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Systemic Anti-Cancer Therapy Regimen Library

Myelodysplastic syndrome - azacitidine [7 day]

Treatment Overview

Minimum of 6 cycles then can continue until disease progression or unacceptable toxicity.

Cycle 1 (and all further cycles) - 28 days

Cycle length:
28

Days of treatment may be altered to omit weekend administration with remainder of treatment recommencing within 3 days as per institutional practice. 

Cycle details

Cycle 1 (and all further cycles) - 28 days

Medication Dose Route Days Max Duration
azacitidine 75 mg/m² Once daily subcutaneous injection 1 to 7

Days of treatment may be altered to omit weekend administration with remainder of treatment recommencing within 3 days as per institutional practice. 

Full details

Cycle 1 (and all further cycles) - 28 days

Day: 1

Medication Dose Route Max duration Details
azacitidine 75 mg/m² Once daily subcutaneous injection
Instructions:

Injection site reactions are common with subcutaneous azacitidine. Ensure injection sites are rotated and that new injections are at least 2.5 cm from the previous site.

Day: 2

Medication Dose Route Max duration Details
azacitidine 75 mg/m² Once daily subcutaneous injection
Instructions:

Injection site reactions are common with subcutaneous azacitidine. Ensure injection sites are rotated and that new injections are at least 2.5 cm from the previous site.

Day: 3

Medication Dose Route Max duration Details
azacitidine 75 mg/m² Once daily subcutaneous injection
Instructions:

Injection site reactions are common with subcutaneous azacitidine. Ensure injection sites are rotated and that new injections are at least 2.5 cm from the previous site.

Day: 4

Medication Dose Route Max duration Details
azacitidine 75 mg/m² Once daily subcutaneous injection
Instructions:

Injection site reactions are common with subcutaneous azacitidine. Ensure injection sites are rotated and that new injections are at least 2.5 cm from the previous site.

Day: 5

Medication Dose Route Max duration Details
azacitidine 75 mg/m² Once daily subcutaneous injection
Instructions:

Injection site reactions are common with subcutaneous azacitidine. Ensure injection sites are rotated and that new injections are at least 2.5 cm from the previous site.

Day: 6

Medication Dose Route Max duration Details
azacitidine 75 mg/m² Once daily subcutaneous injection
Instructions:

Injection site reactions are common with subcutaneous azacitidine. Ensure injection sites are rotated and that new injections are at least 2.5 cm from the previous site.

Day: 7

Medication Dose Route Max duration Details
azacitidine 75 mg/m² Once daily subcutaneous injection
Instructions:

Injection site reactions are common with subcutaneous azacitidine. Ensure injection sites are rotated and that new injections are at least 2.5 cm from the previous site.

Supportive Care Factors

Factor Value
Antifungal prophylaxis: Routine antifungal prophylaxis may be considered
Antiviral prophylaxis for herpes virus: Routine antiviral prophylaxis may be considered
Constipation risk: Consider prescribing laxatives with this treatment
Diarrhoea risk: Consider prescribing antidiarrhoeals with this treatment
Emetogenicity: Medium
Tumour lysis syndrome prophylaxis: Tumour lysis syndrome prophylaxis may be considered

Antiviral prophylaxis for hepatitis B virus: Guidance is limited to high-risk anti-cancer medicines. Clinicians will need to assess individual patient risk for other anti-cancer medicines.

References

Lyons, R. M., T. M. Cosgriff, S. S. Modi, et al. 2009. "Hematologic response to three alternative dosing schedules of azacitidine in patients with myelodysplastic syndromes." J Clin Oncol 27(11):1850-1856. , PMID: 19255328

Gore, S. D. 2011. "New ways to use DNA methyltransferase inhibitors for the treatment of myelodysplastic syndrome." Hematology Am Soc Hematol Educ Program 2011:550-555. , PMID: 22160088

Keating, G. M. 2012. "Azacitidine: a review of its use in the management of myelodysplastic syndromes/acute myeloid leukaemia." Drugs 72(8):1111-1136., PMID: 22571445

Batty, G. N., H. Kantarjian, J. P. Issa, et al. 2010. "Feasibility of therapy with hypomethylating agents in patients with renal insufficiency." Clin Lymphoma Myeloma Leuk 10(3):205-210. , PMID: 20511166

Silverman, L. R., E. P. Demakos, B. L. Peterson, et al. 2002. "Randomized controlled trial of azacitidine in patients with the myelodysplastic syndrome: a study of the cancer and leukemia group B." J Clin Oncol 20(10):2429-2440. , PMID: 12011120

Silverman, L. R., D. R. McKenzie, B. L. Peterson, et al. 2006. "Further analysis of trials with azacitidine in patients with myelodysplastic syndrome: studies 8421, 8921, and 9221 by the Cancer and Leukemia Group B." J Clin Oncol 24(24):3895-3903. , PMID: 16921040

Fenaux, P., G. J. Mufti, E. Hellstrom-Lindberg, et al. 2009. "Efficacy of azacitidine compared with that of conventional care regimens in the treatment of higher-risk myelodysplastic syndromes: a randomised, open-label, phase III study." Lancet Oncol 10(3):223-232. , PMID: 19230772

* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.

s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.