title: The euphoria of hypomethylating agents in MDS and AML: is it justified?
abstract: While it is logical to use hypomethylating agents to treat patients with myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML), trial results with azacitidine and decitabine have been inconsistent. Azacitidine confers a survival benefit in higher-risk MDS patients, while decitabine does not. Neither agent has demonstrated a survival advantage in older AML patients in prospective studies. Reasons for this are explored here along with a recommendation to reconsider clinical trial design endpoints.
authors.affiliation: Leukemia Program, Cleveland Clinic Taussig Cancer Institute, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Electronic address: sekerem@ccf.org.
authors.forename: Mikkael A
authors.initials: MA
authors.lastname: Sekeres
mesh_terms: D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D001374:Azacitidine / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D003561:Cytarabine / Q000627:therapeutic use*; D019175:DNA Methylation / Q000187:drug effects; D000077209:Decitabine; D023381:Endpoint Determination; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality / Q000473:pathology; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality / Q000473:pathology; D018579:Patient Selection; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D003561:Cytarabine; D000077209:Decitabine; D001374:Azacitidine
keywords: AML; MDS; acute myeloid leukemia; azacitidine; cytarabine; decitabine; hypomethylating agents; myelodysplastic syndromes