Efforts are made to reduce these chemotherapy-induced complications by ensuring age-dependent doses of
dactinomycin and cyclophosphamide, especially in patients <36 months of age.
Parker RJ, Adamson RH, Douros JD, Sieber SM (1983) Comparative pharmacologic studies of
dactinomycin and pip-1-beta actinomycin.
(b) One patient with
dactinomycin use was excluded from this analysis.
The typical chemotherapeutic agents used are vincristine,
dactinomycin, adriamycin, cyclophosphamide, ifosamide and etoposide.[sup.15] The addition of ifosfamide and etoposide has been shown to improve overall survival in patients with non-metastatic skeletal Ewing's sarcoma.[sup.16] Neoadjuvant chemotherapy can improve surgical outcomes and potentially avoid adjuvant radiotherapy, which is often reserved for patients with positive margins after resection or involvement of Gerota's fascia.[sup.17,18]
Patient was started in EMA-CO therapy (
Dactinomycin, Ectoposide, Methrotrexate, Cyclophosphamide and Vincristine).
ritonavir): [down arrow] efficacy Inhibition: [up arrow] risk of adverse effects (hot flushes, peripheral oedema, etc.) Toremifene CYP3A4 Active Induction: [up arrow] efficacy Inhibition: [up arrow] risk of adverse effects Glucocorticoids CYP3A4 Inhibitors: CYP3A4 inducer [up arrow] risk corticosteroid -related toxicity Inducers: [down arrow] efficacy Reduces efficacy of CYP3A4 substrates Table IV Anticancer drugs that are p-glycoprotein substrates Clilorambucil Etoposide Cisplatin Methylprednisolone
Dactinomycin Mitoxantrone Daunorubicin Paclitaxel Dexamethasone Tamoxifen Docetaxel Vinblastine Doxorubicin Vincristine
2003, mOS with HDCT: 27.1 m retrospective [3] TBI: total body irradiation, HDCT: high-dose chemotherapy, SCT: stem cell transplant, CR: complete response, PR: partial response, EFS: event-free survival, OS: overall survival, V: vincristine, E: etoposide, M: methotrexate, A:
dactinomycin, If: ifosfamide, C: cyclophosphamide, D: doxorubicin, T: topotecan, I: irinotecan, Te: temozolomide, Ca: carboplatin, NL: not listed, high I: high-dose ifosfamide, mOS: median overall survival, mRFS: median relapse-free survival, COR: consortium of other regimens, and ONR: outcomes not reported.
A randomized trial of etoposide + cisplatin versus vinblastine + bleomycin + cisplatin + cyclophosphamide +
dactinomycin in patients with good-prognosis germ cell tumours.
Dactinomycin at 1.25 mg per square meter per dose is substituted for doxorubicin when a total doxorubicin dose of 375 mg per square meter is reached.
Data from a current COG study evaluating the pharmacokinetics and pharmacogenetics of vincristine and
dactinomycin in children (including infants) will help guide the dosing of these agents in future trials 3.