decitabine + arsenic trioxide + ascorbic acid

This is a combination therapy consisting of three agents—decitabine, arsenic trioxide, and ascorbic acid—investigated primarily for the treatment of myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML)[1][3][5]. - **Decitabine** is a nucleoside analog that acts as a DNA methyltransferase inhibitor, leading to hypomethylation of DNA and reactivation of silenced genes involved in cell differentiation and apoptosis. - **Arsenic trioxide** induces apoptosis through multiple mechanisms including generation of reactive oxygen species (ROS), mitochondrial damage, and inhibition of angiogenesis. It is approved for acute promyelocytic leukemia but has been studied in other leukemias in combination regimens. - **Ascorbic acid** (vitamin C) may potentiate the cytotoxic effects of arsenic trioxide by enhancing oxidative stress within malignant cells[6]. The rationale for this combination is to exploit synergistic pro-apoptotic effects via epigenetic modulation (decitabine), direct cytotoxicity/oxidative stress induction (arsenic trioxide), and further ROS potentiation (ascorbic acid)[6]. The regimen has been evaluated in phase I clinical trials for MDS and AML[1][2][3][4], with some evidence suggesting enhanced efficacy compared to single-agent therapies.