Generic Name: Decitabine
Brand Name: Dacogen
Drug Class: Hypomethylating agent (HMA)
Mechanism of Action:
Decitabine is a cytidine analog that gets incorporated into DNA and irreversibly inhibits DNA methyltransferase (DNMT). This leads to hypomethylation of DNA, reactivating silenced tumor suppressor genes and promoting cell differentiation and apoptosis, especially in myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML).
Clinical Indications
- Intermediate to high-risk MDS (IPSS/IPSS-R)
- Chronic myelomonocytic leukemia (CMML)
- AML in older or unfit patients (off-label in some regions)
Dosing Regimens
- MDS (FDA-approved): 20 mg/m² IV over 1 hour daily × 5 days every 4 weeks
- Alternative regimens: 20 mg/m² IV daily × 10 days (used in AML or MDS with excess blasts)
Adverse Effects
- Hematologic: Neutropenia, thrombocytopenia, anemia
- GI: Nausea, constipation, diarrhea
- Infectious: Febrile neutropenia, sepsis
- Others: Fatigue, injection site reactions
Synonyms
Dacogen