications listed for decitabine, but certain patients should use caution:

• Pregnancy: Decitabine can cause fetal harm. Women who are pregnant or may become pregnant should not use this medication. Effective contraception is required for women of childbearing potential during treatment and for 6 months after the last dose. Men with female partners of reproductive potential should use contraception during treatment and for 3 months after.
• Breastfeeding: Women should avoid breastfeeding while receiving decitabine and for at least 2 weeks after the last dose.
• Severe organ impairment: There is no data on use in patients with significant kidney or liver dysfunction, so risks and benefits should be carefully considered.

Always inform your healthcare provider of your full medical history before starting decitabine.

Commonly used with

Decitabine is often used alone, but it may be combined with supportive care treatments such as blood transfusions, antibiotics, and growth factors (like G-CSF for low white blood cells) to manage side effects and complications.

In some cases, it may be used in combination with other medications for blood cancers, depending on your specific diagnosis and treatment plan.

Commonly tested with

Decitabine has been studied in combination with supportive care measures, including transfusions and growth factors. Clinical trials have also explored its use with other chemotherapy agents and targeted therapies, especially in the context of blood cancers like MDS and AML.

Your healthcare team will determine the best combination of treatments based on your individual needs and the latest research.