dactinomycin (actinomycin-D, Cosmegen)
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Introduction
Tradename: Cosmegen.
Indications
- Wilm's tumor
- rhabdomyosarcoma
- Ewing's sarcoma
- melanoma
- neuroblastoma
- retinoblastoma
- trophoblastic neoplasms
- testicular carcinoma
- other malignancies
Contraindications
- patients with chicken pox or Herpes zoster
- infants < 6 months of age
Dosage
- 1-2 mg/m2 every 3-4 weeks
- 0.25-0.6 mg/m2 daily for 5 days every 3-4 weeks
Powder for injection: 0.5 mg/3mL.
Do NOT use inline cellulose filter for IV administration.
Pharmacokinetics
- well distributed to tissues
- poor CSF penetration
- metabolized by liver
- eliminated in the bile & urine
- 1/2life 30-40 hours
elimination via liver
elimination via kidney
1/2life = 30-40 hours
Adverse effects
(worse with consecutive doses)
- common (> 10%)
- alopecia (reversible)
- hyperpigmentation of the skin
- fatigue
- esophagitis
- nausea/vomiting (moderate to severe)
- less common (1-10%)
- uncommon (< 1%)
- other
- extravasation may lead to tissue necrosis
- myelosuppression
- dose-limiting toxicity
- onset 7 days; nadir 14-21 days; recovery 21-18 days
- leukopenia (moderate)
- thrombocytopenia (moderate)
- pancytopenia, agranulocytosis, aplastic anemia
- mucositis
- radiation recall
Drug interactions
- may interfere with drug level determination of vancomycin & gentamicin
Mechanism of action
- anti-tumor antibiotic
- DNA intercalating agent
- inhibits DNA replication
- inhibits RNA synthesis
- topoisomerase inhibitor[3]
- non cell-specific
More general terms
References
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Jump up to: 3.0 3.1 Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 529