Dactinomycin Dosage

Usual Adult Dose for Wilms' Tumor

15 mcg/kg/day or 400 to 600 mcg/m2/day intravenously for 5 days as a part of a combination regimen. Dosage for obese or edematous adult patients may be calculated on the basis of body surface area to relate dosage to lean body mass. Dosage may be repeated every 3 to 6 weeks.

Usual Adult Dose for Ewing's Sarcoma

15 mcg/kg/day or 400 to 600 mcg/m2/day intravenously for 5 days as a part of a combination regimen. Dosage for obese or edematous adult patients may be calculated on the basis of body surface area to relate dosage to lean body mass. Dosage may be repeated every 3 to 6 weeks.

Usual Adult Dose for Rhabdomyosarcoma

15 mcg/kg/day or 400 to 600 mcg/m2/day intravenously for 5 days as a part of a combination regimen. Dosage for obese or edematous adult patients may be calculated on the basis of body surface area to relate dosage to lean body mass. Dosage may be repeated every 3 to 6 weeks.

Usual Adult Dose for Testicular Cancer

For use in the treatment of metastatic nonseminomatous testicular cancer:

1000 mcg/m2 intravenously on day 1 as part of a combination regimen with cyclophosphamide, bleomycin, vinblastine, and cisplatin.

Usual Adult Dose for Trophoblastic Disease

For use in the treatment of gestational trophoblastic neoplasia:

12 mcg/kg intravenously daily for five days as a single agent.

or

500 mcg intravenously on days 1 and 2 as part of a combination regimen with etoposide, methotrexate, folinic acid, vincristine, cyclophosphamide and cisplatin.

Usual Adult Dose for Malignant Disease

For use as a component of regional perfusion in the palliative and/or adjunctive treatment of locally recurrent or locoregional solid malignancies:

50 mcg/kg for lower extremity or pelvis

or

35 mcg/kg for upper extremity.

(Please note that the dosage schedules and the technique itself vary from one investigator to another. Please consult the published literature for details.)

Usual Adult Dose for Osteosarcoma

600 mcg/m2/day on days 1, 2, and 3 as part of a combination chemotherapy regimen

Usual Adult Dose for Ovarian Cancer

For use in the treatment of ovarian (germ cell) tumor:

500 mcg/day for 5 days every 4 weeks

or

300 mcg/m2/day for 5 days every 4 weeks

Usual Pediatric Dose for Wilms' Tumor

Greater than 6 months:

15 mcg/kg/day or 400-600 mcg/m2/day intravenously for 5 days (in various combination regimens and schedules). Dosage may be repeated every 3 to 6 weeks.

Usual Pediatric Dose for Ewing's Sarcoma

Greater than 6 months:

15 mcg/kg/day or 400-600 mcg/m2/day intravenously for 5 days (in various combination regimens and schedules). Dosage may be repeated every 3 to 6 weeks.

Usual Pediatric Dose for Rhabdomyosarcoma

Greater than 6 months:

15 mcg/kg/day or 400-600 mcg/m2/day intravenously for 5 days (in various combination regimens and schedules). Dosage may be repeated every 3 to 6 weeks.

Usual Pediatric Dose for Testicular Cancer

For use in the treatment of metastatic nonseminomatous testicular cancer:

1000 mcg/m2 intravenously on day 1 as part of a combination regimen with cyclophosphamide, bleomycin, vinblastine, and cisplatin.

Usual Pediatric Dose for Trophoblastic Disease

For use in the treatment of gestational trophoblastic neoplasia:

12 mcg/kg intravenously daily for five days as a single agent.

or

500 mcg intravenously on days 1 and 2 as part of a combination regimen with etoposide, methotrexate, folinic acid, vincristine, cyclophosphamide and cisplatin.

Usual Pediatric Dose for Malignant Disease

For use as a component of regional perfusion in the palliative and/or adjunctive treatment of locally recurrent or locoregional solid malignancies:

50 mcg/kg for lower extremity or pelvis

or

35 mcg/kg for upper extremity.

(Please note that the dosage schedules and the technique itself vary from one investigator to another. Please consult the published literature for details.)

Usual Pediatric Dose for Osteosarcoma

600 mcg/m2/day on days 1, 2, and 3 as part of a combination chemotherapy regimen

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dose Adjustments

Dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range.

The dosage of dactinomycin varies depending on the tolerance of the patient, the size and location of the neoplasm, and the use of other forms of therapy. It may be advisable to use lower doses in obese patients, or when previous chemotherapy or radiation therapy has been employed.

Dialysis

Data not available

Other Comments

Calculation of the dosage for obese or edematous patients should be on the basis of body surface area in an effort to relate dosage to lean body mass.

The dose intensity per 2-week cycle for adults or children should not exceed 15 mcg/kg/day or 400 to 600 mcg/m2 /day intravenously for five days.

In both adults and children, a second course may be given after at least three weeks have elapsed, provided all signs of toxicity have disappeared.

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