Wilms Tumor Medication

Updated: May 21, 2020
  • Author: Arnold C Paulino, MD; Chief Editor: Jennifer Reikes Willert, MD  more...
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Medication Summary

As previously stated, several cytotoxic agents may cause liver damage in patients treated for Wilms tumor. Reports have documented hepatic toxicity with the combination of vincristine and dactinomycin even in the absence of radiation therapy (which many early reports suggested was the major etiologic factor in liver damage).

In the fourth NWTSG report, the incidence of hepatotoxicity was 2.8-14.3% in patients who did not receive irradiation. The fact that patients who received less dactinomycin than others (ie, those with relatively low-stage disease) had a low incidence of 2.8% suggests a dose-related toxicity for dactinomycin.

Patients who survive Wilms tumor are at risk because inherited disposition and treatment (eg, chemotherapy, irradiation) can induce second malignant neoplasms. Although most secondary malignant neoplasms reported (eg, bone tumors, breast and thyroid cancers) have occurred in irradiated areas, certain chemotherapeutic agents, including doxorubicin, dactinomycin, and vincristine, may contribute to an increased risk for secondary malignancies.

A study by Pritchard-Jones et al on 583 children from 251 hospitals in 26 countries aimed to assess whether doxorubicin can be omitted safely from chemotherapy for stage II-III, histologic intermediate-risk Wilms' tumor in order to avoid doxorubicin-related cardiotoxicity effects. The study concluded that doxorubicin does not need to be included in treatment of stage II-III intermediate risk Wilms tumor when the histologic response to preoperative chemotherapy is incorporated into the risk stratification. [37, 38]


Antineoplastic agents

Class Summary

These chemotherapeutic agents used to treat patients with Wilms tumor depend on the stage and histology of disease. Commonly used agents include dactinomycin, vincristine, doxorubicin, cyclophosphamide, etoposide, and carboplatin. The dosage depends on the particular stage of the disease and on the child.

Dactinomycin (Cosmegen)

This antibiotic is derived from Streptomyces bacterium. It binds to the guanine portion of deoxyribonucleic acid (DNA) and causes topoisomerase-mediated breaks in DNA strands.

Vincristine (Vincasar PFS)

Vincristine inhibits tubulin polymerization; therefore, it targets dividing cells.


This alkylating agent is believed to be cytotoxic to dividing cells through cross-linkage of cellular DNA. It is processed in the liver to active metabolites; byproducts (eg, acrolein) accumulate in the bladder and cause cystitis.

Etoposide (Toposar)

Etoposide inhibits topoisomerase II; therefore, it is toxic to cells undergoing DNA replication.


This analog of cisplatin is used in treatment regimens for relapse.

Doxorubicin (Adriamycin)

Doxorubicin is a cytotoxic anthracycline antibiotic isolated from cultures of Streptomyces peucetius (var caesius). It binds to nucleic acids, presumably by the specific intercalation of the anthracycline nucleus with the DNA double helix