How it is administered

Decitabine is given as an intravenous (IV) infusion or as an oral tablet (in combination with cedazuridine). For IV use, it is supplied as a sterile powder that is reconstituted and diluted before administration. The most common dosing regimens are:

• 15 mg/m² IV over 3 hours every 8 hours for 3 days, repeated every 6 weeks
• 20 mg/m² IV over 1 hour daily for 5 days, repeated every 4 weeks

For oral use (as part of INQOVI, a combination with cedazuridine), it is taken as a tablet once daily for 5 days in a 28-day cycle.

Your healthcare provider will determine the best regimen and monitor you closely during treatment.

How it works

Decitabine is a nucleoside metabolic inhibitor that works by affecting the DNA of cancer cells. After it enters the body, decitabine is incorporated into the DNA of rapidly dividing cells, such as those found in blood cancers like chronic myelomonocytic leukemia (CMML).

It inhibits an enzyme called DNA methyltransferase, leading to hypomethylation of DNA. This process can reactivate genes that control normal cell growth and differentiation, which may have been silenced in cancer cells. By restoring the function of these genes, decitabine can slow down or stop the growth of abnormal blood cells, promote their maturation into normal cells, or trigger cell death (apoptosis).

Decitabine is most effective in cells that are actively dividing, so it tends to target cancerous cells more than normal cells. However, it can also affect normal rapidly dividing cells, which is why side effects can occur.

Who Should take it

Decitabine is indicated for adult patients with myelodysplastic syndromes (MDS), including chronic myelomonocytic leukemia (CMML). It can be used in patients who have been previously treated or untreated, and in both de novo (newly diagnosed) and secondary (developed after other treatments or conditions) cases.

It is suitable for patients with various subtypes of MDS and CMML, especially those considered intermediate-1, intermediate-2, or high-risk according to the International Prognostic Scoring System (IPSS). Decitabine may help improve blood counts, reduce the need for transfusions, and slow disease progression.

Your doctor will decide if decitabine is right for you based on your specific diagnosis, overall health, and treatment goals.

Who should not take it

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

• Pregnant women: Decitabine can cause harm to an unborn baby and should not be used during pregnancy. Effective contraception is recommended for women of childbearing potential and for men with partners of childbearing potential.
• Breastfeeding women: Women should not breastfeed while receiving decitabine and for at least 2 weeks after the last dose.
• Patients with severe, uncontrolled infections or significant organ dysfunction (such as severe liver or kidney impairment) should discuss risks and benefits with their doctor, as safety data in these populations is limited.

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

Commonly used with

Decitabine is often used as a single agent for CMML and MDS. However, it may be given alongside supportive care measures such as blood transfusions, antibiotics, and growth factors (like G-CSF for neutropenia) to manage side effects and complications.

In some cases, decitabine may be used as a bridge to stem cell transplantation, or in combination with other therapies as part of a clinical trial.

Commonly tested with

Decitabine has been studied in combination with cedazuridine (as the oral formulation INQOVI), which increases its availability when taken by mouth. It has also been tested with supportive care measures such as transfusions and growth factors.

Clinical trials may explore decitabine in combination with other chemotherapy agents, targeted therapies, or immunotherapies for blood cancers, including CMML.