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. 2025 Apr;21(8):929-941.
doi: 10.1080/14796694.2025.2468578. Epub 2025 Mar 6.

A plain language summary of the ASCERTAIN trial: oral decitabine and cedazuridine versus intravenous decitabine for MDS or CMML

Affiliations

A plain language summary of the ASCERTAIN trial: oral decitabine and cedazuridine versus intravenous decitabine for MDS or CMML

Guillermo Garcia-Manero et al. Future Oncol. 2025 Apr.
No abstract available

Plain language summary

What is this summary about?This summary describes results from a phase 3 clinical trial called ASCERTAIN.Researchers compared two treatments in people with myelodysplastic syndromes (MDS) or chronic myelomonocytic leukemia (CMML), either of which can develop into acute myeloid leukemia (AML). One group was treated with oral decitabine and cedazuridine (oral DEC-C) and the other with intravenous decitabine.Treatment was given in a series of cycles. In the first cycle, people were randomly assigned to receive oral DEC-C or intravenous decitabine and then switched to the other treatment in the second cycle. After the first two cycles, everyone received oral DEC-C. The aim was to compare whether the same amount of decitabine reached people’s bloodstream in a certain time period after receiving oral DEC-C or intravenous decitabine (known as pharmacokinetics). Researchers also looked at how long people lived while taking treatment, how long people lived without developing AML, and the side effects from receiving treatment.What were the results?The amount of decitabine in the bloodstream during the first 5 days of treatment was almost the same (99% similar) between people who received oral DEC-C and those who received intravenous decitabine. Among people treated with oral DEC-C, the median overall survival was 31.8 months. Overall, people lived without developing AML for a median of 31.7 months. Among people who required red blood cell transfusion at the start of the trial, 52% achieved transfusion independence during the trial with oral DEC-C. Side effects of oral DEC-C were similar to those of intravenous decitabine,most commonly thrombocytopenia and neutropenia. There were five treatment-related deaths during the trial; two in the oral DEC-C group and three in the intravenous decitabine group.What do the results mean?Oral DEC-C was as effective, and had similar side effects, as treatment with intravenous decitabine. Although the trial did not focus on quality of life, oral medicines require fewer visits to a clinic compared with intravenous medicines, which could make it easier for people to stay on treatment. This trial supports using oral DEC-C for treating people with MDS or CMML.[Box: see text].

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Conflict of interest statement

Guillermo Garcia-Manero has consulted for Acceleron; received honoraria and research funding from AbbVie, Astex Pharmaceuticals (now Taiho Oncology, Inc.), Bristol Myers Squibb, Curis, Genentech, and Novartis; received honoraria from Aprea; and received research funding from Gilead. James McCloskey has received research funding from Astex Pharmaceuticals (now Taiho Oncology, Inc.); consulted for AbbVie, Apellis, Bristol Myers Squibb, CTI BioPharma, Novartis, Pfizer, and Takeda; received honoraria from Bristol Myers Squibb, Blueprint, Incyte, Jazz, Novartis, Stemline, and Takeda; and is an equity holder in COTA Healthcare. Elizabeth A Griffiths has received research funding from Astex Pharmaceuticals (now Taiho Oncology, Inc.), Blueprint, and Celldex; received research funding from and consulted and served on advisory committees for Alexion and Bristol Myers Squibb/Celgene; consulted for and served on advisory committees for AbbVie, Apellis, AstraZeneca, CTI BioPharma, Genentech, Novartis, Taiho, and Takeda; and received honoraria from Aplastic Anemia and MDS International Foundation, Medicom, Physician Educational Resource, and Picnic Health. Karen W L Yee has consulted for Bristol Myers Squibb/Celgene, GSK, Jazz, Novartis, Pfizer, Shattuck, Taiho, and Takeda; received research funding from Astex Pharmaceuticals (now Taiho Oncology, Inc.), Forma, Genentech, Geron, Gilead, Janssen, Jazz, Novartis, Roche, Pfizer, and Treadwell; and received honoraria from AbbVie and Novartis. Amer M Zeidan has had leadership roles in boards or committees for AbbVie, Bristol Myers Squibb, Celgene, Geron, Gilead, Kura, and Novartis; received research funding from AbbVie, ADC Therapeutics, Amgen, Aprea, Astex Pharmaceuticals (now Taiho Oncology, Inc.), AstraZeneca, Bristol Myers Squibb, Boehringer Ingelheim, Cardiff Oncology, Celgene, Incyte, MedImmune, Novartis, Otsuka, Pfizer, Takeda, and Trovagene; consulted for AbbVie, Acceleron, Agios, Amgen, Aprea, Astellas, BeyondSpring, Bristol Myers Squibb, Boehringer Ingelheim, Cardiff Oncology, Cardinal Health, Celgene, Daiichi Sankyo, Epizyme, Geron, Gilead, Incyte, Ionis, Janssen, Jazz, Kura, Novartis, Pfizer, Seattle Genetics, Syndax, Taiho, Takeda, Trovagene, and Tyme; received honoraria from AbbVie, Acceleron, Agios, Amgen, Aprea, Astellas, BeyondSpring, Bristol Myers Squibb, Boehringer Ingelheim, Cardiff Oncology, Cardinal, Celgene, Daiichi Sankyo, Epizyme, Geron, Gilead, Incyte, Ionis, Janssen, Jazz, Kura, Novartis, Otsuka, Pfizer, Seattle Genetics, Syndax, Taiho, Takeda, Trovagene, and Tyme; and received travel expenses from Cardiff Oncology, Novartis, and Pfizer. Aref Al-Kali’s institution has received research support from Astex Pharmaceuticals (now Taiho Oncology, Inc.). Mitchell Sabloff has served on advisory committees for AbbVie, Bristol Myers Squibb, Celgene, Jazz, Novartis, Pfizer, Roche, and Taiho, and served on advisory committees for and received research funding from Actinium and Astellas. Mary-Margaret Keating has served on advisory boards for AstraZeneca, BeiGene, Bristol Myers Squibb, Seattle Genetics, and Taiho. Salman Fazal has consulted for and received honoraria from Blueprint, CTI BioPharma, Gilead, GSK, Incyte, Janssen, Jazz, Karyopharm, Novartis, PharmaEssentia, Sanofi, Servier, Stemline, Taiho, and Takeda. Olatoyosi Odenike has consulted for AbbVie, Bristol Myers Squibb/Celgene, CTI BioPharma, Impact, Novartis, and Taiho, and his institution has received research funding from AbbVie, Agios, Aprea, Astex Pharmaceuticals (now Taiho Oncology, Inc.), AstraZeneca, Bristol Myers Squibb/Celgene, CTI BioPharma, Incyte, Janssen, Kartos, NS Pharma, and OncoTherapy. Amy E DeZern has served as chair of a data safety monitoring board for Geron and as 2023 Education Co-Chair and Vice Chair of the American Society of Hematology Committee on Educational Affairs; consulted for Taiho; and received honoraria from Bristol Myers Squibb, Gilead, and Novartis. Casey L O'Connell has received research funding from Astex Pharmaceuticals (now Taiho Oncology, Inc.) and Genentech. Gail J Roboz has consulted or served on advisory boards or data and safety monitoring committees for AbbVie, Actiunuim, Agios, Amgen, Astellas, AstraZeneca, Bluebird Bio, Blueprint, Bristol Myers Squibb, Catamaran, Celgene, Daiichi Sankyo, GSK, Helsinn, Janssen, Jasper, Jazz, Mesoblast, Novartis, Pfizer, Roche, Syndax, Takeda, and Trovagene, and received research support from Janssen. Lambert Busque has consulted for Novartis. Rena Buckstein has received honoraria and research funding from Bristol Myers Squibb and Taiho; received research funding from Takeda; and received honoraria from AbbVie. Brian Leber has received honoraria and served on advisory committees and speakers bureaus for AbbVie, Amgen, and Bristol Myers Squibb; consulted for, received honoraria, and served on advisory committees and speakers bureaus for Novartis and Pfizer. Aditi Shastri has consulted for and received research funding from Kymera, consulted for Janssen and Rigel, and received honoraria from National Association for Continuing Education. Mohammad Azab is a previous employee of and has consulted for Astex Pharmaceuticals (now Taiho Oncology, Inc.). Michael R Savona has consulted and/or served on advisory boards for and received travel expenses from Bristol Myers Squibb, CTI BioPharma, Forma, Geron, GSK, Rigel, Ryvu, Taiho, and Treadwell; is an equity holder in Empath Biosciences, Karyopharm, and Ryvu; and received research funding from ALX Oncology, Astex Pharmaceuticals (now Taiho Oncology, Inc.), Incyte, and Takeda. Aram Oganesian and Harold N Keer are employees of Astex Pharmaceuticals (now Taiho Oncology, Inc). H Joachim Deeg, Nancy Zhu, Nashat Y Gabrail, Joseph Maly, and Harshad Amin declare no competing interests. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Medical writing assistance was provided by Harlene Ghuman, PhD, of Envision Pharma Group, funded by Taiho Oncology, Inc.

Patient reviewers on this PLSP have received honorarium from Future Oncology for their review work but have no other relevant financial relationships to disclose.

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