Trabectedin(Yondelis) is a drug that exerts anti-lesional effects by targeting guanine residues in the minor groove of DNA. Its unique molecular mechanism makes it an important choice for the treatment of specific advanced sarcomas.

Indications, efficacy and effects of Trabectedin

Core indications and target mechanisms

Trabectedin is suitable for unresectable or metastatic liposarcoma or leiomyosarcoma that has been treated with anthracyclines before. The drug interferes with the transcriptional repair process of diseased cells and induces cell apoptosis by embedding into the minor groove of DNA. Clinical data show that it can prolong progression-free survival (PFS) and improve the quality of life of patients.

Efficacy advantages and limitations

Compared with traditional chemotherapy, trabectedin has a regulatory effect on the lesion microenvironment and can reduce the infiltration of immunosuppressive cells. However, the drug has restrictions on patients with abnormal liver function and is contraindicated for patients with severe liver damage (bilirubin>3 times the upper limit of normal value). The specification of Johnson & Johnson's original drug in the United States is 1mg/box, and the price is about US$1,354. It needs to be obtained through cross-border medical channels.

After understanding the therapeutic value of the drug, patients need to master the standardized medication method. The following content will explain the dosage and infusion requirements in detail.

Usage and dosage of trabectedin

Trabectedin needs to be administered through central venous infusion. Strict dose adjustment and pretreatment are the key to ensuring efficacy and safety.

Standard dose and infusion process

The recommended dose is 1.5mg/m², infused once every 21 days, each time for 24 hours. Dexamethasone 20mg needs to be injected intravenously 30 minutes before infusion to prevent allergic reactions. The drug needs to be reconstituted with 20mL of sterile water, diluted in 500mL of 0.9% sodium chloride or 5% glucose solution, and infused using a 0.2 micron filter. The whole process must be completed within 30 hours.

Dose adjustment for patients with liver damage

The dose for patients with moderate liver damage (bilirubin 1.5-3 times the upper limit of normal value) is adjusted to 0.9mg/m². During the infusion, it is necessary to avoid light. If the reconstituted solution changes color or contains particles, it must be discarded. Unopened drugs must be refrigerated at 2-8℃, and the remaining solution after opening must not be stored.

Standardized medication procedures can reduce treatment risks. The following content will analyze common side effects and coping strategies.

Side effects and precautions of trabectedin

Trabectedin may cause a variety of serious adverse reactions, and regular monitoring and timely intervention are required to ensure patient safety.

Common side effects and monitoring indicators

More than 20% of patients experience nausea, fatigue, neutropenia, and elevated transaminases. Neutrophil count, liver function (ALT/AST), and creatine phosphokinase (CK) should be tested before each medication. If neutrophils are <1.0×10⁹/L or CK is >5 times the upper limit of normal, the medication should be suspended and white blood cell injections or hydration therapy should be given.

Serious risks and contraindications

Trabectedin may cause rhabdomyolysis, cardiomyopathy, or capillary leak syndrome. Before treatment, cardiac function should be assessed by echocardiography, and reexamination should be performed every 2-3 months during treatment. Pregnant women and their partners should strictly practice contraception during treatment and within 2-5 months after discontinuation of medication to avoid the risk of fetal exposure.

Avoid combined use with strong CYP3A inhibitors (such as ketoconazole) or inducers (such as rifampicin) during treatment. If muscle pain, urine discoloration, or difficulty breathing occurs, seek medical attention immediately. Central venous infusion can reduce the risk of extravasation. Patients need to participate in multidisciplinary follow-up regularly, combined with nutritional support and psychological intervention to maximize treatment tolerance.