trabectedin at a glance
Medicine class
Cytotoxic antineoplastic agent
Usual uses
Selected advanced soft tissue sarcomas and relapsed platinum-sensitive ovarian cancer
Administration
Given by intravenous infusion under specialist oncology supervision; central venous access is strongly recommended
Important monitoring
Blood counts, liver and kidney function, creatine phosphokinase and cardiac function
What is trabectedin used for?
UK licensed uses represented by the selected product are:
Advanced soft tissue sarcoma in adults after anthracyclines and ifosfamide have failed, or when these treatments are unsuitable; evidence is mainly from liposarcoma and leiomyosarcoma.
Relapsed platinum-sensitive ovarian cancer, used with pegylated liposomal doxorubicin.
How does trabectedin work?
Trabectedin binds within the minor groove of DNA and bends the DNA helix. This disrupts transcription factors, DNA-associated proteins and repair pathways, disturbing the cell cycle and limiting tumour-cell growth; effects on the tumour microenvironment may also contribute.
trabectedin preparations and strengths
Solution for infusion
Route: Intravenous
Strengths: 0.25 mg, 1 mg
How to take trabectedin
Trabectedin is prepared and given as an intravenous infusion by a specialist cancer team. Central venous access is strongly recommended because leakage into surrounding tissue can cause severe injury.
A corticosteroid and anti-sickness treatment are given beforehand to reduce nausea and help protect the liver.
The powder is reconstituted and diluted by trained staff using cytotoxic-handling precautions.
Tell staff immediately about pain, burning, swelling or leakage near the infusion line.
trabectedin side effects
Common or expected effects
- Low white blood cells, platelets or red blood cells
- Nausea, vomiting, reduced appetite, diarrhoea or constipation
- Tiredness, fever or headache
- Temporary increases in liver enzymes or bilirubin
- Abdominal pain, mouth inflammation, cough or breathlessness
Get urgent medical advice
- Fever or infection associated with low white blood cells, including sepsis
- Severe liver injury or jaundice
- Severe muscle breakdown, sometimes with kidney injury
- Allergic reaction or breathing difficulty
- Capillary leak syndrome causing unexplained swelling and low blood pressure
- Infusion leakage causing tissue damage
- Cardiac dysfunction or pulmonary complications
trabectedin in pregnancy
Trabectedin should not normally be used during pregnancy because its mechanism indicates a risk of serious fetal harm. People who could become pregnant should use highly effective contraception during treatment and for 8 months afterwards; pregnancy should be reported immediately so specialist review and possible genetic counselling can be arranged. Men who could father a child should use highly effective contraception during treatment and for 5 months afterwards.
trabectedin while breastfeeding
Breastfeeding is contraindicated during trabectedin treatment and for 3 months afterwards because transfer into human milk is unknown and serious effects in a breastfed child are possible.
trabectedin interactions
The oncology team should review prescribed, over-the-counter and herbal products before treatment.
Potent CYP3A4 inhibitors, including clarithromycin, azole antifungals, ritonavir and aprepitant
May increase trabectedin exposure and toxicity; avoid where possible or monitor closely.
Strong CYP3A4 inducers, including rifampicin, phenobarbital and St John’s wort
May reduce trabectedin exposure and should be avoided where possible.
Phenytoin
Trabectedin may reduce phenytoin absorption and worsen seizure control; the combination is not recommended.
Common questions about trabectedin
Answers are fully visible for fast scanning and source review.
Why is a steroid given before trabectedin?
It helps prevent nausea and vomiting and provides protection against liver toxicity.
Can trabectedin lower blood counts?
Yes. Neutropenia, thrombocytopenia and anaemia are very common, so regular blood counts are required.
Why are liver tests needed with trabectedin?
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.