# Dactinomycin (actinomycin D)

Source: https://onco.cc/drugs/dactinomycin/  
OnCo record `dactinomycin` (Treatment). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The first antibiotic used as an anticancer drug (1954) and still the core of chemotherapy for Wilms tumour, rhabdomyosarcoma and gestational trophoblastic disease.

## Summary

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.

## Fields

- Kind: Treatment
- Status: approved
- Last checked: 2026-09-08
- Also known as: Actinomycin D; Actinomycin
- Tags: gap-fill; generic; who-essential
- Brand: Cosmegen
- Modality: Actinomycin antibiotic (transcription inhibitor)
- Mechanism: Intercalates GC-rich DNA and blocks RNA polymerase elongation; potent radiosensitiser.
- Approvals: US 1964: Wilms tumour, rhabdomyosarcoma, Ewing sarcoma, gestational trophoblastic neoplasia, metastatic testicular cancer, regional perfusion for sarcoma

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Dactinomycin
- Label (DailyMed): https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=dactinomycin

## Connected records

- cancers: [Childhood lung and airway tumours (pleuropulmonary blastoma, tracheobronchial tumours)](https://onco.cc/cancers/pleuropulmonary-blastoma/), [Ewing sarcoma](https://onco.cc/cancers/ewing-sarcoma/), [Gestational trophoblastic neoplasia](https://onco.cc/cancers/gestational-trophoblastic/), [High-risk gestational trophoblastic neoplasia (FIGO score 7 or more, including ultra-high-risk)](https://onco.cc/cancers/high-risk-gtn/), [Low-risk gestational trophoblastic neoplasia (FIGO score 0 to 6)](https://onco.cc/cancers/low-risk-gtn/), [Placental-site trophoblastic tumour and epithelioid trophoblastic tumour](https://onco.cc/cancers/placental-site-trophoblastic-tumour/), [Rhabdomyosarcoma](https://onco.cc/cancers/rhabdomyosarcoma/), [Testicular germ cell tumours](https://onco.cc/cancers/testicular/), [Wilms tumour (nephroblastoma)](https://onco.cc/cancers/wilms-tumor/)
- technologies: [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/), [Isolated limb perfusion and infusion](https://onco.cc/technologies/isolated-limb-perfusion/)
- companies: [Nobelpharma](https://onco.cc/companies/nobelpharma/), [Recordati](https://onco.cc/companies/recordati/)
- terms: [FOXO1 fusion status and IRS group (rhabdomyosarcoma)](https://onco.cc/terms/foxo1-fusion-status/), [Re-irradiation](https://onco.cc/terms/re-irradiation/), [Wilms tumour risk markers (anaplasia, 1p/16q loss, 1q gain, SIOP and COG risk groups)](https://onco.cc/terms/wilms-risk-markers/)
- people: [Sidney Farber](https://onco.cc/people/sidney-farber/)
- key papers: [EMA/CO for high-risk gestational trophoblastic tumours: results from a cohort of 272 patients](https://onco.cc/key-papers/paper-bower-ema-co-high-risk-gtn-charing-cross-jco-1997/), [FIGO Cancer Report 2021: diagnosis and management of gestational trophoblastic disease](https://onco.cc/key-papers/paper-figo-cancer-report-gestational-trophoblastic-disease-ijgo-2021/), [GOG 174: weekly methotrexate or pulsed dactinomycin for low-risk gestational trophoblastic neoplasia](https://onco.cc/key-papers/paper-gog-174-methotrexate-vs-dactinomycin-low-risk-gtn-jco-2011/)
- trials: [COG AREN0532](https://onco.cc/trials/aren0532/), [COG AREN0533](https://onco.cc/trials/aren0533/)
- roadmaps: [Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs](https://onco.cc/roadmaps/chemotherapy-roadmap/), [Drug discovery roadmap: screening in mice → maps of dependency → designing in silico](https://onco.cc/roadmaps/drug-discovery-roadmap/)

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