USE LOWER DOSE OF AZACYTIDINE FOR MDS

Low-Dose Azacitidine Better Tolerated by Myelodysplastic Syndrome Patients

NEW YORK (Reuters Health) Mar 19 - The use of a less intensive azacitidine dosing schedule than the current standard in patients with lower-risk myelodysplastic syndrome is better tolerated, and still provides treatment advantages, researchers report in a March 2nd on-line publication in the Journal of Clinical Oncology.

"This study, done in the community setting, largely in 'lower risk' patients," lead investigator Dr. Roger M. Lyons told Reuters Health, "provides support for a more convenient and cost-effective way to treat patients with the myelodysplastic syndrome."

"We observed the same response with less toxicity with only 5 days of treatment every 28 days as opposed to 7 or 10 days, in all three settings avoiding weekends," he said.

Dr. Lyons of Cancer Care Centers of South Texas and US Oncology, San Antonio, and colleagues randomized 151 patients to three different regimens every 4 weeks for 6 cycles.

The first regimen was azacitidine 75 mg per square meter per day subcutaneously for 5 days followed by 2 days of no treatment and then a further 2 days of treatment at the same dosage. The second was 50 mg per square meter for 5 days, followed by 2 days of no treatment and then the same dosage for 5 days. The last group of patients was given 75 mg per square meter subcutaneously for 5 days.

Hematological improvement was seen in 44% of the first group, 45% of the second and 56% of the last group. Corresponding proportions for RBC transfusion-dependent patients who achieved independence were 50%, 55% and 64%. For transfusion-dependent patients in the lower risk category, the figures were 53%, 50% and 61%.

Overall, one or more grade 3 to 4 adverse events were experienced by 84% of the first group, 77% of the second and 58% of the third group.

The researchers conclude that all three approaches provide hematologic improvement and a reduction in transfusion dependence. They add that the straightforward 5-day regimen "may be better tolerated, with a more convenient dosing schedule than the other two alternative dosing regimens."