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Dacogen (Decitabine)

Dacogen (decitabine) is a cancer medication that interferes with the growth and spread of cancer cells in the body.

Dacogen injection is used to treat myelodysplastic syndromes (certain types of blood or bone marrow cancer).

HOW DACOGEN IS GIVEN

Dacogen is given as an infusion into a vein. A healthcare provider will give you this injection.

The actual dosage of decitabine that you will receive depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition you have. Your doctor will determine your exact dosage and schedule. 

SIDE EFFECTS

Important things to remember about the side effects of Dacogen:

  • You will not get all of the side effects mentioned below.
  • Side effects are often predictable in terms of their onset, duration, and severity.
  • Side effects are almost always reversible and will go away after therapy is complete.
  • Side effects are quite manageable. There are many options to minimize or prevent them.

The following side effects are common (occurring in greater than 30%) for patients taking Dacogen:-

  • Low blood counts. Your white and red blood cells and platelets may temporarily decrease. This can put you at increased risk for infection, anemia and/or bleeding, and may increase need for blood or platelet transfusions.
  • Fatigue
  • Fever
  • Nausea
  • Cough
  • Petechiae (Tiny red dots on your skin, called petechiae. Can occur with low platelet count.)
  • Constipation
  • Diarrhea
  • Hyperglycemia – high blood glucose levels

These are less common side effects for patients receiving Dacogen:-

  • Headache
  • Difficulty sleeping
  • Swelling 
  • Low albumin 
  • Low magnesium 
  • Chills 
  • Low potassium 
  • Bruising 
  • Rash 
  • Low sodium 
  • Dizziness 
  • Generalized aches and pains
  • Cardiac murmur 
  • Poor appetite 
  • Sore throat 
  • Abdominal pain 
  • High bilirubin blood level
  • High potassium 
  • Mouth sores
  • Drowsiness 
  • Abnormal liver function blood tests
  • Confusion 
  • Anxiety 
  • Itching 
  • Heartburn 

This list includes common and less common side effects for those taking Dacogen. But you should always inform your health care provider if you experience any unusual symptoms.

DOSAGE

Usual Adult Dose for Myelodysplastic Syndrome:

TREATMENT REGIMEN OPTION 1:-

15 mg/m2 IV over 3 hours; repeat every 8 hours for 3 days; repeat this cycle every 6 weeks; patients may be premedicated with standard antiemetic therapy

If hematologic recovery (ANC 1,000/mcL or greater and platelets 50,000/mcL or greater) from a previous treatment cycle requires more than 6 weeks, then the next cycle should be delayed and dosing temporarily reduced by following this algorithm:-

  • Recovery requiring more than 6, but less than 8 weeks: Delay dosing for up to 2 weeks and temporarily reduce the dose to 11 mg/m2 IV every 8 hours (33 mg/m2/day, 99 mg/m2/cycle) when restarting therapy
  • Recovery requiring more than 8, but less than 10 weeks: Assess patient for disease progression (by bone marrow aspirates); in the absence of progression, the dose should be delayed up to 2 more weeks and then reduced to 11 mg/m2 IV every 8 hours (33 mg/m2/day, 99 mg/m2/cycle) when restarting therapy, then maintained or increased in subsequent cycles as clinically indicated

TREATMENT REGIMEN OPTION 2:-

20 mg/m2 IV over 1 hour; repeat daily for 5 days; repeat this cycle every 4 weeks; patients may be premedicated with standard antiemetic therapy

If myelosuppression is present, subsequent treatment cycles should be delayed until there is hematologic recovery (ANC 1,000/mcL or greater and platelets 50,000/mcL or greater)

Comments:-

  • With either regimen, it is recommended that patients be treated for a minimum of 4 cycles; however, a complete or partial response may take longer than 4 cycles.
  • Perform complete blood and platelet counts before each cycle and as needed to monitor response and toxicity.
  • Perform liver chemistries and serum creatinine before initiation of therapy.

Use:-

For the treatment of myelodysplastic syndromes (MDS) including previously treated and untreated, de novo and secondary MDS of all French-American-British subtypes (refractory anemia, refractory anemia with ringed sideroblasts, refractory anemia with excess blasts, refractory anemia with excess blasts in transformation, and chronic myelomonocytic leukemia) and intermediate-1, intermediate-2, and high-risk International Prognostic Scoring System groups.

Precautions for decitabine

  • Before starting decitabine treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). Do not take aspirin, products containing aspirin unless your doctor specifically permits this.
  • Do not receive any kind of immunization or vaccination without your doctor’s approval while taking decitabine.
  • Inform your health care professional if you are pregnant or may be pregnant before starting this treatment. Pregnancy category D (decitabine may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus.)
  • For both men and women: Do not conceive a child (get pregnant) while taking decitabine. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
  • Males should avoid fathering a child while on decitabine therapy and for 2 months after treatment. 
  • Do not breastfeed while taking this medication.

SELF-CARE TIPS OF DECITABINE

  • Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
  • You may be at risk of infection so try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your health care provider.
  • Wash your hands often.
  • To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1/2 teaspoon of table salt and 1 tablespoon of baking soda mixed with 8 ounces of water.
  • Use an electric razor and a soft toothbrush to minimize bleeding.
  • Avoid contact sports or activities that could cause injury.
  • To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.
  • Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing.
  • In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
  • Get plenty of rest.
  • Maintain good nutrition.
  • If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Expert Guidance from Cancer Coach

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