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Care During Chemotherapy and Beyond

Trabectedin

(tra BEK te din)

Trade Name: Yondelis®

Trabectedin is the generic name for the trade name drug Yondelis®. In some cases health care professionals may use the trade name Yondelis® when referring to the generic drug name trabectedin.

Drug Type: Trabectedin is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. Trabectedin is classified as an "alkylating agent." (For more detail, see "How trabectedin works" section below).

What Trabectedin Is Used For:

  • The treatment of patients with unresectable or metastatic liposarcoma or leiomyosarcoma who received a prior anthracycline-containing regimen

Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.

How Trabectedin Is Given:

  • As a 24-hour IV (intravenous) infusion, every 3 weeks.
  • The amount of trabectedin that you will receive depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition being treated. Your doctor will determine your exact dosage and schedule.

Side Effects:

Important things to remember about the side effects of trabectedin:

  • Most people do not experience all of the side effects listed.
  • Trabectedin side effects are often predictable in terms of their onset and duration.
  • Trabectedin side effects will improve after therapy is complete.
  • Trabectedin side effects may be manageable. There are many options to help minimize or prevent the side effects of trabectedin.

The following common side effects are reported (occurring in greater than 30%) for patients taking trabectedin:

These are less common side effects (occurring in about 10-29%) for patients receiving trabectedin:

Not all side effects are listed above. Some that are rare (occurring in less than 10% of patients) are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms.

When to contact your doctor or health care provider:

Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:

  • Fever of 100.4° F (38° C) or higher, chills (possible signs of infection)
  • Any leaking of trabectedin outside of your vein or around the catheter site during the infusion, or if you notice any redness, swelling, itching or discomfort at the infusion site at any time. If trabectedin leaks into the tissues around the infusion site there is potential for tissue damage
  • Chest discomfort or fast, irregular heart beat
  • Shortness of breath

The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following:

  • Severe muscle pain or weakness
  • Swelling of legs, ankles or feet
  • Yellowing of the skin or eyes
  • Right sided upper abdominal pain
  • Nausea (interferes with ability to eat and unrelieved with prescribed medication)
  • Vomiting (vomiting more than 4-5 times in a 24 hour period)
  • Problems concentrating, confusion, sleepiness
  • Unusual bleeding or bruising
  • Black or tarry stools, or blood in your stools or urine
  • Extreme fatigue (unable to carry on self-care activities)
  • Diarrhea (4-6 episodes in a 24-hour period)
  • Signs of an infection (sore throat; ear or sinus pain; cough; more sputum or change in color of sputum; mouth sores or pain with urination)
  • Redness or irritation of the palms of hands or soles of the feet
  • Burning, tingling or numbness of fingers or toes
  • Signs of low potassium (muscle pain or weakness; muscle cramps)

Always inform your health care provider if you experience any unusual symptoms.

Precautions:

  • Before starting trabectedin treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.) Do not take aspirin, or products containing aspirin unless your doctor specifically permits this.
  • Before starting any over-the-counter, vitamin, or herbal remedies please consult your doctor or healthcare provider.
  • Avoid grapefruit and grapefruit juice during treatment with trabectedin.
  • Avoid drinking alcohol.
  • Use a soft toothbrush or electric razor.
  • Do not receive any kind of immunization or vaccination without your doctor's approval while taking trabectedin.
  • Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Trabectedin may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus.
  • For both men and women: Do not conceive a child (get pregnant) while taking trabectedin. Barrier methods of contraception, such as condoms, are recommended during treatment and for 5 months after treatment is complete if you are a man and when for 3 months after treatment ends if you are a woman. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
  • Do not breast feed while taking trabectedin.

Self-Care Tips:

  • Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
  • You may be at risk of infection so try to avoid crowds or people with colds and those not feeling well, and report fever or any other signs of infection immediately to your health care provider.
  • Wash your hands often.
  • Use an electric razor and a soft toothbrush to minimize bleeding.
  • Avoid contact sports or activities that could cause injury.
  • If you should experience nausea, take anti-nausea medications as prescribed by your doctor, and eat small frequent meals. Sucking on lozenges and chewing gum may also help.
  • In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
  • Get plenty of rest.
  • Maintain good nutrition.
  • If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing:

You will be checked regularly by your health care professional while you are taking trabectedin, to monitor side effects and check your response to therapy. Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor.

How Trabectedin Works:

Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue. "Normal" cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition. Cancerous cells lose this ability. Cancer cells no longer have the normal checks and balances in place that control and limit cell division. The process of cell division, whether normal or cancerous cells, is through the cell cycle. The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division).

The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division. Usually, the drugs work by damaging RNA or DNA that tells the cell how to copy itself in division. If the cells are unable to divide, they die. The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink. They also induce cell suicide (self-death or apoptosis).

Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific. Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific. The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective. This is why chemotherapy is typically given in cycles.

Chemotherapy is most effective at killing cells that are rapidly dividing. Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The "normal" cells will grow back and be healthy but in the meantime, side effects occur. The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss. Different drugs may affect different parts of the body.

Trabectedin is classified as an alkylating agent. Alkylating agents are most active in the resting phase of the cell. These drugs are cell-cycle non-specific. There are several types of alkylating agents classified according to the substances with which they interfere.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

References:

Trabectedin. Lexicomp Online® [updated 2015 October 27th; cited 2015 October 30th]. Lexi-Drugs®. Hudson, Ohio: Lexi-Comp, Inc.; October 30th, 2015.

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