Effect of Food on Blood Levels of ASTX727

Inclusion Criteria:

1. Able to understand and comply with the study procedures, including the ability to completely consume the breakfast meal in 20 minutes, understand the risks involved in the study, and provide written informed consent before the first study-specific procedure.

2. Men or women ≥18 years with either:

   1. MDS, including all French-American-British subtypes (refractory anemia, refractory anemia with ringed sideroblasts, refractory anemia with excess blasts, refractory anemia with excess blasts in transformation, CMML), and subjects with MDS IPSS int-1, -2, or high-risk MDS.
   2. AML, as diagnosed according to the 2016 WHO guidelines on acute leukemia, of any subtype except M3 (Acute Promyelocytic Leukemia), who are not candidates for intensive chemotherapy
3. Eastern Cooperative Oncology Group (ECOG) performance status of 0-2.

4. Adequate organ function defined as follows:

   1. Hepatic: Total or direct bilirubin ≤2 × upper limit of normal (ULN); aspartate aminotransferase/serum glutamic oxaloacetic transaminase (AST/SGOT) and alanine aminotransferase/serum glutamic pyruvic transaminase (ALT/SGPT) ≤5 × ULN.
   2. Renal: serum creatinine ≤1.5 × ULN or if serum creatinine is elevated; calculated creatinine clearance or glomerular filtration rate ≥50 mL/min.
5. Women of child-bearing potential (according to recommendations of the Clinical Trial Facilitation Group) must not be pregnant or breastfeeding and must have a negative pregnancy test at screening.
6. Subjects and their partners with reproductive potential must agree to use 2 highly effective contraceptive measures during the study and must agree not to become pregnant or father a child for 3 months after the last dose of study treatment.

Exclusion Criteria:

1. Known or suspected hypersensitivity to decitabine, azacitidine, or cedazuridine.
2. Treated with any investigational drug or therapy within 2 weeks of study treatment, or 5 half-lives, whichever is longer, before the protocol-defined first dose of study treatment, or ongoing clinically significant adverse events (AEs) from previous treatment with investigational drug or therapy.
3. Poor medical risk because of other conditions such as uncontrolled systemic diseases or active uncontrolled infections.
4. Life-threatening illness, medical condition or organ system dysfunction, or other reasons including laboratory abnormalities, which, in the investigator's opinion, could compromise the subject's safety, interfere with the absorption or metabolism of decitabine + cedazuridine or compromise the integrity of the study outcomes.
5. Prior gastric surgery for ulcer disease, weight loss, etc., that would impair normal motility or absorption.
6. Second malignancy currently requiring active chemotherapy. To clarify, patients with breast or prostate cancer stable on or responding to endocrine therapy, are eligible.
7. Known history of human immunodeficiency virus or if known seropositive for hepatitis C virus or hepatitis B virus.
8. Active uncontrolled gastric or duodenal ulcer.
9. Subjects with Acute Promyelocytic Leukemia.