Dactinomycin (Cosmegen lyovac)
How does it work?
Cosmegen lyovac injection contains the active ingredient dactinomycin (sometimes known as actinomycin D). This is a type of chemotherapy medicine used to treat cancer.
Cancers form when some cells within the body multiply uncontrollably and abnormally. These cells then spread and destroy nearby tissues. Dactinomycin works by stopping the cancer cells from dividing and multiplying. This kills the cancer cells and stops the cancer growing.
Dactinomycin belongs to a group of chemotherapy medicines called cytotoxic antibiotics. These are synthetic medicines that have been derived from compounds found in certain bacteria and fungi. Dactinomycin works by inserting itself into the strands of genetic material (DNA) inside the cancerous cells and binding them together. This prevents the cells from making genetic material (DNA and RNA) and proteins, which stops the cells from growing and multiplying.
Unfortunately, anticancer medicines also affect normal, healthy cells, particularly those that multiply quickly such as blood, gut and hair cells. The most important side effect is usually on the bone marrow where blood cells are made. Doxorubicin can decrease the production of white blood cells, leaving people susceptible to infection. Regular blood tests are therefore needed to monitor levels of blood cells.
In most chemotherapy regimens, doses are administered in courses at various intervals to allow normal cells to recover from the adverse effects of the anticancer medicines between doses. However, during this period, cancer cells will also recover and start to replicate again. Successful treatment depends on the administration of the next course of therapy before the cancer has regrown to its previous size and the net effect is to decrease the amount of cancer with each successive course.
What is it used for?
- A type of childhood cancer that develops from muscle tissue (rhabdomyosarcoma).
- Childhood cancer of the kidneys (Wilms' tumour).
- Ewing's sarcoma - a type childhood cancer originating in the bone or soft tissue.
- Very rare tumours called gestational trophoblastic tumours (GTT for short) that develop from the tissue that forms in the womb during pregnancy.
- Testicular cancer.
- Skin cancer (melanoma) (by regional arterial perfusion in combination with another chemotherapy medicine called melphalan - see 'How is this treatment given?' section below).
Dactinomycin may be used on its own, or as part of combination chemotherapy.
How is this treatment given?
- Dactinomycin is usually given via a drip into a vein (intravenous infusion). Dactinomycin injection can also be given as a slow injection into a vein.
- Treatment with dactinomycin is given in several cycles of treatment.
- The length of your treatment and the number of cycles you have will depend on the type of cancer you are being treated for, how well it responds and how well your body copes with the treatment.
- If dactinomycin leaks into the tissues around the vein, it can cause damage to the tissue there. For this reason, it is important to tell the doctor or nurse administering the medicine if you feel any burning or stinging around the vein, or if you notice any fluid leaking out of the injection site.
- Dactinomycin can also be given via a procedure called regional arterial perfusion, to treat melanomas affecting a localised area of a limb, eg arm or leg. This is carried out under general anaesthetic. A tight band is first applied to the top of the limb to prevent the chemotherapy from reaching other areas of the body. The medicine is then injected into an artery in the arm or leg.
- Chemotherapy medicines can decrease the number of blood cells in your blood. A low white blood cell count can increase your susceptibility to infections, a low red blood cell count causes anaemia and a low platelet count can cause problems with blood clotting. For this reason, you will need to have regular blood tests to monitor your blood cells during treatment with this medicine. Tell your doctor immediately if you experience any of the following symptoms during your treatment, as they may indicate problems with your blood cells: unexplained bruising or bleeding, purple spots, sore mouth or throat, mouth ulcers, high temperature (fever) or other signs of infection, or suddenly feeling tired, breathless, or generally unwell.
- You should also have regular blood tests to monitor your liver and kidney function while having treatment with this medicine.
- This medicine may be harmful to an unborn baby, and for this reason you should use effective contraception to avoid getting pregnant or fathering a child during treatment. You should continue to use contraception to prevent pregnancy for at least a few months after stopping this medicine; discuss this with your doctor. Women should consult their doctor immediately if they get pregnant during treatment.
- Your ability to get pregnant or father a child may be affected by this medicine. It is important to discuss fertility with your doctor before starting treatment.
Use with caution in
- Children less than one year old.
- People also receiving radiotherapy or who have had radiotherapy treatment recently.
- People with decreased kidney or liver function.
Not to be used in
- People with chickenpox (varicella zoster infection).
- People with shingles (herpes zoster).
This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancyor breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- This medicine may be harmful to a developing baby. It should not be used in pregnancy, unless considered essential by your doctor to treat life-threatening disease.
- Women who could get pregnant should use effective contraception to prevent pregnancy, and men should use effective contraception to prevent fathering a child, both during treatment, and for at least a few months after treatment is finished. Seek further medical advice from your doctor.
- It is not known if this medicine passes into breast milk. Mothers who need treatment with this medicine should not breastfeed. Seek medical advice from your doctor.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
- Decrease in the number of healthy white blood cells, red blood cells or platelets in the blood (leukopenia and neutropenia, anaemia and thrombocytopenia) see warning section above.
- Feeling or being sick. You will be given medicines to help with this.
- Abdominal pain.
- Loss of appetite.
- Inflammation of the lining of the mouth (stomatitis), causing a sore mouth or mouth ulcers.
- A general feeling of being unwell (malaise).
- Feeling tired and lacking energy.
- Hair loss (alopecia).
- Skin reactions such as rash, itching, acne or redness.
- Liver disorders including hepatitis, enlargement of liver or liver failure.
- Inflammation of the lungs (pneumonitis).
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.
For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you or your child are already taking, including those bought without a prescription and herbal medicines, before treatment with this medicine is started. Similarly, check with your doctor or pharmacist before taking any new medicines during treatment with this one, to make sure that the combination is safe.
Vaccines may be less effective in people receiving chemotherapy. This is because chemotherapy medicines reduce the activity of the immune system and can prevent the body forming adequate antibodies. Live vaccines should be postponed until at least six months after finishing chemotherapy because they may cause infection. Live vaccines include the following: oral polio; rubella; measles, mumps and rubella (MMR); BCG; chickenpox; yellow fever and oral typhoid vaccines.
There may be an increased risk of side effects if this medicine is used in combination with other medicines which can also suppress bone marrow function and affect blood cell counts, for example other chemotherapy medicines, or the antipsychotic clozapine.
Other medicines containing the same active ingredient
Dactinomycin injection is also available generically (ie without a brand name).