Trabectedin

Trabectedin is an alkylating agent, which works to slow or stop growth of cancer cells in the patient’s body.

Overview

Trabectedin is an injection given over a 24-hour period to patients who suffer from certain types of cancer. It is used to treat liposarcoma and leiomyosarcoma. These types of cancer begin in fat cells or in smooth muscle tissue, respectively. This treatment is used if surgery to remove the cancer is out of the question and other parts of the patient's body have been affected.

A patient receiving this medication will already have undergone chemotherapy treatment. It is generally administered every three weeks during treatment. As a medication, trabectedin is classified as an alkylating agent, which halts the growth of, or at least hinders, the spread of the disease in areas of the body affected.

The medication Yondelis can offer the possibility of recovery to patients that have found other treatments for their liposarcoma or leiomyosarcoma insufficient or ineffective. There are negative side effects and complications associated with the use of this medication, and very rarely they may be serious or fatal.

Conditions treated:

  • Liposarcoma
  • Leiomyosarcoma

Type of Medicine:

  • Alkylating agent

Side Effects

The most common side effects associated with the use of trabectedin include tiredness, headache, joint pain, body aches, constipation, diarrhea, decreased appetite, and difficulty sleeping or falling asleep. It is common for patients using new medications to experience side effects at first, but these dissipate after the body has become more accustomed to treatment. If the patient experiences any of these side effects and they persist or worsen over time, they should contact their doctor.

Nausea and vomiting may occur, and there is the possibility that it may be severe. The patient’s doctor may prescribe medication to prevent or relieve this side effect, often administering it prior to the dose of trabectedin. If the patient experiences severe nausea and vomiting, they should contact their doctor immediately. Some strategies to help to prevent or lessen these effects include planning the day so that the patient eats several smaller meals rather than large ones, making sure not eat before treatment, and limiting physical activity as much as possible.

Certain side effects, though rare, may be cause for concern and the patient should alert their doctor immediately if they experience the following:

  • discomfort where the medication was injected, including itching, swollen skin, or redness of the skin
  • dizzy spells or feeling lightheaded, lapses in concentration, or confusion
  • yellowing of the eyes or skin(jaundice)
  • chest pain or tightness, wheezing, difficulty breathing
  • swelling of the legs, ankles, feet, or face
  • fever or fever-like symptoms

Pain, tenderness, or weakness in the muscles may indicate rhabdomyolysis. If the patient experiences these symptoms or signs of kidney problems (e.g. a change in the amount of urine), they should contact their doctor.

Patients that experience unusual bruising, bleeding, tiredness or paleness should contact their doctor immediately, in case they are suffering from myelosuppression as a result of taking trabectedin.

Side effects associated with liver problems are increased if the patient drinks alcoholic beverages. Yellowing of the eyes or skin (jaundice), dark urine, severe stomach or abdominal pain, or persistent nausea and/or vomiting may be associated with the patient’s liver problems and the effects of this medication. The patient should not drink alcohol while taking trabectedin.

Chest pain, trouble breathing, coughing up blood, swelling of the ankles or feet, sudden unexplained weight gain, severe tiredness, or fast heartbeat may indicate a blood clot in the lungs or serious heart problems related to taking this medication. These side effects are rare but should be taken seriously if they occur.

This is not a comprehensive list of side effects. The patient may experience other side effects related to the use of trabectedin. If the symptoms seem serious or the patient experiences high levels of discomfort, they should contact their doctor.

Dosage

Trabectedin is a powder that is mixed with a liquid and injected into the vein of the patient over a 24-hour period by a doctor or health care professional in a medical facility. The dosage is 1 milligram (mg) of lyophilized powder, found in a single-dose vial. The injection is generally administered every three weeks during treatment of trabectedin.

Often, the doctor will order a corticosteroid (e.g. dexamethasone, 20 milligrams [mg]) shot to lower the risk of liver problems or prevent certain common side effects (e.g. nausea or vomiting). This is usually administered 30 minutes prior to the dose of trabectedin.

Individual dosage is up to the patient’s doctor and will take into account variables such as height, weight, condition, response to treatment, lab results, among others. Patients should follow all instructions given by their doctor and/or the health professional who is administering the medication.

Interactions

Certain medications may affect the body’s removal of trabectedin, possibly affecting its rate of success and/or possible side effects. These medications include, but are not limited to:

  • antifungals (e.g. fluconazole, ketoconazole, posaconazole)
  • macrolide antibiotics (e.g. clarithromycin)
  • HIV drugs (e.g. ritonavir, lopinavir, nelfinavir)
  • rifamycins (e.g. rifabutin)
  • St. John’s wort
  • Drugs used to treat seizures (e.g. carbamazepine, phenobarbital, primidone)

Eating grapefruit or drinking grapefruit juice while taking Trabectedin will have a negative effect on treatment and the patient should avoid it.

The patient should tell their doctor about all prescription and non-prescription medications they have taken or are currently taking. They should also be sure to include vitamins, nutritional supplements, and herbal products (especially St. John’s wort), as they may contribute to side effects while taking trabectedin.

Warnings

The patient should tell their doctor if they are allergic to trabectedin or any other medications. The patient should also disclose other allergies, as this medication may contain inactive ingredients that may cause a reaction.

Patients with low blood counts, liver disease (e.g. hepatitis), kidney disease, or recent or current infections should notify their doctor and discuss the pros and cons of using trabectedin. The decision to use this medication will depend on the patient’s unique history with these conditions and the professional opinion of their doctor. It may be the case that the patient’s medical history prevents the doctor from recommending use of trabectedin, or that the doctor will prescribe other medications to be used concurrently with trabectedin as a countermeasure.

This medication should be avoided if the patient is pregnant, plans on becoming pregnant, or is currently breastfeeding. Use of this medication may be harmful to the baby in-utero. Not enough research has been done to determine if this medication passes into breast milk, but patients are advised not to breastfeed while using trabectedin, and to refrain from doing so for three months after treatment has ended.

Using this medication may affect your ability to have children in the future, for both men and women. Reliable forms of birth control (e.g. birth control pills, condoms) should be used during treatment and continue to be used for three months after treatment for women and five months after treatment for men to prevent complications. This medication may damage men’s sperm and patients should be sure to use contraception if engaging in sexual intercourse.

Patients using trabectedin should not receive immunizations or vaccinations without talking with their doctor first and avoid contact with people that have been recently vaccinated, especially those receiving live vaccines (e.g. flu vaccines inhaled through the nose).

Serious allergic reaction to this medication may occur, including anaphylaxis. If the patient experiences a rash, itching, trouble breathing, trouble swallowing, or swelling after taking this medication, they should contact their doctor immediately. Anaphylaxis can be life-threatening and requires immediate medical attention.

Using this medication may contribute to a higher likelihood of infection or worsen existing infections. As a precaution, it is recommended that the patient should wash their hands frequently to avoid germs and avoid contact with people suffering from infections that may be contagious such as chickenpox, measles, or flu. If the patient suspects they have been exposed to an infection, they should contact their doctor.

The use of alcohol or marijuana in concurrence with trabectedin may exacerbate certain symptoms, such as feeling tired or weak. The patient should not drive, operate machinery, or perform activities that require alertness if they experience these symptoms. Alcohol can increase the risk of liver problems and should be avoided by patients taking trabectedin.

There is currently little information regarding the medication’s possible negative effects on pediatric and geriatric patients. Patients (or guardians of patients) who are children or are advanced in age should consult their doctor.

The patient should tell their doctor or dentist all medications they are taking prior to having surgery so as to avoid interactions and possible infections.

The patient should not take other medications (including over-the-counter), vitamins, nutritional supplements, or herbal products (especially St. John’s wort) concurrently with trabectedin without consulting their doctor first.

Storage

Trabectedin will be stored and administered at a healthcare facility by a trained professional, whether it is a doctor, nurse, or other medical professional. 1 milligram (mg) single-use vials of the medication are to be stored in a refrigerator. Trabectedin is a cytotoxic drug and should be handled with all the necessary precautions.

Summary

The use of trabectedin to combat liposarcoma and leiomyosarcoma has the potential to slow or stop the growth of new cancer cells after the disease has spread to other parts of the patient’s body. This medication is used after the patient has undergone other treatments such as chemotherapy and the cancer may not possibly be removed by surgery.

There are negative side effects and potential complications that could occur with the use of trabectedin, and it is up to the doctor and patient to consider whether the potential benefits outweigh the potential negative effects. It is essential that the patient is forthright about previous medical conditions (such as liver disease, to mention one example) and their full regimen of medications (both prescription and non-prescription), vitamins, nutritional supplements, and herbal products to ensure that the patient does not have any unintended reactions to the medication. Failure to disclose information could be serious, or even fatal.

Trabectedin is administered in a health facility by a trained professional, usually every 3 weeks while the patient is undergoing treatment. The patient is required (for their own health) to refrain from certain activities during treatment or to take special care while taking this medication. In particular, pregnancy or sexual intercourse without birth control (for both men and women) is out of the question during, and for a period following, treatment.

Trabectedin could be a life-saving medication for the right patient, who may have exhausted their other options for the treatment of cancer. Patients that are interested in using trabectedin to treat liposarcoma or leiomyosarcoma that has spread to other parts of the body should talk to their doctor to see if they are a good candidate to receive this treatment.

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Last Reviewed:
December 24, 2017
Last Updated:
December 22, 2017
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