Indication

• The treatment of patients with myelodysplastic syndromes (MDS) including:
• Previously treated and untreated
• De novo and secondary MDS
• 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.

Important Safety Information:

Treatment with DACOGEN^® is associated with neutropenia and thrombocytopenia. Complete blood and platelet counts should be performed as needed to monitor response and toxicity but at a minimum prior to each dosing cycle. Clinicians should consider the need for early institution of growth factors and/or antimicrobial agents for the prevention or treatment of infections in patients with MDS.

DACOGEN^® may cause fetal harm when administered to a pregnant woman. Women of childbearing potential should be advised to avoid becoming pregnant while receiving treatment with DACOGEN^® and for 1 month following completion of treatment. Men should be advised not to father a child while receiving treatment with DACOGEN^® and for 2 months following completion of treatment.

In the phase 3 clinical trial, the highest incidences of Grade 3 or Grade 4 adverse events in the DACOGEN^® arm were neutropenia (87%), thrombocytopenia (85%), febrile neutropenia (23%), and leukopenia (22%). Bone marrow suppression was the most frequent cause of dose reduction, delay, and discontinuation. Six patients had fatal events associated with their underlying disease and myelosuppression (anemia, neutropenia, and thrombocytopenia) that were considered at least possibly related to drug treatment. Of the 83 DACOGEN^®-treated patients, 8 permanently discontinued therapy for adverse events compared to 1 of 81 patients in the supportive care arm.

In the single-arm study, the highest incidence of Grade 3 or Grade 4 adverse events was neutropenia (37%), thrombocytopenia (24%), and anemia (22%). Seventy-eight percent of patients had dose delays. Hematologic toxicities and infections were the most frequent causes of dose delays and discontinuation. Eight patients had fatal events due to infection and/or bleeding that were considered at least possibly related to drug treatment. Nineteen of 99 patients permanently discontinued therapy for adverse events.

Other commonly occurring reactions include fatigue, pyrexia, nausea, cough, petechiae, constipation, diarrhea, and hyperglycemia.

If hematologic recovery from a previous DACOGEN^® treatment cycle requires more than 6 weeks when administering the 3-day dosing, then the next DACOGEN^® cycle should be delayed and dosing temporarily reduced. When administering the 5-day dosing, the DACOGEN^® cycle should be delayed until there is hematologic recovery. If the following nonhematologic toxicities are present, DACOGEN^® treatment should not be restarted until the toxicity is resolved: (1) serum creatinine ≥2 mg/dL; (2) SGPT, total bilirubin ≥2 × ULN; and (3) active or uncontrolled infection.

Because there are no data on use of DACOGEN^® in patients with renal or hepatic dysfunction, DACOGEN^® should be used with caution in these patients.

For more information about DACOGEN^® please see full Prescribing Information.