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AMG 176 + azacitidine is an investigational combination therapy for hematological malignancies, specifically designed for higher-risk myelodysplastic syndromes (HR-MDS), chronic myelomonocytic leukemia (CMML), and relapsed/refractory acute myeloid leukemia (AML). AMG 176 is a small molecule antagonist of *myeloid cell leukemia sequence 1 (Mcl-1)*, an anti-apoptotic BCL-2 family protein overexpressed in many cancers, which promotes tumor cell survival and resistance to apoptosis[6]. Azacitidine is a pyrimidine nucleoside analogue and DNA methyltransferase inhibitor that induces hypomethylation and cell death; it is approved for MDS and AML as a standard of care. The combination aims to increase cancer cell death by targeting complementary survival pathways: direct Mcl-1 inhibition and epigenetic modulation of gene expression[1][3][5][7]. Development is led by Amgen for AMG 176; azacitidine is widely manufactured as a generic drug.
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