Hypomethylators

Question 1

What drugs are in the Hypomethylator class?

Answer 1

Drugs in this class are:
- Azacitidine
- Decitabine

Question 2

What is the brand name of Azacitidine?

Answer 2

The brand name of this generic drug is:
- Vidaza (IV, SubQ)
- Onureg (Oral)

Question 3

What is the brand name of Decitabine?

Answer 3

The brand name of this generic drug is:
- Dacogen

Question 4

What is the generic of name of Vidaza?

Answer 4

The generic name of this brand name drug is:
- Azacitidine

Question 5

What is the generic of name of Onureg?

Answer 5

The generic name of this brand name drug is:
- Azacitidine

Question 6

What is the generic of name of Dacogen?

Answer 6

The generic name of this brand name drug is:
- Decitabine

Question 7

What are the main indications for use of Azacitidine?

Answer 7

The main indications of this drug are:
- AML
- MDS

Question 8

What are the main indications for use of Decitabine?

Answer 8

The main indications of this drug are:
- AML
- MDS

Question 9

What are the main/common indications of the Hypomethylator class?

Answer 9

The main/common indications of this drug class are:
- AML
- MDS

Question 10

What is the class and MOA of Azacitidine?

Answer 10

This drug in the following class:
- Hypomethylator

This drug’s MOA is as follows:
- Methylation (via methyltransferase) of tumor suppressor genes can contribute to the growth and survival of the cancer. Hypomethylating agents prevent DNA methylation by inhibiting methyltransferase, thus allowing for tumor suppressor gene expression which thus inhibits cancer growth.

Question 11

What is the class and MOA of Decitabine?

Answer 11

This drug in the following class:
- Hypomethylator

This drug’s MOA is as follows:
- Methylation (via methyltransferase) of tumor suppressor genes can contribute to the growth and survival of the cancer. Hypomethylating agents prevent DNA methylation by inhibiting methyltransferase, thus allowing for tumor suppressor gene expression which thus inhibits cancer growth.

Question 12

What is the emetic potential of Azacitidine?

Answer 12

The emetic potential of this drug is:
- Moderate

Question 13

Describe the emetic potential of Decitabine.

Answer 13

The emetic potential of this drug is:
- Minimal

Question 14

What drugs in the Hypomethylator class have a high emetic potential?

Answer 14

Drugs in the class with a high emetic potential are:
- None, N/A

Question 15

What drugs in the Hypomethylator class have a moderate emetic potential?

Answer 15

Drugs in the class with a moderate emetic potential are:
- Azacitidine

Question 16

What drugs in the Hypomethylator class have a low emetic potential?

Answer 16

Drugs in the class with a low emetic potential are:
- None, N/A

Question 17

What drugs in the Hypomethylator class have a minimal emetic potential?

Answer 17

Drugs in the class with a minimal emetic potential are:
- Decitabine

Question 18

Describe the extravasation risk and management strategies for Azacitidine.

Answer 18

The extravasation risk and management strategies for this drug are as follows:
- None, N/A

Question 19

Describe the extravasation risk and management strategies for Decitabine.

Answer 19

The extravasation risk and management strategies for this drug are as follows:
- None, N/A

Question 20

Describe the extravasation risk and management strategies for the Hypomethylator class.

Answer 20

The extravasation risk and management strategies for this drug class are as follows:
- None, N/A

Question 21

Describe the distribution of the Hypomethylator class.

Answer 21

The distribution of this class is described as follows:
- Hypomethylating agents do not cross the blood brain barrier and will have limited utility in treating patients with central nervous system disease.

Question 22

Describe the administration of Azacitidine.

Answer 22

The administration of this drug is described as follows:
- Vidaza is given IV or SubQ
- Onureg is given orally

Question 23

What are the notable/common ADRs of the Hypomethylator class?

Answer 23

The notable/common ADRs of this drug class are:
- Bone marrow suppression

Question 24

Describe the strategy and rationale for management of bone marrow suppression caused by hypomethylators.

Answer 24

The strategy and rationale for management of this condition caused by this drug are:
- This is the major side effect of the hypomethylators, however it can be difficult to determine if it is from the chemotherapy or the patient’s disease.
- In many cases, we will treat through it for the first few cycles of therapy (due to the long time to response of hypomethylators) but patients with this after 3-4 months of therapy may need a bone marrow biopsy to rule out relapsed disease.

Question 25

What are the clinical pearls of the Hypomethylator class?

Answer 25

The clinical pearls of this drug class are as follows:
- When used as single agent therapy. hypomethylators have a median response time of 3-4 months.
- These agents are typically well tolerated and are a good choice of therapy for older/frail patients who may not be able to tolerate intensive chemotherapy.
- Recent data has shown that patients have improved response rates when combining hypomethylators with venetoclax (an oral BCL2 inhibitor).
- This combination also increases toxicity but is preferentially used in patients who can tolerate it.