Dactinomycin (Intravenous)

Administered during treatment for cancer, Dactinomycin affects and inhibits the growth of cancer cells.

Overview

When patients are diagnosed with certain types of cancer, Dactinomycin may be considered as a form of treatment. Generally, Dactinomycin is prescribed for the treatment of Wilms' tumors, cancer of the uterus or womb, rhabdomyosarcoma, cancer of the testicles, Ewing's sarcoma and trophoblastic neoplasm. Dactinomycin can also be used to treat cancer affecting the bones and soft tissues, as well as cancers affecting the tendons and muscles.

Believed to block the creation of ribonucleic acid (RNA), Dactinomycin affects the growth of cells in the body. When applied to cancer cells, Dactinomycin prevents the cell from replicating or duplicating and will eventually allow the cancer cell to be destroyed.

Although Dactinomycin is effective in preventing the growth of cancer cells, it can affect healthy cells in the body as well. Due to this, most patients do experience some side effects when receiving treatment with Dactinomycin.

Normally delivered intravenously, patients receive Dactinomycin via an injection into one of their veins. This means that the medicine doesn't have to be metabolized by the body in the same way that oral medications do and, as a result, it can begin to take effect quickly.

In most cases, Dactinomycin will be prescribed in conjunction with other anti-cancer drugs as a form of chemotherapy. Due to its effectiveness, Dactinomycin can be a life-saving medicine for many patients who have been diagnosed with cancer.

Conditions Treated:

  • Cancers of the bones, soft tissues, muscles and tendons
  • Wilms' tumors
  • Cancer of the womb or uterus
  • Rhabdomyosarcoma
  • Trophoblastic Neoplasm
  • Testicular cancer
  • Ewing's sarcoma

Type of Medicine:

  • Cytotoxic antibiotic
  • Chemotherapy medication

Side effects:

Although adverse effects can occur when taking any medication, chemotherapy drugs, such as Dactinomycin, are associated with a significant number of side effects. As chemotherapy is normally administered in cycles, patients may notice their side effects worsen in the week following treatment.

Common side-effects associated with Dactinomycin include:

  • Vomiting
  • Nausea
  • General feeling of weakness or discomfort
  • Acne
  • Unusual feeling of sluggishness or dullness
  • Skin rash
  • Darkening of the skin

As these side effects are not particularly uncommon, patients may not need to seek medical help for them. However, if patients experience these side effects and they are severe or concerning, patients shouldn't hesitate to access medical help.

The following side effects are also associated with Dactinomycin but they do warrant medical intervention:

  • Tarry, black stools
  • Blood in the stools or urine
  • Diarrhea (continuing)
  • Hoarseness or a cough accompanied by chills or fever
  • Heartburn
  • Difficulty swallowing
  • Lower side or back pain accompanied by chills or fever
  • Red, pinpoint spots on skin
  • Difficult or painful urination accompanied by chills or fever
  • Unusual bruising or bleeding
  • Sores on the lips or in mouth
  • Pain in stomach (continuing)
  • Unusual weakness, joint pain and/or tiredness
  • Chills or fever
  • Pain at injection site
  • Swelling of the lower legs or feet
  • Yellow skin or eyes
  • Wheezing
  • Stomach or abdominal cramps
  • Body pain or aches
  • Blisters
  • Red, swollen or chapped lips
  • Congestion
  • Runny nose
  • Convulsions
  • Difficulty breathing
  • Cough
  • Difficulty moving
  • Soreness or dryness of the throat
  • Difficulty swallowing
  • Redness or flushing of the skin
  • Muscle cramping or aches
  • Growth retardation
  • Muscle cramps in arms, hands, legs, feet and/or face
  • Irregular heartbeats
  • Tingling and numbness of the fingertips, feet or around the mouth
  • Shortness of breath
  • Muscle stiffness or pain
  • Confusion
  • Pain, burning, redness, scaling or other signs of inflammation of the lips
  • Swollen, tender glands in neck
  • Tremors
  • Swollen joints
  • Changes to voice
  • Unusually warm skin

If patients experience these side effects after receiving treatment with Dactinomycin, they should contact their physician or oncologist for advice. If any side effects constitute a medical emergency, such as trouble breathing, irregular heart rate or difficulty swallowing, patients should call 911 or visit the nearest emergency room.

In some cases, patients may experience side effects which are not listed above when receiving treatment with Dactinomycin. If so, they should seek medical advice and further treatment, if necessary. Patients should always inform their physician if they begin to experience adverse effects which are not listed above.

It should be noted that patients may experience adverse effects whilst receiving treatment with Dactinomycin but they could also develop or experience side-effects in the weeks, months or years after receiving treatment.

As Dactinomycin and chemotherapy drugs, in general, are associated with significant side effects, patients should discuss this with their physician prior to beginning treatment. In many cases, doctors and specialist nurses can provide advice regarding the side effects which may occur and how they can be managed.

Dosage:

Although Dactinomycin is delivered intravenously, the patient's dose will depend on the condition they've been diagnosed with. Their current clinical presentation, medical history, age and weight will also be taken into account when chemotherapy medications and prescribed.

Generally, Dactinomycin is prepared at a strength of 500mcg per vial but more than one vial can be administered to the patient, if it is required. When treating adults with trophoblastic neoplasms, for example, Dactinomycin will usually be given at a rate of 12mcg per kg of body weight for a period of five days. If necessary, this can be repeated every fortnight.

When treating testicular cancer, however, Dactinomycin may be administered at a rate of 1000mcg/m² on one day, with a combination of other drugs. In this case, the patient would receive 1000mcg of Dactinomycin per square meter of body surface area. Generally, doctors will calculate this by taking the patient's height and weight into account so that the appropriate dose of Dactinomycin can be administered.

Alternatively, if physicians are treating adult patients for Ewing's sarcoma, a standard dose of Dactinomycin may be 15mcg per kg of body weight over five days, with the treatment repeated if necessary.

Although the above examples are indicative of standard Dactinomycin doses, the treatment will vary according to the patient's needs. Cancer can present in many forms and this is likely to affect the dose of medication which is used. In addition to this, patients may be treated with numerous medications at once. The dose of Dactinomycin will vary, therefore, depending on any other medications the patient is receiving.

If patients are receiving treatment with Dactinomycin and are also taking other medications, they may need to seek advice from their doctor. Often, chemotherapy medications must be taken at specific times in order to have the most effect and minimize side-effects. If the patient is taking some medications orally, as well as receiving Dactinomycin intravenously, they should ask their physician to help them create a treatment schedule so they know when it is the best time to take their medication.

If required, Dactinomycin can be used to treat pediatric patients. Typically, a standard dose of Dactinomycin is lower for younger patients but their size and body weight will be taken into account when their dose of Dactinomycin is calculated.

As patients are given Dactinomycin intravenously, they will not have to manage this medication alone or administer it at home. Instead, a trained healthcare practitioner will place a needle in the patient's vein and administer the medicine in this way.

When administered, Dactinomycin can cause patients to feel nauseous or to start vomiting. In most cases, however, it is important for treatment to continue. If patients feel unwell when receiving Dactinomycin, they should ask their doctor or nurse for assistance.

Dactinomycin can be dangerous if it comes into contact with anyone's eyes, nose, throat, skin and/or lungs. When Dactinomycin is being administered, doctors and nurses will take precautions to ensure that the medicine does not come into contact with the patient's skin, clothes or eyes.

However, if this does occur, patients should wash their skin for at least fifteen minutes, under medical supervision. Similarly, if Dactinomycin gets into the patient's eyes, they will need to rinse their eyes with water or saline for at least fifteen minutes, under medical supervision. If the medication gets on to the patient's clothes, shoes or belongings, these items should be destroyed and disposed of safely. In addition to this, the surrounding areas should be cleaned by experienced professionals.

If patients have any contact with Dactinomycin when they are receiving treatment, they should request medical help immediately so that they can be shown the appropriate procedure for washing the medicine off the affected areas.

Potential Drug Interactions:

Although Dactinomycin is often prescribed in conjunction with other chemotherapy medications, there are some medicines which shouldn't normally be taken at the same time as Dactinomycin.

In most cases, patients will not be treated with Dactinomycin if they are also receiving treatment with Dasabuvir. If physicians believe the benefits of treating the patients with both drugs outweigh the risks, they may adjust the doses to try and prevent an interaction occurring.

When patients are receiving treatment with Dactinomycin, or any chemotherapy drugs, they should seek medical advice before taking any other medicines, including over-the-counter medicines, vitamins, and supplements. In some cases, these could interact with their prescribed medication and unwanted effects may occur.

Similarly, patients should inform their physician if they are taking any other medicines before they receive treatment with Dactinomycin.

Warnings:

Although patients are given Dactinomycin during treatment for cancer, if the patient has any other medical conditions, it may affect the safety and efficacy of the medication. Before receiving any treatment, patients should disclose their entire medical history to their physician so that the best treatment can be arranged.

If patients have any of the following conditions or have received certain treatments, it may affect the use of Dactinomycin:

  • Liver disease
  • Kidney disease
  • Bone marrow problems
  • Chickenpox
  • Blood disorders
  • Blocked veins in the liver (also known as veno-occlusive live disease)
  • Infection
  • Shingles (Herpes zoster)
  • Radiation treatment

Whilst the presence of the above conditions will not necessarily prevent Dactinomycin from being prescribed, they may alter the way the medicine is used. If patients are suffering from shingles, for example, Dactinomycin should not typically be given. Similarly, if patients have an active infection, Dactinomycin may not be prescribed as it could limit the patient's ability to fight the infection.

If Dactinomycin is being used to treat a Wilms' tumor and the patient has received radiation therapy in the last two months, doctors may not want to administer Dactinomycin. If the radiation treatment was given longer than two months ago, however, Dactinomycin may be considered an appropriate form of treatment.

By discussing their medical history and recent treatments with their physician, patients can ensure that they are given the safest and most-effective form of treatment for their condition.

Dactinomycin may be given to pediatric patients but the safety of the drug has not been tested on infants under the age of twelve months. Due to this, infants who are under a year old are not usually treated with this medication.

If required, Dactinomycin can be prescribed to older or geriatric patients. However, older patients may have existing health problems which could affect the use of Dactinomycin. As geriatric patients tend to have more bone marrow problems, for example, their dose of Dactinomycin may need to be altered accordingly.

Dactinomycin is not safe for use in patients who are pregnant and should only be given if the patient is in a life-threatening situation. This medicine does pose a risk to the unborn fetus if administered to a pregnant patient and may cause birth defects.

Both male and female patients should use reliable forms of birth control whilst receiving treatment with Dactinomycin and for some time after.

If patients become pregnant whilst receiving treatment with Dactinomycin, they should seek urgent medical advice.

Patients are typically advised not to breastfeed if they are receiving treatment with Dactinomycin.

Being treated with Dactinomycin can increase the patient's risk of developing other tumors, such as leukemia. These risks should be addressed before the patient receives any type of treatment.

Dactinomycin can lower the patient's immunity to diseases and infections. Due to this, patients will need to take extra care to avoid any illnesses. In addition to this, patients should not receive any live vaccines if they are receiving or have received treatment with Dactinomycin, unless their doctor provided authorization

Dactinomycin can also affect the blood's ability to clot. This means that patients may blood more than usual and will need to take extra precaution to avoid cuts and scrapes. Patients should also take extra care when brushing their teeth to avoid bleeding in their mouth or from their gums. Doctors may provide specific oral hygiene advice so that patients can reduce the risk of bleeding occurring.

Patients should avoid being in crowds or around people who are ill when they are receiving treatment with Dactinomycin. They are much more likely to contract illnesses during this time and they may find them harder to fight off whilst they are undergoing treatment. Patients should wash their hands regularly to try and prevent the spread of germs and should avoid touching their eyes, nose and/or mouth unless they have just washed their hands.

If patients experience nausea, diarrhea, white patches or sores on their lips, mouth or throat when receiving this medication, they should inform their doctor straight away. Similarly, if patients suspect they have contracted a virus or have developed an infection, they should seek immediate medical assistance.

When Dactinomycin is administered, it should go directly into the patient's vein. However, if any other medication seeps on to surrounding tissue, it may cause damaging and scarring. If patients experience any pain, redness or swelling at the site of the injection, they should notify a doctor or nurse immediately.

If patients interact with any doctors, nurses, dentists or other healthcare practitioners, they should notify them that they are receiving treatment with Dactinomycin.

If patients have any existing allergies, they should inform their doctor before receiving any type of treatment.

Storage

Generally, Dactinomycin vials can be stored at room temperature but they should be protected from light. However, this medicine is administered in a clinical setting so patients will not need to store, prepare or dispose of the medication themselves.

Summary

Although Dactinomycin is a highly toxic substance, it can be effective in treating certain types of cancers. Whilst patients may experience side-effects when being treated with Dactinomycin, these can be preferable to leaving the cancer untreated or using a less effective medication.

Before receiving treatment, however, physicians should discuss the possible risks with patients and create a unique treatment plan to minimize the impact of adverse effects and the risk of long-term side-effects.