Vidaza vs. Dacogen

[annmonster]

Hi Everyone .......

I've heard that there isn't a significant difference between Vidaza and Dacogen.... true ?? ( One Dr. said they were like Coke and Pepsi ! )

I've also read somewhere that if someone with MDS is on Dacogen, transfusions aren't needed as often ......is there research to back this up ... ???

Thanks for any info / help !

[Greg H]

Hey Ann!

As I understand it, Vidaza and Dacogen both work in pretty much the same way. They are both "hypomethylating agents," which means they affect important processes at the level of DNA. I'd like to be more specific than that, but the point in Biology 201 where you start understanding the inner workings of DNA is about the point that I decided to major in Religion.

I believe the testing that won Vidaza its FDA approval produced better results than similar testing for Dacogen, which is why folks typically go with Vidaza first. The test design may have had something to do with the less impressive Dacogen performance.

It's not uncommon for folks who try one of these drugs without success, or relapse after some period of success, to try the other one.

Both tend to lower counts initially before improving them. When they work, they can make folks less transfusion dependent, lower blast counts, and sometimes get rid of chromosomal abnormalities.

These drugs won FDA approval after being tested in higher risk MDS patients, those with IPSS scores that put them in the INT-2 or High Risk categories. They are much less effective in lower risk patients. For example, Vidaza can produce improvement in perhaps two-thirds of higher risk patients, but is likely to help only a quarter of lower risk folks. So they are generally reserved for later in the course of the disease.

That's the narrative version. Birgitta has way more actual data at her fingertips, so I hope she'll jump in and correct me or back me up with some data.

Take care!

Greg

[Birgitta-A]

Hi Ann,
As far as I understand everything Greg wrote is OK. One of the differences between Vidaza and Dacogen seems to be that Vidaza is incorporated into both RNA and DNA. In contrast, Dacogen is incorporated solely into DNA.
http://www.plosone.org/article/info:...l.pone.0009001

Vidaza has showed better overall survival but we know that some patients that don’t respond to Vidaza do respond to Dacogen like the member Kirby Stone.

There are studies reporting that transfusion dependent low risk MDS patients don’t respond well to Vidaza.
http://ash.confex.com/ash/2011/webpr...aper38568.html

One Dacogen study (rather small) showed clinical benefit was shown in 50% of those known to be intermediate-1 MDS.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2895778/
Kind regards
Birgitta-A

[annmonster]

Greg and Birgitta ....


Hey, thanks SO much for your answers....very, very helpful.... I may copy the articles that Birgitta sent along and give them to my hematologist : )

I am in the "low-risk" MDS category, getting Vidaza... ( 6th cycle this week ),Procrit and am transfusion dependent every two weeks or so .....

Again , thanks for taking the time to answer.... and do the research : ) !!

Ann

[Birgitta-A]

Hi Ann,
Perhaps very low dose Revlimid or Thalidomide combined with Prednisone could have better effect?
Kind regards
Birgitta-A

[Darice]

Originally Posted by Greg H

As I understand it, Vidaza and Dacogen both work in pretty much the same way. They are both "hypomethylating agents," which means they affect important processes at the level of DNA. I'd like to be more specific than that, but the point in Biology 201 where you start understanding the inner workings of DNA is about the point that I decided to major in Religion.

I'm wondering whether I can infer from this that if my hubby was unable to tolerate the Vidaza he will likely have the same reaction to the Dacogen? No one is suggesting the Dacogen . . . yet, anyway . . . but I imagine we will get to that point sooner or later so I'm thinking ahead.

I quit on Biology in 8th or 9th grade when we had to disect frogs . . . now I feel like I'm getting a crash course.

Thanks

[Greg H]

Hey Darice!

The drugs apparently do work the same way, and both have neutropenia nd thrombocytopenia as primary adverse reactions. So if it was plunging counts that caused a problem for Jens with Vidaza, Dacogen might have the same effect. On the other hand, other adverse effects (like nausea, rash, etc.) might be peculiar to each drug.

Here's the prescribing info for Vidaza, and the package insert for Dacogen. If you look for the "Adverse Effects" section in each, you could compare and see what you think.

Take care!

Greg

[cheri]

Recently, my Dr suggested Dacogen, as I have tried Vidaza, and Revlimid without success. There is concern on my part as to the lowering of my WBC and Platelets to the point of being succeptible to infections and also, with my serious ongoing gut problems, more GI distress. I did say that I will not go on anything until that is resolved. Finally, I am getting some relief, as my white count is up (thanks to Neupogen) and I can eat fresh fruits and veggies and yogurt to try and get my system repaired from all of the antibiotics I have recieved over the past two years.

This past weekend I felt well enough to travel to Washington DC--after my platelet and 2 blood transfusions!

Dacogen is the last resort, as I have tried all of the other meds. Transplant is not an option. I forget how it is administered--IV? How often and for how long, and what are the major side effects? I will let my overall feelings of well being determine my next course of action, if any......

Any input from Dacogen users would be appreciated!

[Birgitta-A]

Hi Cheri,
Hope you will get info from Dacogen users.

Here is some info from the package insert from Dacogen that Greg posted:
First Treatment Cycle
The recommended Dacogen dose is 15 mg/m2 administered by continuous intravenous infusion over 3 hours repeated every 8 hours for 3 days. Patients may be premedicated with standard anti-emetic therapy.
Subsequent Treatment Cycles
The above cycle should be repeated every 6 weeks. 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. Treatment may be continued as long as the patient continues to benefit.

In many studies they now administrate Dacogen like Vidaza during 5 days/month because the initially used dose probably was too low.

The adverse effects are among others:
Neutropenia 90%, Low platelets 89%, Anemia 82%, Anorexia 16%, Joint pain 20%, Pain in limb 19%, Back pain 17%, Headache 28%, Insomnia 28%. Patients treated with Dacogen were compared with patients treated with supportive therapy and these patients often had these symptoms too.
Kind regards
Birgitta-A

[cheri]

Thank you Birgitta!
I can always count on you for the easiest, most concise information to digest.
I asked at my hospital infusion room yesterday: "Do you administer Dacogen?"
One nurse never heard of it; the other shrugger her shoulders and said " I think we gave it to somebody once"....so garnering info can be hard!

Remember, there are countless others on this site who may glean information from those of us who dare to ask the questions!

Please Dacogen patients, feel free to contribute!

[kgtuck]

Hello, Cheri, have had a good experience with dacogen. My only side effects have been constipation (controlled with senocot s) just for a couple days at the end of the treatment week; and the fact that the drug can affect the white counts; seems to be bringing mine down after each treatment, but they bounce back during the 3 weeks off treatments. But, I have been transfusion free for about 3 years now. May just have a couple sluggish days a month that only requires an afternoon nap! Also, my hgb and platelets have not been affected by the drug after the initital 3 months that it took the drug to become effective. I had heard, but may not be a fact, that the drugs vidaza and dacogen are very similar, but dacogen having slightly milder side effects. If you have any other questions re: dacogen, just send me a note! Take care!

[cheri]

Thanks for your response and so glad you are having such good numbers with Dacogen....
I will be in touch!

[Whizbang]

Figured I'd post this here for future reference...

Received 41mg daily for 5 days Dacogen 8/5 - 8/9/2013...

Side effects, slight nausea (minor), major constipation... My advice is to start taking Miralax the day before you start chemo... Took 3 days to get regular again. Also was very tired / sluggish, which is par for course...

As you can see below, Dacogen made my WBC & Neutrophils take a dive, and I am waiting for my third post Dacogen blood test 8/29, which will hopefully show a rebound...

I'm currently on 250mg of Dicloxacillan 4 times/day for pop up bacterial infections (boils under the arm pits, and sty in one eye)...

Dr. is reluctant to give me nueprogen fearing it will raise my blasts...
(although I've read somewhere that it doesn't do so statistically)

I'm scheduled for my second round 9/3 - 9/7/2013, we'll see if I can improve by then...

Component  Standard Range  6/14  6/19  7/18  7/30  8/15  8/22
RDW-CV     11.6-14.4 %     18.1  18.1  16.1  15.1  13.8  18.5
RDW-SD     35.1-43.9 fl    59.1  58.1  51.5  48.1  40.9  55.9
HGB        13.7-17.5 g/dl   8.0   9.1  11.0  11.0   9.9  10.6
HCT        40-51 %         23.3  26.0  31.7  32.4  27.8  30.3
PLT        150-400 K/ul      70    76    95    91    51    60
RBC        4.63-6.08 M/uL  2.57  2.91  3.56  3.64  3.29  3.45
WBC        4.2-9.1 k/ul     2.0   1.9   3.2   3.5   2.6   1.7
NEUT%      34-68 %           46    48    53    62    52    31
NEUT       1.8-9.0 K/uL     1.0   0.9   1.7   2.2   1.4   0.5
LACT-DEH   313-618 U/L      693   695   670   598   ---   688
BILIRUBIN  0.2-1.3 mg/dL    ---   1.8   1.5   1.1   ---   1.8

[sbk007]

Originally Posted by Greg H

Hey Ann!

As I understand it, Vidaza and Dacogen both work in pretty much the same way. They are both "hypomethylating agents," which means they affect important processes at the level of DNA.
Greg

They are demethylators/hypomethylators. The idea being that hypermethylation(too many methyl chains) inhibits gene expression and by releasing the methyl chains the genes are able to express themselves.
I've had 4 rounds of Vidaza so far with great results, and no side effects luckily. My understanding is it depends on the docs you use and the experience they have with it For example if your treated at Cornell-weill they'll go with vidaza, over at mt Sinai they go with Dacogen. Hope that helps.

[redslw]

My brother had his first Dacogen in late July and is going back in September. He complained about terrible constipation. They suggested warm prune juice and milk of magnesium (mixed). Doesn't sound too tasty but it worked!
redslw

[Whizbang]

Miralax did wonders, and is supposedly non damaging to the digestive tract....

The trick is to start taking it before the treatment, since it's gentle and slow acting...

Also, I don't think it is actually the Dacogen that causes constipation, rather the anti nausea injectible that they give along side of Dacogen... I forgot what it's called...

They also gave me anti nausea pills, but I didn't take one... (the pill has an R on onside, and 154 on the other)

[sbk007]

Originally Posted by Whizbang

Miralax did wonders, and is supposedly non damaging to the digestive tract....

The trick is to start taking it before the treatment, since it's gentle and slow acting...

Also, I don't think it is actually the Dacogen that causes constipation, rather the anti nausea injectible that they give along side of Dacogen... I forgot what it's called...

They also gave me anti nausea pills, but I didn't take one... (the pill has an R on onside, and 154 on the other)

I take an R 154( just looked at my pills) an hour or 2 before Vidaza infusion. its the generic version of a very popular anti nausea called Zofran but a fraction of the price. It can cause constipation, dizziness and a host of other lovely side effects but I read good things about its ability to cut whatever reflex it is that triggers nausea.

[Whizbang]

Received 2nd round 41mg daily for 5 days Dacogen 9/9 - 9/13/2013...

Was scheduled for the week earlier, but caught a cold and got a few small infections.. The extra week off did me good...

As can be seen Dacogen did wonders for me...

Component  Standard Range  7/18  7/30# 8/15  8/22  8/29  9/09# 9/16  9/20  10/7
RDW-CV     11.6-14.4 %     16.1  15.1  13.8  18.5  17.0  14.3
RDW-SD     35.1-43.9 fl    51.5  48.1  40.9  55.9  53.5  45.0
HGB        13.7-17.5 g/dl  11.0  11.0   9.9  10.6  11.9  13.9  14.4  13.9  15.4
HCT        40-51 %         31.7  32.4  27.8  30.3  35.4  41.1  43.5  40.6  45.7
PLT        150-400 K/ul      95    91    51    60   209   333   249   176   209
RBC        4.63-6.08 M/uL  3.56  3.64  3.29  3.45  4.07  4.76  5.01  4.74  5.43
WBC        4.2-9.1 k/ul     3.2   3.5   2.6   1.7   1.8   2.2   4.0   4.1   3.5
NEUT%      34-68 %           53    62    52    31    32    46
NEUT       1.8-9.0 K/uL     1.7   2.2   1.4   0.5   0.6   1.0   2.7   3.0   2.1
LACT-DEH   313-618 U/L      670   598   ---   688   ---   517   ---   ---   557*
BILIRUBIN  0.2-1.3 mg/dL    1.5   1.1   ---   1.8   ---   1.0   ---   1.0   ---
# started Dacogen chemo
*estimate based on different testing ranges

Heading into the city tomorrow for a few last minute appointments / CBC / Checkup, and on track for 10/21 admittance for SCT/BMT...

[Birgitta-A]

Hi Whizbang,
Wonderful response to Dacogen! Congratulations! it is not common that patients respond after such a short time.
Kind regrds
Birgitta-A

[tytd]

Hi Whizbang,
That response to Dacogen is great - did the bone marrow respond with decreased blasts and chromosomal improvement. What would your doctors say about postponing the transplant for awhile since you are doing so well on Dacogen?? tytd

[Whizbang]

Birgetta-A,

I know... I am very blessed...

tytd,

I am right there with you, I questioned whether or not I should even do Dacogen, after my blasts dropped from 5.5% to 3% on there own... Now, I haven't gotten the results of my 10/7 BMB/BMA/Cytogenetics yet (tomorrow I get them), but both of my previous BMB's read pretty much the same, except for decreased blasts... And my cytogenetics were terrible back in June... http://forums.marrowforums.org/showt...0046#post30046

With that being said, my dr said that with the initial response I got from Dacogen, I could probably stay on it and see good results for two years.... The issue is, I'm pretty much symptomatically in remission right now, I'm healthy, and everything is in alignment for a great transplant, I'm young, I have great insurance, my job is willing to give me the time off...

Do I chance all of the above and wait for something to go wrong? I'm not willing right now to risk long term success for the short term, since my 3 daughters are still young, I need to be around for them 25-30 years from now...

Anyway that's the way I'm looking at it...

Best to all, and God Bless...

[Whizbang]

So just got back from my hemo/oncologist, and everything is a go for monday...

Blasts came back par for course at 4%... Considering the first BMA was 5.5%, the second was 3%, it's all within the margin of error / estimation...

Doctor said it's great, as less than 5% is considered within the normal range...

Periferral blood shows zero blasts... Still haven't gotten the cytogentics report back (10/7), but considering the 4% blasts, there is no show stopper...

I'll be at home, enjoying the last weekend with my old immune system, and maybe some my daughter's soccer games...

God Bless and may all be well...

[sbk007]

Originally Posted by Whizbang

So just got back from my hemo/oncologist, and everything is a go for monday...

Blasts came back par for course at 4%... Considering the first BMA was 5.5%, the second was 3%, it's all within the margin of error / estimation...

Doctor said it's great, as less than 5% is considered within the normal range...

Periferral blood shows zero blasts... Still haven't gotten the cytogentics report back (10/7), but considering the 4% blasts, there is no show stopper...

I'll be at home, enjoying the last weekend with my old immune system, and maybe some my daughter's soccer games...

God Bless and may all be well...

Dave, Don't get hung up with the counts, it'll drive you nuts. When your done it will be a moot point. People go in with blast counts in the double digits and complex cytogenetics. Hopefully we wont get any hurricanes and everything will go fine.. Enjoy the weekend and eat as much as your tummy can hold.
Don't juggle swords or anything like that.. I'm expecting you to be posting from the hospital every day anyway that's how smooth its gonna be.
All The Best!! Keep posting!