Dacogen

[Greg H]

Hi all!

This could be my imagination, but it seems like I'm seeing a lot of folks lately on marrowforums who are being started on Dacogen instead of Vidaza. I know, early on, there was a definite preference for Vidaza, because the trial that got it approved by the FDA showed better results than the somewhat flawed trial for Dacogen.

I'm wondering if something has happened that I missed to flip this on its head and make Dacogen the preferred therapy. I have to admit that I didn't keep up with my reading as well as I should have while I was taking a vacation from thinking about MDS. So maybe I missed something.

If I did, I'll bet Birgitta or DanL caught it. Someone fill me in on why so many folks seem to be getting Dacogen instead of Vidaza.

Take Care!

Greg

[PattiDean]

Thank you Greg for this post, I would be interested in knowing as well.

[kgtuck]

Greg - Very good question!! The dacogen has been my "wonder drug" for 3 years now, and think it was selected by "the toss of a coin". But, seriously, a PA working with my doctor had just attended a conference (June '09)and "heard that Dacogen's success rates were very good"! And, don't quote me, but I, in talking with others, seem to think Dacogen has less harsh side effects (mine being mild constipation, some slight fatigue and washed out feeling--for short periods of time--after the treatments every 4 weeks).
Dacogen can also bring down white counts, but for me, they bounce back up! I'm also glad to hear that there are combinations of drugs to try when needed!

One other note why Dacogen is preferred over Vidaza. The Dacogen schedule is alot more convenient for some patients. Dacogen is usually 5 days a week,
M-F, 1 hr per day, and I believe Vidaza is 7 day regimen, M-F and then Mon & Tues of the following week.

[DanL]

Greg,

Great question. I think there are several possibilities, including the increased convenience noted previously. Some studies seem to imply greater transfusion independence:

http://www.mdsbeacon.com/news/2011/0...a-azacitidine/

For Decitabine, Complete Response numbers appear to be higher, but Overall Response Rate (including HI) is lower - 17% CR, 15% marrow CR, 18% HI. ORR is about 50%. Most responses seem to take place by the end of the second cycle, which is a little faster than with Azacitidine. Cytogenic responses also seem to be more common.

Vidaza studies have a lot of variability, but they seem to have a common theme of lower CR (7-12%) and PR (12%-16%), with higher rates of HI (37%), so a better overall response rate at around 60% on average. Vidaza seems to see a response by 3-4 months, though best response may not occur until 6-9 months.

Cost - Vidaza between 7k and 8k generally per cycle, Dacogen about $7600 per cycle - more or less the same.

Personally, I believe that the makers of Dacogen are being more aggressive in marketing the drug and getting it involved in more of the cutting-edge research with cure as an objective as opposed to maintenance, as it is being combined with some pretty strong chemo drugs in several trials. Most of the Vidaza trials appear to be a little more conservative and are looking for small gains. This could also be having an impact on perception of the drug.

One other note - some other research indicates that dacogen prior to stem cell transplant has lower AGVHD rates than Vidaza, but these have been very small studies - 20-30 people.

[Greg H]

Hey Dan!

I knew you would come through for me. Your points make perfect sense. I do think the stance the drug company makes, in terms of participation in trials, visibility in sponsorships, etc. makes a difference in terms of what docs are more likely to prescribe.

And, given the number of posts I've read here about Vidaza side effects, anything that has fewer of those, and provokes a more rapid response, would certainly have a lot to recommend it.

Thanks for the education!

Take care,

Greg

[kris]

http://www.mdsbeacon.com/news/2012/0...mds-asco-2012/

So often transplant is offered after all other treatment options have been explored. This article is of interest.