Dactinomycin
Synonym :
Actinomycin-D
Mechanism :
Dactinomycin is one of the actinomycin, a group of antibiotics produced by various species of Streptomyces. The cytotoxic action is the basis for its use in the treatment of certain types of cancer. Dactinomycin is believed to produce its cytotoxic effects by binding DNA and inhibiting RNA synthesis.
Indication :
- Ewing’s tumor
- Wilms’ tumor
- Rhabdomyosarcoma
- Testicular cancers
- Gestational Trophoblastic Neoplasm
- Malignant Germ Cell Tumors
Contraindications :
Hypersensitivity to any component of this product. It should not be given at the time of infection with chickenpox or herpes zoster because of the risk of severe generalized disease which may result in death. Concurrent and recent radiotherapy may exaggerate toxicity. In cases of biliary obstruction dose reduction should be considered.
Pregnancy & when breastfeeding.
Dosing :
Always consult the current treatment protocol for details of dosage and scheduling.
Ewing’s Sarcoma:
1250 mcg/m² IV every three weeks for 17 doses.
Wilm’s Tumor:
45 mcg/kg IV every 3-6 weeks for upto 26 weeks.
Metastatic Non-seminomatous Testicular Cancer:
1,000 mcg/m 2 once every 3 weeks for 3 months as part of cisplatin-based, multi agent combination regimen.
Rhabdomyosarcoma:
15 mg/kg IV on first five days every 3-9 weeks upto 112 weeks.
Adverse Effect :
Malaise, fatigue, lethargy, fever, myalgia, proctitis, hypoglycemia, hypocalcemia, hyperuricemia, cheilitis, dysphagia, esophagitis, ulcerative stomatitis, pharyngitis, anorexia, nausea, vomiting, abdominal pain, diarrhea, gastrointestinal ulceration, hepatitis anemia, aplastic anemia, agranulocytosis, leukopenia, thrombocytopenia, pancytopenia, reticulocytopenia, epidermolysis, erythema, alopecia, acne, flare-up of erythema or increased pigmentation of previously irradiated skin, maculopapular rash.
Interaction :
Potentiates effect of radiotherapy.
Enflurane and Halothane: Increased hepatotoxicity when given with enflurane and halothane.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Use with caution Dose as in normal renal function |
| <10 | Use with caution Dose as in normal renal function |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Unlikely to be dialysed. Dose as in GFR<10 mL/min |
| HD | Unlikely to be dialysed. Dose as in GFR<10 mL/min |
| HDF/High flux | Unknown dialysability. Dose as in GFR<10 mL/min |
| CAV/VVHD | Unknown dialysability. Dose as in GFR=10–20 mL/min |
Hepatic Dose :
Reduce dose by 50% in hepatic impairment.