Trabectedin is a chemotherapy drug that is given to people with advanced soft tissue sarcoma when other chemotherapy drugs have failed or are not suitable because of side effects.
It’s also used to treat ovarian cancer that has come back after previous treatment has failed.
This information should ideally be read with our general information about chemotherapy and your type of cancer.
The National Institute for Health and Clinical Excellence (NICE) give advice on which new drugs or treatments should be available on the NHS in England and Wales. The Scottish Medicines Consortium (SMC) is an organisation similar to NICE for the NHS in Scotland.
Trabectedin has been recommended by NICE for the treatment of soft tissue sarcoma in England and Wales. However, it has not been recommend for the treatment of ovarian cancer. The SMC hasn’t approved the use of trabectidin for either soft tissue sarcoma or ovarian cancer. You can read our section on access to cancer treatment for more information on the availability of cancer treatments.
You'll see your doctor regularly while you have this treatment so they can monitor the effects of the chemotherapy.
What trabectedin looks like
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Trabectedin is a white powder that's dissolved to form a colourless fluid.
Trabectedin is given as a drip (infusion):
through a fine plastic tube that is inserted under the skin and into a vein near the collarbone (central line)
into a fine tube that is inserted into a vein in the crook of your arm (PICC line).
To help prevent some of the side effects of trabectedin, you will be given an injection of a steroid drug 30 minutes before the chemotherapy. The steroid is injected into your central or PICC line.
Treating soft tissue sarcoma
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The trabectedin infusion will take about 24 hours, and you will usually have it during an overnight stay in hospital. It may be possible to give the infusion using a lightweight, portable pump that you can go home with. The pump will need to be disconnected after 24 hours and your line flushed. Your hospital team can show you how to do this or organise for a district nurse to do it for you. Alternatively, you may have to return to the hospital so the hospital team can disconnect the pump.
The trabectedin infusion will be repeated every three weeks.
Treating ovarian cancer
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Before having the trabectedin, you will first be given the chemotherapy drug pegylated liposomal doxorubicin (PLD) as an infusion into your line. This is then followed by the infusion of trabectedin, which will take about three hours. The treatment is usually given as an outpatient and will be repeated every three weeks.
Chemotherapy is usually given as a course of several sessions (cycles) of treatment over several months. The length of your treatment and the number of cycles you have will depend on your progress and how well you feel. Your doctor or nurse will discuss your treatment plan with you.
Before you have your treatment you doctor will arrange for you to have blood tests. You will usually be given anti-sickness drugs before and/or during your treatment.
Each person’s reaction to chemotherapy is different. Some people have very few side effects while others may experience more. The side effects described here won’t affect everyone who is given trabectedin and may be different if you're having PLD as well.
We’ve outlined the most common side effects but haven’t included those that are rare and therefore unlikely to affect you.
If you notice any effects that aren't listed here, discuss them with your doctor or nurse.
Risk of infection
Trabectedin can reduce the number of white blood cells, which help fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low, you'll be more prone to infections. A low white blood cell count is called neutropenia.
Neutropenia begins seven days after treatment, and your resistance to infection is usually at its lowest 10-14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straight away if:
your temperature goes above 38°C (100.4°F)
you suddenly feel unwell, even with a normal temperature.
You will have a blood test before having more chemotherapy to check the number of white cells. Occasionally, your treatment may need to be delayed if your number of blood cells (blood count) is still low.
Bruising and bleeding
Trabectedin can reduce the production of platelets, which help the blood to clot. Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You can have a platelet transfusion if your platelet count is low.
Trabectedin can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if the number of red blood cells becomes too low.
Feeling sick (nausea) and being sick (vomiting)
This may begin soon after the treatment is given and can last for a few days. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If the sickness isn't controlled, or if it continues, tell your doctor; they can prescribe other anti-sickness drugs that may be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Loss of appetite
Some people lose their appetite while they’re having chemotherapy. This can be mild and may only last a few days. If it doesn’t improve you can ask to see a dietitian or specialist nurse at your hospital. They can give you advice on improving your appetite and keeping to a healthy weight. You might find our section on eating well useful.
Feeling tired is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with taking some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
Trabectedin can cause changes in the way that your liver works, although your liver will return to normal when the treatment has finished. Your skin and the whites of your eyes may become yellow (jaundiced). The doctor will take regular blood samples to check your liver is working properly.
Some people find that trabectedin causes headaches. Let your doctor or nurse know. They can give you painkillers to relieve this.
Some people may feel dizzy or light headed. Tell your doctor if you have any of these side effects.
You may get constipated. This can usually be helped by drinking plenty of fluids, eating more fibre and doing some gentle exercise. You may need to take medicine (laxative) to help. Your doctor can prescribe these or you can buy them at a pharmacy.
Less common side effects
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You may notice that food tastes different. Normal taste usually comes back after treatment finishes. A dietitian or specialist nurse at your hospital can give you advice about ways of coping with this side effect.
Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Some people find that sucking on ice may be soothing. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections. You may find our section on mouth care during chemotherapy helpful
This is rare with this treatment, but your hair may become thinner. If you lose any hair it will grow back once the treatment has finished. Your nurse can give you advice about coping with hair loss.
Trabectedin can cause diarrhoea. This can usually be easily controlled with medicine but tell your doctor if it is severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
Muscle/joint pain and weakness
You may develop muscle pain and weakness. You should let your doctor or nurse know if these symptoms occur. If they are severe, you should let your doctor know straight away.
Always let your doctor or nurse now about any side effects you have. There are usually ways in which they can be controlled or improved.
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Risk of developing a blood clot
Cancer can increase the risk of developing a blood clot (thrombosis), and chemotherapy may increase this risk further.
A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it’s important to tell your doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood. The doctor or nurse can give you more information.
Some medicines, including those that you can buy in a shop or chemist, can be harmful to take when you are having chemotherapy. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Your ability to become pregnant or father a child may be affected by this treatment. It’s important to discuss fertility with your doctor before starting treatment.
It’s not advisable to become pregnant or father a child while taking trabectedin, as it may harm the developing baby. It’s necessary to use effective contraception while taking this drug and for at least a few months afterwards. You can discuss this with your doctor or nurse.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you are having chemotherapy treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.
This section is based on our trabectedin factsheet which has been compiled using information from a number of reliable sources, including:
electronic Medicines Compendium (eMC). www.medicines.org.uk (accessed October 2011).
British National Formulary. 62nd edition. 2011. British Medical Association and Royal Pharmaceutical Society of Great Britain.
Trabectedin for the treatment of advanced soft tissue sarcoma. 2010. National Institute for Health and Clinical Excellence (NICE).
Demetri, et al. Efficacy and safety of trabectedin in patients with advanced or metastatic liposarcoma or leiomyosarcoma after failure of prior anthracyclines and ifosfamide: Results of a randomized phase II study of two different schedules. Journal of Clinical Oncology. 2009. 27:25: 4188-4196.
Schoffski P, et al. Clinical impact of trabectedin (ecteinascidin-743) in advanced soft tissue sarcoma. Expert Opinion Pharmacotherapy. 2008. 9 (9): 1609-1618.