Dactinomycin (Actinomycin D)

• What dactinomycin is
• Common side effects
• Occasional side effects
• Rare side effects
• Important points to remember
• Immunisations and chemotherapy

Dactinomycin is used to treat sarcomas, Wilm’s tumour, germ cell cancers (testicular cancer), melanoma and choriocarcinoma. Dactinomycin is an anti-tumour antibiotic. One way that dactinomycin works is by sticking itself to a strand of the cancer cells’ DNA. The cells then cannot split into 2 new cancer cells.

Dactinomycin is a yellow liquid that you have as a slow injection into a vein.

You usually have chemotherapy as a course of several cycles of treatment. The treatment plan for dactinomycin depends on which cancer you are being treated for. There is more about planning chemotherapy in the main chemotherapy section of CancerHelp UK.

We've listed the side effects associated with dactinomycin below. You can use the links (underlined) to find out more about each side effect. Where there is no link please see our chemotherapy side effects section, or use the search box at the top of the page.

With this drug, many people have a temporary drop in the number of blood cells made by the bone marrow, leading to the following side effects

• Increased risk of getting an infection from a drop in white blood cells - it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery. 
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) - you may need a blood transfusion
• Bruising more easily due to a drop in platelets - you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia).

These effects on your bone marrow can begin about 7 days after each treatment and usually go back to normal after about 21 to 28 days. Some of these side effects can be life threatening, particularly infections.  You should contact your doctor if you have any of these side effects.  Your doctor will check your blood counts regularly to see how well your bone marrow is working

Other common side effects include

• Fatigue - during and after treatment – most people find their energy levels are back to normal within 6 months to a year
• Feeling or being sick usually comes on within 2 hours of having the drug and can last for up to 24 hours, but is usually well controlled with anti sickness drugs
• Loss of appetite
• Hair loss
• Mouth sores can happen in up to 1 in 3 people treated
• Diarrhoea can be severe and happens in up to 1 in 3 people treated. It usually begins within a week of having treatment. You should have anti-diarrhoea tablets to take. – drink plenty of fluid and tell your doctor if diarrhoea becomes severe, or continues for more than 3 days
• Skin changes - this drug can cause a rash, darkening of your skin (particularly along the vein where you have your injection), or reddening of areas of skin that have had radiotherapy
• Dactinomycin may have a harmful effect on a developing baby – do talk to your doctor about contraception before having treatment if there is any chance that you or your partner could become pregnant

 

Some people have the following side effects

• Fever or chills
• Abdominal cramps
• Depression
• Difficulty swallowing
• Inflammation around the drip site– if you notice any signs of redness, swelling or leaking at your drip site, tell your chemotherapy nurse immediately

 

• Liver changes that are very mild and unlikely to cause symptoms – the liver will almost certainly go back to normal when treatment is finished, but you will have regular blood tests to check how well your liver is working
• Loss of fertility - we don’t know exactly how this drug affects fertility so do talk with your doctor before starting treatment if this is important to you 
• Women may stop having periods (amenorrhoea). This may only be temporary.

 

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

• How many times you've had the drug before Your general health
• The amount of the drug you have (the dose)
• Other drugs you are having

Some side effects are inconvenient or upsetting but not damaging to your health.

Some side effects are serious medical conditions and need treating. Where we have urged you to contact your doctor, this is because

• Your side effect may need treating
• Your drug dose may need reducing to try to prevent the side effect

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies - some drugs can react together.

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your chemotherapy nurse, clinic or ward nurse will have given you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. These include rubella, mumps, measles, BCG, yellow fever, typhoid and polio. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy.

It is perfectly safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but no one in the UK is given an oral vaccine now. So there is no problem in being with any baby or child who has recently had any vaccination in the UK. If you live abroad, you might need to make sure that you aren't in contact with anyone who has had oral polio or oral typhoid vaccination recently.