Trabectedin (Yondelis)

Trabectedin is a chemotherapy drug used to treat a number of types of advanced cancers. This includes advanced soft tissue sarcoma for people who have had treatment with ifosfamide and an anthracycline chemotherapy such as doxorubicin. Researchers are also looking at it as a treatment for breast cancer and womb cancer.

Trabectedin works by sticking to the DNA in cells and damaging it. This stops the cancer cells growing and multiplying.

You have trabectedin into your bloodstream (intravenously). You can have it through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it.

You usually have chemotherapy as a course of several cycles of treatment. The number of cycles of treatment you have depends on your treatment plan. The treatment plan for trabectedin depends on which type of cancer you have.

For soft tissue sarcoma you have trabectedin through a drip for 24 hours. Once the drip has finished you have no treatment for 3 weeks. Then you have your next treatment.

For ovarian cancer you have the drip for 3 hours the first time. If this goes well you can have the next treatment over an hour. You have treatment every 3 weeks.

You usually continue having the trabectedin for as long as it works.

There is detailed information about the way doctors plan chemotherapy in the planning chemotherapy section.

The side effects associated with trabectedin are listed below. You can use the links to find out more about each side effect. For general information, see our cancer drugs side effects section.

More than 10 in every 100 people have one or more of the side effects listed below.

Temporary drop in the number of blood cells made by the bone marrow, causing

• Increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
• Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your doctor if you have any of these effects. Your doctor will check your blood counts before and during your treatment to see how well your bone marrow is working.

Other common side effects include

• Fatigue during and after treatment – most people find that they are back to normal after about 6 months
• Feeling or being sick happens in about 7 out of every 10 people (70%), but is usually well controlled with anti sickness drugs
• Headache in 1 in 4 people (25%)
• Taste changes
• Dizziness
• Constipation in just over 3 out of 10 people (30%) – your doctor may give you laxatives to help prevent this but do tell them if you are constipated for more than 3 days
• Loss of appetite happens in 1 out of 5 people (20%)
• A sore mouth
• Indigestion
• Liver changes that are mild and unlikely to cause any symptoms – this normally goes back to normal once the treatment ends. You will have regular blood tests to check how well your liver is working
• Abdominal pain
• Shortness of breath and a cough in just over 1 in 10 people (10%)
• Trabectidin may have a harmful effect on a developing baby – do talk to your doctor about contraception before having treatment if there is any chance that you or your partner could become pregnant
• Loss of fertility – we don’t know exactly how this drug affects fertility in women but some men are permanently infertile after treatment. It is important to talk to your doctor before starting treatment if having a baby is important to you

Between 1 and 10 in every 100 people have one or more of these.

• Numbness or tingling in fingers and toes that can cause difficulty with fiddly things such as doing up buttons – this starts within a few days or weeks and usually goes within a few months of finishing treatment
• Diarrhoea affects up to 1 out of 10 people (10%) – drink plenty of fluid and tell your doctor if it becomes severe, or continues for more than 3 days
• Hair thinning
• Painful joints
• Difficulty in sleeping
• Kidney changes – you will have regular blood tests to check how well your kidneys are working and will have fluids to flush the drugs through
• Fluid retention – your ankles may swell and you may put on weight

You won’t get all these side effects. Any that you do get may be mild. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on

• How many times you've had a drug before
• Your general health
• How much of the drug you have (the dose)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies – some drugs can react together.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.