Dactinomycin is sometimes called actinomycin D. It is a chemotherapy drug that is given as a treatment for some types of cancer. It is most commonly used to treat cancers that occur in children, although it may sometimes be used for adults. This information describes dactinomycin, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy and about your type of cancer, which give further information and advice.

If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

Dactinomycin is a yellow fluid.

Dactinomycin can be givenby slow injection:

• into a vein (intravenously) through a fine tube placed into the vein (cannula)
• through a central line, which is a thin tube inserted under the skin into a vein near the collarbone, or a PICC line which is inserted in the crook of the arm.

Chemotherapy is usually given as a course of several sessions (or cycles) of treatment over a few months. The length of your treatment and the number of cycles you have will depend on the type of cancer for which you are being treated. Your nurse or doctor will discuss your treatment plan with you.

Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described in this information will not affect everyone who is given dactinomycin, and may be different if you are having more than one chemotherapy drug.

We have outlined the most common side effects and some of the less common ones, so you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you do notice any effects which you think may be due to the drug, but which are not listed in this information, please discuss them with your doctor or chemotherapy nurse.

Feeling sick (nausea) and being sick (vomiting) If you do feel sick this may begin a few hours after the treatment is given and last for up to 24 hours. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea and vomiting. If the sickness is not controlled, or continues, tell your doctor; they can prescribe other anti-sickness drugs which may be more effective. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.

Hair loss Your hair may fall out completely, or may just thin. This usually starts 3–4 weeks after the first dose of dactinomycin, although it may occur earlier. You may also have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss is temporary and all your hair will return to normal once the treatment ends.

Lowered resistance to infection Dactinomycin can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, and your resistance to infection usually reaches its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily, and will usually have returned to normal levels before your next course of chemotherapy is due.

Contact your doctor or the hospital straightaway if:

• your temperature goes above 38ºC (100.5ºF)
• you suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy, to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.

Bruising or bleeding Dactinomycin can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.

Anaemia (low number of red blood cells) While having treatment with dactinomycin you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if you develop these symptoms.

Loss of appetite A dietitian or specialist nurse at your hospital can give advice on dealing with loss of appetite, and tips on coping with eating difficulties and maintaining weight.

Tiredness and feeling weak You may feel very tired. It is important to allow yourself plenty of time to rest.

Sore mouth and ulcers Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Tell your nurse or doctor if you have any of these problems, as special mouthwashes and medicines to prevent or clear any mouth infection can be prescribed. Using a soft toothbrush may be helpful.

Taste changes You may also notice that your food tastes different. Normal taste will usually come back after the treatment finishes.

Diarrhoea This can usually be easily controlled with medicine, but let your doctor know if it is severe or if it continues. It is important to drink plenty of fluids if you have diarrhoea.

Fever and chills These may occur with dactinomycin, but they do not usually last long. Your doctor may prescribe medicines to reduce this effect.

Skin changes Dactinomycin can cause an acne-like rash. Areas which have previously been treated with radiotherapy may become red and sore. Let your doctor know if this occurs.

Your liver may be temporarily affected Dactinomycin may cause changes in the way that your liver works, though your liver will return to normal when the treatment is finished. This is unlikely to cause you any harm but your doctor will monitor this carefully. Samples of your blood will be taken from time to time to check your liver is working properly.

Difficulty in swallowing (dysphagia) If you have problems with swallowing, tell your doctor.

Leakage into the tissue If dactinomycin leaks into the tissue around the vein it can damage the tissue in that area. If you notice any stinging or burning around the vein while the drug is being given, or any leakage of fluid from the cannula site, it is very important that you tell your doctor or nurse.

If the area around the injection site becomes red or swollen at any time you should tell the doctor or nurse on the ward, or if at home, ring the clinic or ward and ask to speak to the doctor or nurse.

Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information.

Other medicines Some medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.

Fertility Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking dactinomycin, as the developing foetus may be harmed. It is important to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

This section is based on our Dactinomycin factsheet which has been compiled using information from a number of reliable sources, including:

• Martindale: The Complete Drug Reference (35th edition). Eds. Sweetman et al. Pharmaceutical Press, 2007.
• British National Formulary (54th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2007.
• The Medicines.org.uk website – www.medicines.org.uk (November 2007).
• The Chemotherapy Source Book (3rd edition). Ed. Perry. Lippincott, Williams and Wilkins, 2001.

For further references, please see general bibliography.