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The first antibiotic used as an anticancer drug (1954) and still the core of chemotherapy for Wilms tumour, rhabdomyosarcoma and gestational trophoblastic disease.
Dactinomycin (actinomycin D) intercalates into GC-rich DNA and blocks RNA polymerase elongation, halting transcription; it also sensitises tissue to radiation. It was the first antibiotic used as an anticancer drug in 1954, and Sidney Farber's Wilms tumour work in the 1950s established it before US approval in 1964. It remains central to paediatric oncology: in VA and DD-4A for Wilms tumour, in VAC and IVA for rhabdomyosarcoma, historically in Ewing sarcoma regimens, and in EMA-CO and pulsed single-agent therapy for gestational trophoblastic neoplasia, one of the most curable cancers. It is a vesicant, can cause sinusoidal obstruction syndrome of the liver in young children, and can provoke radiation recall in previously irradiated skin. Dactinomycin is a seventy-year-old drug that still cures children.
Ball-and-stick model from PubChem 2D record (no 3D conformer available). PubChem record
Intercalates GC-rich DNA and blocks RNA polymerase elongation; potent radiosensitiser.
1.Dactinomycin (actinomycin D) slips into a pocket on its target.
Given by infusion or injection in a clinic or hospital outpatient department, so it is a Part B drug: Medicare pays 80% after the Part B deductible and the patient owes 20% coinsurance, uncapped in Original Medicare unless a Medigap policy applies. Generic; paediatric and gestational trophoblastic uses.
Multi-source generic; covered under the medical benefit without prior authorisation in most plans, as part of standard regimens.
Sources: Medicare.gov: Chemotherapy · Medicare.gov: Prescription drugs (outpatient, Part B). Not medical or financial advice; verify with your plan.
Sources: NICE search: dactinomycin. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.
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| Region | Year | Indication |
|---|---|---|
| US | 1964 | Wilms tumour, rhabdomyosarcoma, Ewing sarcoma, gestational trophoblastic neoplasia, metastatic testicular cancer, regional perfusion for sarcoma |
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The standard-of-care rows on all three trophoblastic pages follow this report and the national centres it describes.
Pulsed dactinomycin is at least as good as weekly methotrexate for low-risk GTN, but many centres still prefer the multi-day methotrexate-folinic acid schedule, which was not tested here; overall cure approaches 100 percent whichever drug comes first.
EMA/CO remains the first-line regimen for high-risk GTN worldwide; later Charing Cross work added low-dose induction etoposide-cisplatin for women with very high scores.
Query for this drug: (TITLE:"Dactinomycin" OR ABSTRACT:"Dactinomycin" OR TITLE:"actinomycin D" OR ABSTRACT:"actinomycin D" OR TITLE:"Cosmegen" OR ABSTRACT:"Cosmegen" OR TITLE:"Actinomycin D" OR ABSTRACT:"Actinomycin D" OR TITLE:"Actinomycin" OR ABSTRACT:"Actinomycin") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Dactinomycin (actinomycin D), not a curated reading list.
Shares GOG 174: weekly methotrexate or pulsed dactinomycin for low-risk gestational trophoblastic neoplasia, EMA/CO for high-risk gestational trophoblastic tumours: results from a cohort of 272 patients, FIGO Cancer Report 2021: diagnosis and management of gestational trophoblastic disease, Sidney Farber and the tags generic, who-essential.
Shares EMA/CO for high-risk gestational trophoblastic tumours: results from a cohort of 272 patients, COG AREN0532, Wilms tumour risk markers (anaplasia, 1p/16q loss, 1q gain, SIOP and COG risk groups), FOXO1 fusion status and IRS group (rhabdomyosarcoma) and the tags generic, who-essential.
Shares EMA/CO for high-risk gestational trophoblastic tumours: results from a cohort of 272 patients, FIGO Cancer Report 2021: diagnosis and management of gestational trophoblastic disease, COG AREN0533, Placental-site trophoblastic tumour and epithelioid trophoblastic tumour and the tags generic, who-essential.
Shares FOXO1 fusion status and IRS group (rhabdomyosarcoma), Rhabdomyosarcoma, Ewing sarcoma, Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs and the tags generic, who-essential.
Shares EMA/CO for high-risk gestational trophoblastic tumours: results from a cohort of 272 patients, FOXO1 fusion status and IRS group (rhabdomyosarcoma), COG AREN0533, Low-risk gestational trophoblastic neoplasia (FIGO score 0 to 6) and the tags generic, who-essential.
Shares Testicular germ cell tumours, Cytotoxic chemotherapy and the tags generic, who-essential.
Shares Testicular germ cell tumours, Cytotoxic chemotherapy and the tags generic, who-essential.
Shares Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs, Cytotoxic chemotherapy and the tags generic, who-essential.