Chemotherapy with dactinomycin in combination with other agents is associated with serum enzyme elevations in a high, but variable proportion of patients depending upon the dose, other agents used as well as the frequency of monitoring and criteria used to define elevations. The ALT elevations are usually asymptomatic and transient and may resolve without dose modification. In many instances, it is difficult to attribute the liver test abnormalities to dactinomycin, because of the exposure to other potentially hepatotoxic agents.
Dactinomycin can also cause a distinctive form of clinically apparent liver injury referred to as hepatopathy-thrombocytopenia syndrome (HTS) that can be severe and even fatal. This syndrome appears to be due to sinusoidal obstruction, but there may also be an element of direct hepatic and bone marrow injury. In large studies, between 1% and 5% of children with cancer treated with regimens including dactinomycin developed acute hepatic injury and thrombocytopenia suggestive of HTS. The syndrome is more common in younger children and with higher doses of dactinomycin. The time to onset is typically within 3 to 6 weeks after the initial dose, often arising 5 to 10 days after the 2nd or 3rd course of cyclic chemotherapy with dactinomycin. The onset of symptoms is sudden, and children characteristically present with right upper quadrant pain or tenderness, hepatomegaly, liver test abnormalities and signs of excessive bleeding such as epistaxis or bruising. Serum aminotransferase levels are markedly elevated (10 to 100 times ULN) early in the course, but fall rapidly and can be normal within 7 to 14 days. The platelet count is generally less than 25,000/μL and also resolves rapidly. Serum alkaline phosphatase is typically normal and bilirubin levels are minimally elevated, except if the course is progressive and fatal. Serum ammonia and INR may also be raised, and ascites often develops during the acute syndrome. The overall pattern of injury resembles acute hepatic necrosis, and liver histology shows centrolobular necrosis and evidence of sinusoidal obstruction. Recovery is rapid and usually complete.
Likelihood score: C (Probable cause of clinically apparent liver injury).
来源:LiverTox
毒理性
致癌性证据
人类致癌性证据不足。动物致癌性证据有限。总体评估:第3组:该物质对人类致癌性无法分类。
Inadequate evidence of carcinogenicity in humans. Limited evidence of carcinogenicity in animals. OVERALL EVALUATION: Group 3: The agent is not classifiable as to its carcinogenicity to humans.
来源:Hazardous Substances Data Bank (HSDB)
毒理性
致癌物分类
国际癌症研究机构致癌剂:放线菌素D
IARC Carcinogenic Agent:Actinomycin D
来源:International Agency for Research on Cancer (IARC)
毒理性
致癌物分类
国际癌症研究机构(IARC)致癌物分类:第3组:对其对人类的致癌性无法分类
IARC Carcinogenic Classes:Group 3: Not classifiable as to its carcinogenicity to humans
来源:International Agency for Research on Cancer (IARC)
毒理性
致癌物分类
国际癌症研究机构专论集:第10卷:(1976年)一些自然存在的物质
IARC Monographs:Volume 10: (1976) Some Naturally Occurring Substances
来源:International Agency for Research on Cancer (IARC)
吸收、分配和排泄
链霉素从胃肠道吸收不良。该药物对组织极为刺激,因此必须静脉给药。
Dactinomycin is poorly absorbed from the GI tract. The drug is extremely irritating to tissues and, therefore, must be administered iv.
Dactinomycin is rapidly distributed into tissues, with high concentrations in bone marrow and nucleated cells, including granulocytes and lymphocytes. The drug appears to cross the blood-brain barrier poorly, if at all.
来源:Hazardous Substances Data Bank (HSDB)
吸收、分配和排泄
大环内酯素蛋白质结合率为5%。
Plasma protein binding /of dactinomycin/ is 5%.
来源:Hazardous Substances Data Bank (HSDB)
吸收、分配和排泄
显然,放线菌素D会穿过胎盘。目前尚不清楚放线菌素D是否分布到乳汁中。
Dactinomycin apparently crosses the placenta. It is not known if dactinomycin is distributed into milk.