Dactinomycin (actinomycin D, Cosmegen Lyovac)
Dactinomycin is a type of chemotherapy. It is also known as actinomycin D or by its brand name Cosmegen Lyovac.
You might have it as a treatment for a number of different cancer types such as:
- Wilm's tumour
- Ewing's sarcoma
How dactinomycin works
Dactinomycin works by damaging the cancer cells' DNA. When DNA is damaged, a cell cannot divide into 2 new cells, so it helps to stop the cancer growing.
How you have dactinomycin
You have dactinomycin as a drip into your bloodstream (intravenously).
Drugs into your bloodstream
You have the treatment through a drip into your arm or hand. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.
You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.
When you have dactinomycin
When you have dactinomycin depends on your cancer type. You usually have it in combination with other cancer drugs such as:
- vincristine, actinomycin D and cyclophosphamide (VAC)
- vincristine, actinomycin D and ifosfamide (VAI)
Your treatment team can tell can give you more information about your treatment.
Tests
You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
Side effects
How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having.
When to contact your team
Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:
- you have severe side effects
- your side effects aren’t getting any better
- your side effects are getting worse
Early treatment can help manage side effects better.
We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.
There isn't enough information to work out how often these side effects might happen. You might have one or more of them. They include:
Risk of infection
Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.
Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection.
Breathlessness and looking pale
You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.
Bruising and bleeding
This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).
Loss of appetite
You might lose your appetite for various reasons whilst having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.
Feeling or being sick
Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.
It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.
This usually happens a few hours after having treatment.
Diarrhoea
Contact your advice line if you have diarrhoea, such as if you've had 4 or more loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid. Or if it carries on for more than 3 days.
Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.
Mouth sores and ulcers
Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids, avoid acidic foods such as lemons. Chewing gum can help to keep the mouth moist. Tell your doctor or nurse if you have ulcers.
Difficulty swallowing
Let your doctor or nurse know straight away if you have any problems swallowing.
Fatigue
You might feel very tired and as though you lack energy.
Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.
High temperature (fever)
If you get a high temperature, let your healthcare team know straight away. Ask them if you can take paracetamol to help lower your temperature.
Tummy (abdominal) pain
Tell your treatment team if you have this. They can check the cause and give you medicine to help.
Liver problems
This includes inflammation of the liver and changes to the levels of liver enzymes. You have regular blood tests to check for this.
You may also develop a condition in which some of the veins in the liver are blocked. This may cause liver damage and can be life threatening.
A build up of fluid in your tummy (abdomen)
This is called ascites. You may notice that your clothes feel tighter and your tummy feels bloated. You might also find it difficult to sit comfortably or to move around. Tell your doctor if you think you have this.
Low levels of calcium in your body
Low calcium levels in the blood can cause painful muscle spasms, cramps or muscle twitching. You might also get numbness or tingling in your feet, hands or around your mouth.
Inflammation of the lungs
This drug can cause inflammation of the lungs (pneumonitis). Let your doctor know if you have breathlessness, a high temperature and chills, extreme tiredness, a dry cough, or pain in your lungs when you take a deep breath.
Hair loss
You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before.
Skin changes
You might notice skin changes, such as dryness, itching and rashes similar to acne on your face, neck and trunk.
Tell your doctor if you have any rashes or itching. Don't go swimming if you have a rash because the chlorine in the water can make it worse.
If your skin gets dry or itchy, using unperfumed moisturising cream may help. Check with your doctor or nurse before using any creams or lotions. Wear a high factor sun block if you’re going out in the sun.
You might also have soreness, a burning feeling, and dry skin in the areas treated with radiotherapy in the past.
Some people have also developed a severe skin reaction that starts as tender red patches and leads to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light. This is serious and could be life threatening.
Muscle pain
You might have muscle pain during treatment. Let your treatment team know so they can advise you on how to reduce it.
Inflammation at your drip site
Tell your nurse straight away if you have any redness, swelling, pain or leaking at your drip site.
Coping with side effects
We have more information about side effects and tips on how to cope with them.
What else do I need to know?
Other medicines, foods and drink
Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.
Loss of fertility
It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.
Contraception and pregnancy
This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you're having treatment and for a few months afterwards.
Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner falls pregnant while having treatment.
Breastfeeding
Don’t breastfeed during this treatment because the drug may come through into your breast milk.
Treatment for other conditions
Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.
Immunisations
Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.
In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.
You can have:
- other vaccines, but they might not give you as much protection as usual
- the flu vaccine (as an injection)
- the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment
Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your 
recovers from treatment.
Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.
If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.
Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.
More information about this treatment
For further information about this treatment go to the electronic Medicines Compendium (eMC) website.
You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.
This page is due for review. We will update this as soon as possible.
