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Guadecitabine is a next-generation small molecule hypomethylating agent and dinucleotide antimetabolite composed of decitabine linked via a phosphodiester bond to deoxyguanosine. It acts as an inhibitor of DNA cytosine 5-methyltransferase 1 (DNMT1), leading to the reversal of aberrant DNA methylation and reactivation of silenced tumor suppressor genes. Guadecitabine was developed primarily for hematological malignancies such as acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS), with additional investigation in various solid tumors. It was designed for subcutaneous administration to provide prolonged exposure compared to decitabine[2][5][6][7].
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