Dactinomycin Injection: Uses, Dosage, Side Effects, Precautions and Alternates

Quick overview

Dactinomycin Injection (Cosmegen) is a chemotherapy medicine containing dactinomycin, an actinomycin antibiotic and antineoplastic agent given by injection into a vein. It is used alone or with other cancer treatments for conditions such as gestational trophoblastic neoplasia, Wilms' tumor, childhood rhabdomyosarcoma, and Ewing's sarcoma. It works by blocking cancer cells from making the proteins they need to grow and divide. Because it is highly toxic, it requires close monitoring by an experienced cancer care team.

What is Dactinomycin Injection

Cosmegen is a chemotherapy medicine given by injection into a vein. It contains dactinomycin, a highly toxic antibiotic that is used to kill cancer cells rather than to treat infections.

Dactinomycin Injection uses

• Alone or combined with other cancer drugs to treat gestational trophoblastic neoplasia
• Combined with other cancer drugs and/or radiation to treat Wilms' tumor
• Combined with other cancer drugs and/or radiation to treat childhood rhabdomyosarcoma
• Combined with other cancer drugs and/or radiation to treat Ewing's sarcoma
• Used to treat different types of cancers that affect the kidneys, uterus, testicles, bones, muscles, joints, and soft tissues, and to treat solid tumors

Benefits of Dactinomycin Injection

• In Wilms' tumor studies, 2-year relapse-free survival ranged from about 80% to 95% and overall survival from about 85% to 99% depending on stage and regimen
• In a series of 31 patients with nonmetastatic gestational trophoblastic neoplasia, complete and sustained remissions were achieved with Cosmegen alone in 94% of treated patients
• Combination therapy (EMA-CO) with Cosmegen in poor-prognosis gestational trophoblastic neoplasia led to complete responses in 80% of women, with 85% overall survival

How Dactinomycin Injection works

Cosmegen works by attaching to the cell's DNA and blocking the cell from making RNA, which stops the cell from making proteins it needs to grow and divide. Because it targets fast-dividing cells, it affects both cancer cells and some normal cells, which is why it causes many of its side effects.

Dactinomycin Injection dosage

Cosmegen is given to you by a healthcare professional in a healthcare setting through a vein (intravenously). It is not taken by mouth. Your healthcare team will decide how long your treatment lasts, and dosing schedules vary depending on the condition being treated.

Tell your caregivers right away if you feel burning, pain, or swelling around the IV needle while the medicine is being given. Your blood will be tested often during treatment, and your treatment schedule may be adjusted based on the results.

Available forms and strengths

• Lyophilized powder for injection, 0.5 mg (500 mcg) dactinomycin per vial

Side effects of Dactinomycin Injection

Common

• Diarrhea
• Constipation
• Hair loss
• Nausea and vomiting
• Tiredness
• Fever and infections related to low blood cell counts
• Rash
• Trouble swallowing

Serious

• A large decrease in production of blood cells (bleeding, bruising, chills, fatigue, fever, infections, weakness, shortness of breath)
• Severe skin reactions including redness, blistering, and peeling of the skin (can be life-threatening)
• Liver problems including hepatitis and liver failure that may lead to death
• Serious infection of the blood (sepsis), which can be fatal
• Kidney problems
• Blood clotting disorder (disseminated intravascular coagulation)
• Eye nerve damage (optic neuropathy)
• Brain dysfunction caused by liver failure (hepatic encephalopathy)
• Fluid in the lungs (pleural effusion)
• Nerve damage in hands and feet (peripheral neuropathy)
• Vein inflammation caused by blood clots (thrombophlebitis)
• Severe bleeding (hemorrhage)
• Infertility

Warnings and precautions

Cosmegen should only be given under the care of a doctor experienced in cancer chemotherapy. It is highly toxic and can cause a serious drop in blood cell production and severe, life-threatening skin damage.

Taking cancer medicines like Cosmegen may lead to a second cancer, including leukemia, later on.

Do not take Cosmegen if you are allergic to dactinomycin or any ingredient in it, or if you currently have chickenpox or shingles, because of the risk of severe, possibly fatal, generalized disease.

If the medicine leaks out of the vein during injection, it can cause serious damage to the surrounding tissue.

Do not receive live vaccines while being treated with Cosmegen, as this can increase your risk of infection from the vaccine itself.

Cosmegen can harm an unborn baby and may cause birth defects if either the mother or father is using it. Women who can become pregnant should use effective birth control during treatment and for at least seven months after the last dose. Tell your healthcare provider right away if pregnancy occurs.

It is not known if Cosmegen passes into breast milk, but because of the risk of serious side effects in nursing babies, you should stop breastfeeding when you start treatment.

Your kidney function will be checked frequently with blood tests during treatment.

Your liver function will be checked frequently with blood tests during treatment. Liver problems including serious conditions like hepatic veno-occlusive disease can occur, especially in young children.

Alcohol should be discussed with the oncology team, especially if liver function is abnormal.

This medicine can cause side effects that may affect your ability to drive or use machinery. Wait until you know how the medicine affects you before doing tasks that require full attention.

Storage

• Store in a dry place between 15°C and 30°C
• Protect from light and humidity

When to see a doctor

Get emergency medical help right away if you have signs of an allergic reaction such as hives, difficulty breathing, or swelling of the face or throat, or signs of a severe skin reaction such as fever, sore throat, burning eyes, skin pain, or a red or purple rash with blistering and peeling.

Call your doctor right away if you have swelling or tenderness in your upper right stomach area, rapid weight gain, swelling in your arms or legs, dark urine, or yellowing of your skin or eyes.

Call your doctor right away if you have signs of low blood cell counts, such as fever, chills, tiredness, mouth sores, skin sores, easy bruising, unusual bleeding, pale skin, cold hands and feet, or feeling light-headed or short of breath.

Tell your healthcare professional right away about any troublesome symptom or side effect, even if it is not listed, if it becomes bad enough to interfere with your daily activities.

If you think too much Cosmegen has been given, contact your healthcare professional, go to a hospital emergency department, or contact your regional poison control center immediately, even if there are no symptoms.

Alternatives

• Vincristine
• Cyclophosphamide
• Doxorubicin