High Patient Satisfaction Seen With Oral DEC-C in Myelodysplastic Syndromes

A recent study published in Therapeutic Advances in Hematology provides perspectives from patients undergoing treatment with oral decitabine/cedazuridine (DEC-C) for myelodysplastic syndromes (MDS). The study focuses on patient satisfaction, convenience, and quality of life (QOL) impacts, offering an overview of patients' opinions on overall experience with oral decitabine/cedazuridine (DEC-C) compared with intravenous (IV) or subcutaneous (SC) alternatives.¹

Traditionally, hypomethylating agents (HMA) such as IV decitabine and azacitidine have been the standard of care for higher-risk MDS. However, these treatments pose significant challenges, including frequent hospital visits for administration and associated interference with patients' daily lives. Although clinical trials have demonstrated the efficacy of parenteral HMAs, their real-world utilization remains suboptimal, with many patients either not receiving or discontinuing HMA therapy early. For example, retrospective analyses indicate that 44% to 65% of patients with higher-risk MDS did not receive IV/SC HMA therapy, and 44% were nonpersistent, defined as discontinuing therapy before completing the recommended 4 cycles or having a gap of 90 days between cycles.²

Oral DEC-C was introduced in 2020 and provided a promising alternative to parenteral HMAs, offering similar pharmacokinetic exposure and response rates but with the added convenience of at-home administration. | Image Credit: © Seventyfour - stock.adobe.com

Oral DEC-C was introduced in 2020 and provided a promising alternative to parenteral HMAs, offering similar pharmacokinetic exposure and response rates but with the added convenience of at-home administration.¹ The current study included a total of 150 adult patients with MDS who had filled a prescription for oral DEC-C between 2021 and 2022 and completed an online survey between November and December 2022. The survey revealed that 82% of respondents were still receiving oral DEC-C at the time of the survey, and 50% had been on the treatment for 6 months or more.

The study's findings highlight the perceived positive impact of oral DEC-C on patients' daily lives. Most patients (83%) reported that the treatment was convenient, and 86% expressed satisfaction with the therapy. Furthermore, 82% of respondents indicated that oral DEC-C had very little or no interference with their daily activities, and 78% reported minimal impact on their social activities, including volunteer activities, work activities, or hobbies. In addition, 80% of patients younger than 70 years and 64% of patients 70 years or older reported very little or no interference with their overall productivity. When asked about negative impacts on QOL, 30% of patients mentioned adverse effects, making it the most common QOL impact.

These findings show a significant decrease vs the burdens associated with IV/SC HMAs, which in previous studies have been associated with substantial interference with patients' daily lives (56%), including logistical challenges related to frequent health care visits. A patient perspective study found that approximately one-third of patients felt that IV/SC HMA treatments interfered a "great deal" and "quite a bit" with their regular activities (32%) and social activities (30%).³

The current study included 91 patients who had previously received IV/SC HMAs before switching to oral DEC-C.¹ Among these patients, 91% agreed that oral DEC-C interfered less with their daily lives, and 85% reported improved QOL compared with their previous treatment. Additionally, 91% noted a reduction in the number of times they needed to travel to a health care facility.

This survey's results are consistent with broader trends in cancer treatment, where patients often prefer oral therapies over parenteral options due to convenience, reduced time spent in health care facilities, and the ability to maintain a more normal daily routine.⁴ The authors note, "These findings add to the body of evidence suggesting the potential for oral DEC-C to enhance QOL and to alleviate the treatment burden and time toxicity associated with parenteral HMA therapy."¹ They also add, "Future analyses comparing time toxicity including healthy days at home, treatment adherence, and real-world effectiveness among patients receiving oral DEC-C versusIV/ SC HMAs will provide insights for patients and clinicians in treatment decision-making."

References

1. Zeidan AM, Perepezko K, Salimi T, Washington T, Epstein RS. Patients' perspectives on oral decitabine/cedazuridine for the treatment of myelodysplastic syndromes/neoplasms. Ther Adv Hematol. 2024;15:20406207241257313. doi:10.1177/20406207241257313

2. Corman S, Joshi N, Wert T, Kale H, Hill K, Zeidan AM. Under-use of hypomethylating agents in patients with higher-risk myelodysplastic syndrome in the United States: a large population-based analysis. Clin Lymphoma Myeloma Leuk. 2021;21(2):e206-e211. doi:10.1016/j.clml.2020.10.013

3. Zeidan AM, Jayade S, Schmier J, et al. Injectable hypomethylating agents for management of myelodysplastic syndromes: patients' perspectives on treatment. Clin Lymphoma Myeloma Leuk. 2022;22(3):e185-e198. doi:10.1016/j.clml.2021.09.009

4. Eek D, Krohe M, Mazar I, et al. Patient-reported preferences for oral versus intravenous administration for the treatment of cancer: a review of the literature. Patient Prefer Adherence. 2016;10:1609-1621. doi:10.2147/PPA.S106629