Cedazuridine positive in Ames and in vitro chromosome aberration assays; negative in in vivo micronucleus
“Cedazuridine was mutagenic in the Ames assay and genotoxic in the in vitro chromosome aberration assay, but not genotoxic in the in vivo micronucleus assay.”
✓ VerifiedFDA multi-discipline review, p. 38Source ↗
Carcinogenicity
Not conducted (advanced cancer indication, ICH S9)
“Per ICH S9, we agree that carcinogenicity studies are not needed to support the approval of ASTX727 for the proposed indication.”
✓ VerifiedFDA multi-discipline review, p. 66Source ↗
Instead of carcinogenicity
Not stated in public reviews
Not reported in the public reviews. Reviewers summarise selectively, so this usually means it wasn't discussed publicly, not that it wasn't studied.
Instead of genotoxicity
Not stated in public reviews
Not reported in the public reviews. Reviewers summarise selectively, so this usually means it wasn't discussed publicly, not that it wasn't studied.
DRG histopathology
Not stated in public reviews
Not reported in the public reviews. Reviewers summarise selectively, so this usually means it wasn't discussed publicly, not that it wasn't studied.
Reproductive & developmental
Not conducted (ICH S9); malformation or embryofetal lethality expected
“per ICH S9, reproductive and developmental toxicity studies are not needed for this class of drugs. These drugs are expected to cause malformation or embryofetal lethality.”
✓ VerifiedFDA multi-discipline review, p. 67Source ↗
Safety pharmacology
Cedazuridine: no cardiovascular or respiratory findings in single-dose monkey study up to 200 mg/kg
“There were no cardiovascular or respiratory findings in a single-dose standalone safety pharmacology study in cynomolgus monkeys with oral doses of cedazuridine up to 200 mg/kg.”
✓ VerifiedFDA multi-discipline review, p. 36Source ↗
Genotox: Ames
Cedazuridine positive (Ames)
“Cedazuridine was mutagenic in the Ames assay and genotoxic in the in vitro chromosome aberration assay, but not genotoxic in the in vivo micronucleus assay.”
✓ VerifiedFDA multi-discipline review, p. 38Source ↗
Genotox: in vitro mammalian
Positive: decitabine in L5178Y mouse lymphoma assay; cedazuridine in chromosomal aberration assay
“Decitabine increased mutation frequency in L5178Y mouse lymphoma cells, and mutations were produced in an E. coli lac-I transgene in colonic DNA of decitabine-treated mice. Decitabine also caused chromosomal rearrangements in larvae of fruit flies. Cedazuridine was genotoxic in a reverse bacterial mutation assay (Ames assay) and in an in vitro chromosomal aberration study using human lymphocytes.”
Decitabine positive: lac-I transgene mutations in colonic DNA of mice
“Decitabine increased mutation frequency in L5178Y mouse lymphoma cells, and mutations were produced in an E. coli lac-I transgene in colonic DNA of decitabine-treated mice.”
Not conducted; not warranted for the proposed indication
“Carcinogenicity studies were not conducted and are not warranted to support a marketing application for the proposed indication.”
✓ VerifiedFDA multi-discipline review, p. 38Source ↗
Carcinogenicity timing
Not required for the indication (ICH S9); none conducted
“Per ICH S9, we agree that carcinogenicity studies are not needed to support the approval of ASTX727 for the proposed indication.”
✓ VerifiedFDA multi-discipline review, p. 66Source ↗
hERG / QT
Cedazuridine hERG IC50 >300 μM; no effect on guinea pig papillary muscle action potentials
“The cumulative data from these studies indicate that cedazuridine does not have any effect on the cardiovascular system as evidenced by an in vitro concentration giving half-maximal inhibition (IC50) value of >300 μM for inhibition of hERG channel current and no effects on any action potential parameters in isolated papillary muscles from guinea pigs.”
✓ VerifiedFDA multi-discipline review, p. 43Source ↗
Not genotoxic overall: Ames negative; in vitro chromosome aberration positive without (not with) metabolic activation; rat micronucleus and comet negative