The Effect of Actinomycin D on Cancer in Childhood

Actinomycin D has a slight but definite effect in producing regression of tumors in patients with cancer. Wilms' tumor and lymphomas have shown better response than other tumors. Although the effect of the combination of actinomycin D and x-ray therapy is difficult to evaluate, these agents appear to be additive in producing temporary regression of the tumor in some patients. The usual single course of actinomycin D intravenously is 75 µ.g/kg of body weight divided into four or five daily doses. The oral dose of actinomycin D is 3 to 10 mg daily. About 5% of actinomycin D given orally is absorbed as evidenced by production of systemic toxicity. However, severe local gastrointestinal effect usually prevents adequate oral administration of the drug. The toxic effects of actinomycin D are local on the gastrointestinal tract with ulceration of the mouth, nausea, vomiting, anorexia, occasional abdominal pain and diarrhea; exacerbation of skin reaction in previously irradiated areas; alopecia; decrease in leukocyte and platelet counts. The toxicity after intravenous administration of actinomycin D usually develops within the first 2 weeks and disappears within the next 2 weeks. The duration of improvement after a single course of actinomycin D intravenously was usually from 1 to 10 weeks. Two children, one with Wilms' tumor and one with embryonal carcinoma, had no recurrence for 24 and 7 months, respectively. Both received maintenance doses of actinomycin D orally.