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Dacarbazine: Drug information

Dacarbazine: Drug information
(For additional information see "Dacarbazine: Patient drug information" and see "Dacarbazine: Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
ALERT: US Boxed Warning
Experienced physician:

It is recommended that dacarbazine be administered under the supervision of a qualified physician experienced in the use of cancer chemotherapeutic agents.

In treatment of each patient, the physician must weigh carefully the possibility of achieving therapeutic benefit against the risk of toxicity.

Bone marrow suppression:

Hemopoietic depression is the most common toxicity with dacarbazine.

Hepatic effects:

Hepatic necrosis has been reported.

Carcinogenic/teratogenic:

Studies have demonstrated this agent to have a carcinogenic and teratogenic effect when used in animals.

Pharmacologic Category
  • Antineoplastic Agent, Alkylating Agent (Triazene)
Dosing: Adult

Note: Dacarbazine is associated with a high emetic potential; antiemetics are recommended to prevent nausea and vomiting (Ref).

Hodgkin lymphoma

Hodgkin lymphoma:

ABVD regimen: IV: 375 mg/m2 on days 1 and 15 every 4 weeks (in combination with doxorubicin, bleomycin, and vinblastine) for 2 to 4 cycles (Ref). The number of cycles required and follow-up treatment may be determined by PET scan after 2 cycles (Ref).

A-AVD regimen: IV: 375 mg/m2 on days 1 and 15 every 4 weeks (in combination with brentuximab vedotin, doxorubicin, and vinblastine) for up to 6 cycles (Ref). Administer primary prophylaxis with G-CSF (filgrastim) beginning with cycle 1.

Melanoma, metastatic malignant

Melanoma, metastatic malignant: IV: 250 mg/m2 over 30 minutes once daily on days 1 to 5 every 3 weeks for up to 12 cycles or until disease progression or unacceptable toxicity (Ref) or 850 to 1,000 mg/m2 once every 3 weeks until disease progression or unacceptable toxicity (Ref).

Medullary thyroid cancer, advanced or metastatic

Medullary thyroid cancer, advanced or metastatic (off-label use): IV: 200 mg/m2 once daily for 5 days every 8 weeks (in combination with fluorouracil and alternating with doxorubicin/streptozocin) until disease progression or unacceptable toxicity, or for a total of 6 cycles if tumor response or stabilization (Nocera 2000) or 200 mg/m2 once daily for 5 days every 6 weeks (in combination with fluorouracil and alternating with streptozocin/fluorouracil) until disease progression or unacceptable toxicity (Ref) or 600 mg/m2 once daily for 2 days every 3 or 4 weeks (in combination with cyclophosphamide and vincristine); patients received a median of 4 cycles (range: 2 to 17 cycles) (Ref) or 250 mg/m2 over 15 to 30 minutes once daily for 5 days every 4 weeks (in combination with fluorouracil) until disease progression or for a maximum of 6 cycles (Ref).

Pancreatic neuroendocrine tumors, advanced

Pancreatic neuroendocrine tumors, advanced (off-label use): IV: 850 mg/m2 over 60 to 90 minutes on day 1 every 4 weeks until disease progression or unacceptable toxicity (minimum of 2 cycles) (Ref).

Pheochromocytoma, malignant

Pheochromocytoma, malignant (off-label use): CVD regimen: IV: 600 mg/m2 once daily for 2 days every 3 or 4 weeks (in combination with cyclophosphamide and vincristine) until disease progression or unacceptable toxicity (Ref).

Soft tissue sarcoma, advanced

Soft tissue sarcoma, advanced (off-label use):

AD regimen: IV: 250 mg/m2/day as a continuous infusion for 4 days every 3 weeks (total of 1,000 mg/m2/cycle) (in combination with doxorubicin); patients received a median of 3 cycles (Ref) or 187.5 mg/m2/day as a continuous infusion for 4 days every 3 weeks (total of 750 mg/m2/cycle) (in combination with doxorubicin) until disease progression or unacceptable toxicity (Ref).

MAID regimen: IV: 250 mg/m2/day as a continuous infusion for 4 days every 3 weeks (total of 1,000 mg/m2/cycle) (in combination with mesna, doxorubicin, and ifosfamide) (Ref). Continue until disease progression or unacceptable toxicity (Ref).

Gemcitabine/Dacarbazine regimen: IV: 500 mg/m2 once every 2 weeks (in combination with gemcitabine) for 12 cycles (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling. The following adjustments have been recommended:

Kintzel 1995:

CrCl 46 to 60 mL/minute: Reduce dose to 80% of usual dose.

CrCl 31 to 45 mL/minute: Reduce dose to 75% of usual dose.

CrCl ≤30 mL/minute: Reduce dose to 70% of usual dose.

Krens 2019:

CrCl ≥30 mL/minute: No dosage adjustment necessary.

CrCl <30 mL/minute: Consider reducing dose to 70% of usual dose.

Hemodialysis: Consider reducing dose to 70% of usual dose.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling. May cause hepatotoxicity; monitor closely for signs of toxicity.

The following adjustments have been recommended (Ref):

Mild to moderate impairment: No dosage adjustment necessary.

Severe impairment: Use is not recommended.

Dosing: Obesity: Adult

American Society of Clinical Oncology guidelines for appropriate systemic therapy dosing in adults with cancer with a BMI ≥30 kg/m2: Utilize patient's actual body weight for calculation of BSA- or weight-based dosing; manage regimen-related toxicities in the same manner as for patients with a BMI <30 kg/m2; if a dose reduction is utilized due to toxicity, may consider resumption of full weight-based dosing (or previously tolerated dose level) with subsequent cycles only if dose escalations are allowed in the prescribing information, if contributing underlying factors (eg, hepatic or kidney impairment) are sufficiently resolved, AND if performance status has markedly improved or is considered adequate (Ref).

Dosing: Adjustment for Toxicity: Adult

Hematologic toxicity: May require temporary dacarbazine treatment interruption or discontinuation.

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Dacarbazine: Pediatric drug information")

Note: For oncology uses, details concerning dosing in combination regimens should also be consulted. Dacarbazine is associated with a high emetic potential; antiemetics are recommended to prevent nausea and vomiting (Ref).

Hodgkin lymphoma, high-risk

Hodgkin lymphoma, high-risk: Limited data available: ABVD regimen: Children and Adolescents: IV: 375 mg/m2 over 30 to 60 minutes on Days 1 and 15 of a 28-day treatment cycle for 2 to 6 cycles in combination with doxorubicin, vinblastine, and bleomycin (Ref).

Melanoma, high-risk

Melanoma, high-risk: Limited data available: Children ≥10 years and Adolescents: IV: 800 mg/m2 over 1 hour on Day 1 only after vinblastine and in combination with cisplatin, interferon alfa-2b every 21 days for 3 cycles (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer’s labeling; experience in adult patients suggests dose adjustment may be necessary; use with caution.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling. May cause hepatotoxicity; monitor closely for signs of toxicity.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Frequency not always defined.

Central nervous system: Infusion-site pain

Dermatologic: Alopecia

Gastrointestinal: Nausea and vomiting (>90%), anorexia

Hematologic & oncologic: Bone marrow depression (onset: 5 to 7 days; nadir: 7 to 10 days; recovery: 21 to 28 days), leukopenia, thrombocytopenia

<1%, postmarketing, and/or case reports: Anaphylaxis, anemia, diarrhea, dysgeusia, eosinophilia, erythema, facial flushing, facial paresthesia, flu-like symptoms (fever, myalgia, malaise), hepatic necrosis, increased liver enzymes (transient), paresthesia, renal function test abnormality, skin photosensitivity, skin rash, urticaria, venous obstruction (hepatic vein)

Contraindications

Hypersensitivity to dacarbazine or any component of the formulation

Canadian labeling: Additional contraindications (not in the US labeling): Prior severe myelosuppression

Warnings/Precautions

Concerns related to adverse effects:

• Anaphylaxis: May occur following dacarbazine administration.

• Bone marrow suppression: Hematologic toxicity is the most common dacarbazine toxicity. Leukopenia and thrombocytopenia may be severe; anemia may also occur. The onset for leukopenia is ~14 days (range: 10 to 30 days) and the duration is ~1 to 3 weeks. The onset for thrombocytopenia is ~18 days (range: 12 to 30 days) and the duration is ~1 to 3 weeks.

• Extravasation: Dacarbazine is an irritant; local reactions may occur (ESMO/EONS [Pérez Fidalgo 2012]). According to the manufacturer, extravasation may result in tissue damage and severe pain.

• Hepatotoxicity: Hepatic necrosis has been reported with dacarbazine. Hepatotoxicity may be accompanied with hepatic vein thrombosis and hepatocellular necrosis; may be fatal. Hepatotoxicity usually occurs with combination chemotherapy, but may occur with dacarbazine alone.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution Reconstituted, Intravenous:

Generic: 100 mg (1 ea); 200 mg (1 ea)

Solution Reconstituted, Intravenous [preservative free]:

Generic: 200 mg (1 ea [DSC])

Generic Equivalent Available: US

Yes

Pricing: US

Solution (reconstituted) (Dacarbazine Intravenous)

100 mg (per each): $13.04

200 mg (per each): $14.40

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution Reconstituted, Intravenous:

Generic: 600 mg (1 ea)

Administration: Adult

Dacarbazine is associated with a high emetic potential; antiemetics are recommended to prevent nausea and vomiting (Ref).

IV: Infuse over 15 to 60 minutes; rapid infusion may cause severe venous irritation. Other infusion durations have been reported; refer to literature and/or regimen for infusion details (may vary by protocol).

Dacarbazine is an irritant; local reactions may occur (Ref). Monitor infusion site.

Administration: Pediatric

Dacarbazine is associated with a high emetic potential; antiemetics are recommended to prevent nausea and vomiting (Ref).

Parenteral: Administer by IV infusion over 15 to 60 minutes; rapid infusion may cause severe venous irritation. Other infusion durations have been reported; refer to literature and/or regimen for infusion details (may vary by protocol).

Dacarbazine is an irritant; local reactions may occur (Ref). Monitor infusion site.

Hazardous Drugs Handling Considerations

Hazardous agent (NIOSH 2016 [group 1]).

Use appropriate precautions for receiving, handling, storage, preparation, dispensing, transporting, administration, and disposal. Follow NIOSH and USP 800 recommendations and institution-specific policies/procedures for appropriate containment strategy (NIOSH 2016; USP-NF 2020).

Use: Labeled Indications

Hodgkin lymphoma: Treatment of Hodgkin lymphoma (in combination with other chemotherapy agents).

Melanoma, metastatic malignant: Treatment of metastatic malignant melanoma.

Use: Off-Label: Adult

Medullary thyroid cancer (advanced or metastatic); Pancreatic neuroendocrine tumors (advanced); Pheochromocytoma (malignant); Soft-tissue sarcomas (advanced or metastatic)

Medication Safety Issues
Sound-alike/look-alike issues:

Dacarbazine may be confused with dactinomycin, procarbazine

High alert medication:

This medication is in a class the Institute for Safe Medication Practices (ISMP) includes among its list of drug classes which have a heightened risk of causing significant patient harm when used in error.

Metabolism/Transport Effects

Substrate of CYP1A2 (minor), CYP2E1 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

5-Aminosalicylic Acid Derivatives: May enhance the myelosuppressive effect of Myelosuppressive Agents. Risk C: Monitor therapy

Abrocitinib: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination

Antithymocyte Globulin (Equine): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Antithymocyte Globulin (Equine). Specifically, these effects may be unmasked if the dose of cytotoxic chemotherapy is reduced. Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Antithymocyte Globulin (Equine). Specifically, infections may occur with greater severity and/or atypical presentations. Risk C: Monitor therapy

Baricitinib: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Baricitinib. Risk X: Avoid combination

BCG (Intravesical): Myelosuppressive Agents may diminish the therapeutic effect of BCG (Intravesical). Risk X: Avoid combination

BCG Products: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of BCG Products. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of BCG Products. Risk X: Avoid combination

Brincidofovir: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Brincidofovir. Risk C: Monitor therapy

Brivudine: May enhance the adverse/toxic effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination

Chloramphenicol (Ophthalmic): May enhance the adverse/toxic effect of Myelosuppressive Agents. Risk C: Monitor therapy

Cladribine: May enhance the myelosuppressive effect of Myelosuppressive Agents. Risk X: Avoid combination

Cladribine: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Cladribine. Risk X: Avoid combination

CloZAPine: Myelosuppressive Agents may enhance the adverse/toxic effect of CloZAPine. Specifically, the risk for neutropenia may be increased. Risk C: Monitor therapy

Coccidioides immitis Skin Test: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the diagnostic effect of Coccidioides immitis Skin Test. Management: Consider discontinuing cytotoxic chemotherapy several weeks prior to coccidioides immitis skin antigen testing to increase the likelihood of accurate diagnostic results. Risk D: Consider therapy modification

COVID-19 Vaccine (Adenovirus Vector): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of COVID-19 Vaccine (Adenovirus Vector). Management: Administer a 2nd dose using an mRNA COVID-19 vaccine (at least 4 weeks after the primary vaccine dose) and a bivalent booster dose (at least 2 months after the additional mRNA dose or any other boosters). Risk D: Consider therapy modification

COVID-19 Vaccine (Inactivated Virus): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of COVID-19 Vaccine (Inactivated Virus). Risk C: Monitor therapy

COVID-19 Vaccine (mRNA): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of COVID-19 Vaccine (mRNA). Management: Give a 3-dose primary series for all patients aged 6 months and older taking immunosuppressive medications or therapies. Booster doses are recommended for certain age groups. See CDC guidance for details. Risk D: Consider therapy modification

COVID-19 Vaccine (Subunit): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of COVID-19 Vaccine (Subunit). Risk C: Monitor therapy

COVID-19 Vaccine (Virus-like Particles): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of COVID-19 Vaccine (Virus-like Particles). Risk C: Monitor therapy

Deferiprone: Myelosuppressive Agents may enhance the neutropenic effect of Deferiprone. Management: Avoid the concomitant use of deferiprone and myelosuppressive agents whenever possible. If this combination cannot be avoided, monitor the absolute neutrophil count more closely. Risk D: Consider therapy modification

Dengue Tetravalent Vaccine (Live): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Dengue Tetravalent Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Dengue Tetravalent Vaccine (Live). Risk X: Avoid combination

Denosumab: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Management: Consider the risk of serious infections versus the potential benefits of coadministration of denosumab and cytotoxic chemotherapy. If combined, monitor patients for signs/symptoms of serious infections. Risk D: Consider therapy modification

Deucravacitinib: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination

Dipyrone: May enhance the adverse/toxic effect of Myelosuppressive Agents. Specifically, the risk for agranulocytosis and pancytopenia may be increased Risk X: Avoid combination

Fexinidazole: Myelosuppressive Agents may enhance the myelosuppressive effect of Fexinidazole. Risk X: Avoid combination

Filgotinib: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination

Fotemustine: May enhance the adverse/toxic effect of Dacarbazine. Specifically, the risk for pulmonary toxicity (adult acute respiratory distress syndrome) may be increased. Management: Do not administer fotemustine and dacarbazine simultaneously, particularly with high doses of dacarbazine. An interval of 1 week should be left between the last dose of fotemustine and the first dose of dacarbazine. Risk D: Consider therapy modification

Inebilizumab: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Inebilizumab. Risk C: Monitor therapy

Influenza Virus Vaccines: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Influenza Virus Vaccines. Management: Administer influenza vaccines at least 2 weeks prior to initiating chemotherapy if possible. If vaccination occurs less than 2 weeks prior to or during chemotherapy, revaccinate at least 3 months after therapy discontinued if immune competence restored. Risk D: Consider therapy modification

Leflunomide: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Leflunomide. Management: Increase the frequency of chronic monitoring of platelet, white blood cell count, and hemoglobin or hematocrit to monthly, instead of every 6 to 8 weeks, if leflunomide is coadministered with immunosuppressive agents, such as cytotoxic chemotherapy. Risk D: Consider therapy modification

Lenograstim: Antineoplastic Agents may diminish the therapeutic effect of Lenograstim. Management: Avoid the use of lenograstim 24 hours before until 24 hours after the completion of myelosuppressive cytotoxic chemotherapy. Risk D: Consider therapy modification

Lipegfilgrastim: Antineoplastic Agents may diminish the therapeutic effect of Lipegfilgrastim. Management: Avoid concomitant use of lipegfilgrastim and myelosuppressive cytotoxic chemotherapy. Lipegfilgrastim should be administered at least 24 hours after the completion of myelosuppressive cytotoxic chemotherapy. Risk D: Consider therapy modification

Mumps- Rubella- or Varicella-Containing Live Vaccines: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Mumps- Rubella- or Varicella-Containing Live Vaccines. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Mumps- Rubella- or Varicella-Containing Live Vaccines. Risk X: Avoid combination

Nadofaragene Firadenovec: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Nadofaragene Firadenovec. Specifically, the risk of disseminated adenovirus infection may be increased. Risk X: Avoid combination

Natalizumab: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Natalizumab. Risk X: Avoid combination

Ocrelizumab: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Ocrelizumab. Risk C: Monitor therapy

Ofatumumab: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Ofatumumab. Risk C: Monitor therapy

Olaparib: Myelosuppressive Agents may enhance the myelosuppressive effect of Olaparib. Risk C: Monitor therapy

Palifermin: May enhance the adverse/toxic effect of Antineoplastic Agents. Specifically, the duration and severity of oral mucositis may be increased. Management: Do not administer palifermin within 24 hours before, during infusion of, or within 24 hours after administration of myelotoxic chemotherapy. Risk D: Consider therapy modification

Pidotimod: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Pidotimod. Risk C: Monitor therapy

Pimecrolimus: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination

Pneumococcal Vaccines: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Pneumococcal Vaccines. Risk C: Monitor therapy

Poliovirus Vaccine (Live/Trivalent/Oral): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Poliovirus Vaccine (Live/Trivalent/Oral). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Poliovirus Vaccine (Live/Trivalent/Oral). Risk X: Avoid combination

Polymethylmethacrylate: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the potential for allergic or hypersensitivity reactions to Polymethylmethacrylate. Management: Use caution when considering use of bovine collagen-containing implants such as the polymethylmethacrylate-based Bellafill brand implant in patients who are receiving immunosuppressants. Consider use of additional skin tests prior to administration. Risk D: Consider therapy modification

Promazine: May enhance the myelosuppressive effect of Myelosuppressive Agents. Risk C: Monitor therapy

Rabies Vaccine: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Rabies Vaccine. Management: Complete rabies vaccination at least 2 weeks before initiation of immunosuppressant therapy if possible. If combined, check for rabies antibody titers, and if vaccination is for post exposure prophylaxis, administer a 5th dose of the vaccine. Risk D: Consider therapy modification

Ritlecitinib: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Ritlecitinib. Risk X: Avoid combination

Ropeginterferon Alfa-2b: Myelosuppressive Agents may enhance the myelosuppressive effect of Ropeginterferon Alfa-2b. Management: Avoid coadministration of ropeginterferon alfa-2b and other myelosuppressive agents. If this combination cannot be avoided, monitor patients for excessive myelosuppressive effects. Risk D: Consider therapy modification

Ruxolitinib (Topical): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Ruxolitinib (Topical). Risk X: Avoid combination

Sipuleucel-T: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Sipuleucel-T. Management: Consider reducing the dose or discontinuing the use of immunosuppressants, such as cytotoxic chemotherapy, prior to initiating sipuleucel-T therapy. Risk D: Consider therapy modification

SORAfenib: May enhance the adverse/toxic effect of Dacarbazine. SORAfenib may increase serum concentrations of the active metabolite(s) of Dacarbazine. Risk C: Monitor therapy

Sphingosine 1-Phosphate (S1P) Receptor Modulator: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk C: Monitor therapy

Tacrolimus (Topical): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Tacrolimus (Topical). Risk X: Avoid combination

Talimogene Laherparepvec: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Talimogene Laherparepvec. Specifically, the risk of infection from the live, attenuated herpes simplex virus contained in talimogene laherparepvec may be increased. Risk X: Avoid combination

Tertomotide: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Tertomotide. Risk X: Avoid combination

Tofacitinib: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Tofacitinib. Risk X: Avoid combination

Typhoid Vaccine: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Typhoid Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Typhoid Vaccine. Risk X: Avoid combination

Ublituximab: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Ublituximab. Risk C: Monitor therapy

Upadacitinib: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Upadacitinib. Risk X: Avoid combination

Vaccines (Inactivated/Non-Replicating): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Give inactivated vaccines at least 2 weeks prior to initiation of chemotherapy when possible. Patients vaccinated less than 14 days before initiating or during chemotherapy should be revaccinated at least 3 months after therapy is complete. Risk D: Consider therapy modification

Vaccines (Live): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Vaccines (Live). Specifically, the risk of vaccine-associated infection may be increased. Vaccines (Live) may diminish the therapeutic effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination

Yellow Fever Vaccine: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Yellow Fever Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Yellow Fever Vaccine. Risk X: Avoid combination

Reproductive Considerations

Dacarbazine is a component of the ABVD regimen used for the treatment of Hodgkin lymphoma; there may be a low risk of amenorrhea and an intermediate risk of azoospermia associated with therapy. Fertility preservation can be discussed prior to therapy (ESMO [Lambertini 2020]; Traila 2018).

Pregnancy Considerations

Teratogenic effects were observed in animal reproduction studies. Outcome data following maternal use of dacarbazine primarily as part of a regimen for the treatment of Hodgkin lymphoma during pregnancy is available (Avilés 2018; Cotteret 2020; Evens 2013; NTP 2013; Pinnix 2016).

Due to pregnancy-induced physiologic changes, some pharmacokinetic properties of dacarbazine may be altered (Kantrowitz-Gordon 2018).

The European Society for Medical Oncology has published guidelines for diagnosis, treatment, and follow-up of cancer during pregnancy. The guidelines recommend referral to a facility with expertise in cancer during pregnancy and encourage a multidisciplinary team (obstetrician, neonatologist, oncology team). In general, if chemotherapy is indicated, it should be avoided during in the first trimester, there should be a 3-week time period between the last chemotherapy dose and anticipated delivery, and chemotherapy should not be administered beyond week 33 of gestation (ESMO [Peccatori 2013]). An international consensus panel has published guidelines for hematologic malignancies during pregnancy. Dacarbazine is a component of the ABVD regimen, which is used for the treatment of Hodgkin lymphoma. If treatment cannot be deferred until after delivery in patients with early stage Hodgkin lymphoma, ABVD may be administered safely and effectively in the latter phase of pregnancy (based on limited data); for patients with advanced-stage disease, ABVD can be administered in the second and third trimesters (Lishner 2016).

A long-term observational research study is collecting information about the diagnosis and treatment of cancer during pregnancy. For additional information about the pregnancy and cancer registry or to become a participant, contact Cooper Health (1-877-635-4499).

Breastfeeding Considerations

It is not known if dacarbazine is present in breast milk.

Due to the potential for serious adverse reactions in the breastfed infant, a decision should be made to discontinue dacarbazine or to discontinue breastfeeding, taking into account the benefits of treatment to the mother.

Monitoring Parameters

CBC with differential, liver function, renal function. Monitor closely for signs of toxicity in patients with hepatic or kidney dysfunction. Monitor infusion site.

The American Society of Clinical Oncology hepatitis B virus (HBV) screening and management provisional clinical opinion (ASCO [Hwang 2020]) recommends HBV screening with hepatitis B surface antigen, hepatitis B core antibody, total Ig or IgG, and antibody to hepatitis B surface antigen prior to beginning (or at the beginning of) systemic anticancer therapy; do not delay treatment for screening/results. Detection of chronic or past HBV infection requires a risk assessment to determine antiviral prophylaxis requirements, monitoring, and follow-up.

Mechanism of Action

Dacarbazine is an alkylating agent which is converted to the active alkylating metabolite MTIC [(methyl-triazene-1-yl)-imidazole-4-carboxamide] via the cytochrome P450 system. The cytotoxic effects of MTIC are manifested through alkylation (methylation) of DNA at the O6, N7 guanine positions which lead to DNA double strand breaks and apoptosis. Dacarbazine is non-cell cycle specific (Marchesi 2007).

Pharmacokinetics (Adult Data Unless Noted)

Distribution: Exceeds total body water; suggesting binding to some tissue (probably liver) (Perry 2012)

Metabolism: Extensively hepatic to the active metabolite MTIC [(methyl-triazene-1-yl)-imidazole-4-carboxamide]

Half-life elimination: Biphasic: Initial: 19 minutes, 55 minutes (renal and hepatic dysfunction); Terminal: 5 hours, 7.2 hours (renal and hepatic dysfunction)

Excretion: Urine (~40%; as unchanged drug)

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AR) Argentina: Dacarbazina Filaxis | Oncocarbil;
  • (AT) Austria: Dacarbazin lipomed | Dacarbazin Medac | Dtic-dome;
  • (AU) Australia: Dacarbazine Sandoz;
  • (BE) Belgium: Dtic;
  • (BG) Bulgaria: Dacarbazin;
  • (BR) Brazil: D.t.i. | Dacarbazina | Fauldacar;
  • (CL) Chile: Deticene;
  • (CO) Colombia: Carbaven | Dacarbazina | Daracina | Deticene | Tiferomed;
  • (CZ) Czech Republic: Dacarbazin | Dacarbazine medac | Dtic;
  • (DE) Germany: Dacarbazin lipomed | Detimedac | Dtic;
  • (EC) Ecuador: Dacarbazina | Deticene;
  • (EE) Estonia: Dacarbazin Medac | Deticene;
  • (ES) Spain: Dacarbazina almirall | Dacarbazina medac;
  • (ET) Ethiopia: Oncodac;
  • (FI) Finland: Dacarbazine lipomed | Dacarbazine medac | Dacatic;
  • (FR) France: Dacarbazine Dci | Dacarbazine lipomed | Dacarbazine medac | Deticene;
  • (GB) United Kingdom: Dacarbazine;
  • (GR) Greece: Dacarbazine medac | Dacarbazine/medac | Dacarbion | Deticene;
  • (HR) Croatia: Dacarbazine Pliva;
  • (HU) Hungary: Dacin lipomed | Dakarbazin | Dakarbazin medac | Deticene;
  • (ID) Indonesia: Dacarbazine medac;
  • (IN) India: Celdaz | Dabaz | Dacarzine | Decarb | Zicarb;
  • (IT) Italy: Dacarbazina lipomed | Dacarbazina medac | Deticene;
  • (KR) Korea, Republic of: Deticene | Deticin | Detimedac | DTI | Dtic-dome;
  • (LT) Lithuania: Celdaz | Dacarbazin | Dacarbazine medac | Deticene | Detimedac | Dtic;
  • (LV) Latvia: Dacarbazin Medac | Deticene | Dtic;
  • (MX) Mexico: Acocarb | Dacarbazina | Deticeme | Detilem | Ifadac | Tiferomed;
  • (NL) Netherlands: Dacarbazin | Dacarbazine medac | Deticene;
  • (NO) Norway: Dacarbazine lipomed | Dacarbazine medac;
  • (PE) Peru: Dacarbazina | Deticene;
  • (PH) Philippines: Arzi | Duticin;
  • (PK) Pakistan: Darbazine | Decarb;
  • (PL) Poland: Dacarbazin | Dacarbazine medac | Dacin | Deticene | Detimedac | Dtic;
  • (PR) Puerto Rico: Dacarbazine | Dtic-dome;
  • (PT) Portugal: Dacarbazina | Deticene | Detimedac | Fauldetic;
  • (PY) Paraguay: Dacarbazina cipla | Dacarbazina fusa | Dacarzin;
  • (RO) Romania: Dacarbazina lipomed | Dacarbazine medac | Daltrizen;
  • (RU) Russian Federation: Dacarbazin | Dacarbazine lens | Dacarbazine medac | Dakarbazin;
  • (SA) Saudi Arabia: Dacarbazine | Dacarbazine medac | Dacin | Deticene;
  • (SE) Sweden: Dacarbazine medac;
  • (SI) Slovenia: Dacarbazin | Dacarbazine App | Dacarbazine lipomed | Dacin | Detimedac | DTIC-Dome;
  • (SK) Slovakia: Dacarbazin | Dakarbazin medac;
  • (TH) Thailand: Dacarbazine medac | Dacmed;
  • (TN) Tunisia: Dacin | Deticene | Detimedac;
  • (TR) Turkey: Dakarbaz | Deticene;
  • (TW) Taiwan: Dtic-dome;
  • (UA) Ukraine: Dacarbazin | Dacarbazin Medac | Dacarbazine lens | Dacin;
  • (UY) Uruguay: Dacarbazina | Dacarbazina Filaxis | Dacarzin | Oncocarbil;
  • (ZA) South Africa: Dacin | Dtic-dome;
  • (ZM) Zambia: Decarb;
  • (ZW) Zimbabwe: Arzi
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