# Hypomethylating agents (azacitidine, decitabine)

Source: https://onco.cc/terms/hma/  
OnCo record `hma` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Low-intensity chemotherapy that strips chemical 'off' switches (methyl groups) from DNA so silenced genes can be read again. The mainstay for older patients with AML and high-risk MDS, especially combined with venetoclax.

## Summary

Azacitidine and decitabine (approved 2004-06) extend survival in higher-risk MDS and were the only option for AML patients unfit for intensive chemotherapy until venetoclax-azacitidine (VIALE-A, 2020) roughly doubled responses and became the standard, now available fully orally. They are given in outpatient cycles for as long as they work; 'HMA failure' defines a population with very poor outcomes where menin inhibitors, IDH inhibitors and trials of new agents are focused. Response can take several cycles, so early stopping is a common error.

## Fields

- Kind: Term
- Last checked: 2026-09-09
- Also known as: HMA; HMAs; hypomethylating; hypomethylating agent; hypomethylating agents; oral azacitidine; oral decitabine-cedazuridine; venetoclax-azacitidine; venetoclax + azacitidine; ven-aza; Ven/Aza; HMA-venetoclax; venetoclax + HMA; HMA failure

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Azacitidine
- Wikipedia: https://en.wikipedia.org/wiki/Azacitidine

## Connected records

- cancers: [Acute myeloid leukaemia](https://onco.cc/cancers/aml/), [Acute myeloid leukaemia in older or unfit patients](https://onco.cc/cancers/aml-older-unfit/), [Chronic myelomonocytic leukaemia and MDS/MPN overlap neoplasms](https://onco.cc/cancers/cmml/), [Higher-risk myelodysplastic syndromes](https://onco.cc/cancers/mds-higher-risk/), [IDH1- and IDH2-mutated acute myeloid leukaemia](https://onco.cc/cancers/aml-idh/), [Myelodysplastic syndromes / neoplasms (MDS)](https://onco.cc/cancers/mds/), [Secondary and therapy-related acute myeloid leukaemia](https://onco.cc/cancers/aml-secondary/)
- terms: [7+3 induction chemotherapy](https://onco.cc/terms/seven-plus-three/), [IPSS-R and IPSS-M (myelodysplastic syndrome risk scores)](https://onco.cc/terms/ipss-m-ipss-r/), [Performance status (ECOG, Karnofsky)](https://onco.cc/terms/performance-status/)
- fronts: [Chemotherapy](https://onco.cc/fronts/chemotherapy/), [Epigenetic & Transcriptional Therapy](https://onco.cc/fronts/epigenetics/)
- technologies: [Epigenetic drugs (HDAC, DNMT, EZH2, IDH, menin, BET)](https://onco.cc/technologies/epigenetic-drugs/)
- drugs: [Azacitidine](https://onco.cc/drugs/azacitidine/), [Venetoclax](https://onco.cc/drugs/venetoclax/)
- roadmaps: [Epigenetic therapy roadmap: loosening silenced genes → mutation-specific enzymes → editing the epigenome](https://onco.cc/roadmaps/epigenetics-roadmap/)

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