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Guadecitabine + irinotecan is an investigational combination therapy studied primarily in metastatic colorectal cancer (mCRC) patients who are refractory to standard treatments. Guadecitabine is a next-generation DNA methyltransferase inhibitor (DNMTi), also known as a hypomethylating agent, which works by reversing abnormal DNA methylation patterns that can silence tumor suppressor genes. This epigenetic modulation may restore sensitivity to chemotherapeutic agents such as irinotecan, a topoisomerase I inhibitor that interferes with DNA replication in cancer cells. The combination aims to overcome resistance to chemotherapy by priming tumor cells through epigenetic reprogramming before cytotoxic treatment with irinotecan. Clinical trials have shown the regimen is safe and tolerable, with evidence of target modulation and some clinical benefit in heavily pretreated mCRC patients[1][2][3][4][5].
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