Vidaza vs. Dacogen

[Steven]

Hello,

Has anybody responded to dacogen but not to vidaza, or vice versa?

My father was on vidaza for 2 cycles, but becomes severely anemic too quickly. After a 2 unit blood transfusion, his HGB dropped to 5 after less than a week. So we're stopping the vidaza for a cycle to see if his blood production can come up a bit on its own.

I asked my doc about Dacogen, but he says it's the same as vidaza, so there's no reason to try it. I'm wondering if it's worth pushing the doc into trying it anyway, but don't want my father to suffer the same effects if there's virtually no chance of it working. Thanks!

[ann]

Is your father getting Procrit shots as well as the Viadaza? My husband starts on his third round of Viadaza. The first time, he became even more anemic but after the second round and with transfusions of blood and platletes, he has been doing wonderfully for the past 3 weeks. He goes back Monday for his next Viadaza treatments. The first 2 shots of Procrit made him feel tired but not unwell, never really sick. These next shots have not had any effect on him. He is beginning to feel a little run down again, but when we go in Monday we will find out if he needs another transfusion. He also has congestive heart failure and emphysemea and is on oxygen.

[Neil Cuadra]

Steven,

The short answer to your question is that there may be different responses to the two drugs. But of course that's a generalization and it won't be the case for every patient. Your father's doctor may be able to provide an answer more specific to his case. If you don't understand the reasons for the treatment plan, ask more questions.

You said you talked to your doctor about it. Do you mean your father's doctor?

[Birgitta-A]

Hi Steven,
As Neil already told you Vidaza is different from Dacogen but Vidaza is supposed to be a better choice for more patients. Vidaza often initially decreases HGB.
http://www.rxlist.com/vidaza-drug.htm

It is really too early to know if your father is one of the about 50% that responds to Vidaza - as Ann reported many patients need more supportive therapy during the first cycles.
Kind regards
Birgitta-A

[Steven]

Hi All,

Thanks for the responses! My father isn't taking procrit because his erythropoietin level is already abnormally high. Unfortunately, it isn't increasing his blood production at all.

Yes, I meant my father's doctor. I've been seeing his doctor at least twice a week for the past year, so I almost consider him my doctor too!

Birgitta - that's a useful link! I wasn't aware vidaza dosages could be modified based on the patient's WBC. I'll definitely bring this up with the doc next week.

[tytd]

Hello Steven,
You may want to listen to one of the archived MDS webinars entitled "Understanding FDA approved drug treatments for MDS" by Dr. Sekeres from the Cleveland Clinic on the aamds.org website. His opinion seems to be that if Vidaza doesn't work after an adequate trial then he would not recommend trying Dacogen. He also states that counts will get worse before they get better especially in the first 2 months of therapy. He says that of those that will respond, 90% will do so within the first 6 months. How many months of Vidaza did your father have during in first course?

[Birgitta-A]

Hi Steven,
The supportive treatment for us is getting better every year . You know if your father's white blood cells are very low he could be treated with Neupogen injections or a similar drug (I take 2 injections/week since neutropenic fever Sept 2007).

Then at least one member has started treatment with Promacta "off record" for low platelets. Promacta seems to decrease blast cells in tubes from MDS patients.

There are now clinical trials with Promacta for MDS patients in the US . Look at
http://clinicaltrials.gov/ct2/results?term=promacta+mds
and you will find a study for patients with advanced MDS in San Antonio, Texas, and one for patients with low to Interm-2 MDS in National Institutes of Health Clinical Center, Bethesda, Maryland.
Kind regards
Birgitta-A

[ann]

Today, we got good news when my husband started his third round of Vidaza treatments. He also got another shot of Procrit today. His RBC were just a little down from last week's test and his platelets were up!! The doctor is elated. He goes each day this week and may go two days next week, if she thinks he should. If we could just get his heart "fixed" he would feel like a new man.

[Steven]

Hi Tytd,

Hm, if Dr. Sekeres thinks that if vidaza has no effect then dacogen won't either, I wonder if it's because he thinks vidaza is the superior drug? I'll have to give that a listen. Thanks!
My father was on vidaza for 4 months the first time. We saw no improvement in any counts, and he needed weekly transfusions. A BMB then indicated aplastic anemia, and he was on ATG and cyclosporine for a few months. A new BMB then indicated MDS again. The doc guesses the vidaza did it's job of removing abnormal cells temporarily, causing the AA diagnosis several months ago.

Hi Birgitta, my fathers last WBC was at 0.5. A few months ago he had a few injections of leukine, but our doc is reluctant to give it again. Promacta sounds great, but I'm a bit scared of drugs that are only in the clinical trial phase. I hope it turns out to be as effective as it sounds.

Congratulations Ann! Looks like procrit and vidaza are a great combo for your husband. Having MDS, congestive heart failure and emphysema is tough, but having improving counts now is a great sign.

[Birgitta-A]

Hi Steven,
Hopefully it was not your father's white blood cell count but the type of white blood cells called neutrophils that was 0.5. When the neutrophils are so low many clinics give drugs like Leukine as supportive therapy to their patients.

Your father has to be very careful because he has problems if he should get an infection now. There are many sites about neutropenia and here is one:
http://www.neutropenia.ca/about/living.html

Take care!
Kind regards
Birgitta-A

[Steven]

Hi Birgitta,

Your site has good advice. My dad's WBC unfortunately dropped to 0.3 and he got a fever of 102.4 yesterday. He's admitted to the hospital now and getting antibiotics. He may get injections of Leukine as well.

He's pretty stubborn and tends not to listen to my advice unless I have the doctor explicitly tell him to do things, so maybe if I point it out on a website to back me up, he'll finally listen to me!

Thanks,
Steven

[Birgitta-A]

Hi Steven,
Hopefully your father will manage well when he is getting antibiotics. The first time you get neutropenic fever it is almost always due to bacteria that can be treated without difficulties.

Next time it will perhaps be fungi or virus that can be much more difficult to treat. Your father now ought to get Leukine for example 2 injections/week (he can take them himself) as long as his bone marrow can't produce enough white blood cells without Leukine or similar drugs. He really needs this type of supportive therapy even if it is expensive.
Kind regards
Birgitta-A