# Trabectedin

Source: https://onco.cc/drugs/trabectedin/  
OnCo record `trabectedin` (Treatment). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A chemotherapy derived from a sea squirt, used with liposomal doxorubicin in relapsed ovarian cancer in Europe and for sarcomas.

## Summary

Trabectedin is a cytotoxic derived from a sea squirt that binds the DNA minor groove, bends the DNA, blocks transcription-coupled repair and modulates tumour-associated macrophages. In ovarian cancer, OVA-301 showed a PFS benefit with pegylated liposomal doxorubicin in partially platinum-sensitive relapse; the EU approved the combination in 2009, the US never did for this indication, and INOVATYON found no OS advantage over platinum. In sarcoma it is approved in the EU (2007) after anthracycline or ifosfamide and in the US (2015) for liposarcoma and leiomyosarcoma after anthracycline. Grade 3 to 4 neutropenia and ALT elevation are the main toxicities, so liver function is monitored. It is a niche chemotherapy with a distinctive mechanism, most valuable in specific sarcoma subtypes.

## Fields

- Kind: Treatment
- Status: approved
- Last checked: 2026-09-07
- Brand: Yondelis
- Modality: Cytotoxic (DNA minor-groove binder)
- Mechanism: Binds the DNA minor groove, bends DNA, blocks transcription-coupled repair, and modulates tumour-associated macrophages.
- Approvals: EU 2009: Relapsed platinum-sensitive ovarian cancer with PLD; US 2015: Liposarcoma and leiomyosarcoma after anthracycline; EU 2007: Advanced soft-tissue sarcoma after anthracycline/ifosfamide
- Dosing: Intravenous (central line); 1.1 mg/m² with PLD every 3 weeks (ovarian, EU); 1.5 mg/m² 24-hour infusion every 3 weeks (sarcoma)
- Toxicity (grade 3+): Neutropenia grade 3-4 63%; ALT increase grade 3-4 31%

## Notes

- In sarcoma: ET743-SAR-3007 gave PFS 4.2 versus 1.5 months against dacarbazine (HR 0.55) with no OS difference, and US approval followed in October 2015 for liposarcoma and leiomyosarcoma; it is particularly active in myxoid liposarcoma (FUS-DDIT3), where it displaces the FUS-CHOP oncoprotein. Given as a 24-hour infusion of 1.5 mg/m2 every 3 weeks with dexamethasone premedication through a central line; grade 3 or higher ALT elevation in 26 percent and neutropenia in 37 percent, with rare rhabdomyolysis.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Trabectedin
- FDA label (DailyMed): https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=Trabectedin

## Connected records

- cancers: [Leiomyosarcoma](https://onco.cc/cancers/leiomyosarcoma/), [Liposarcoma](https://onco.cc/cancers/liposarcoma/), [Ovarian cancer](https://onco.cc/cancers/ovarian/), [Retroperitoneal sarcoma](https://onco.cc/cancers/retroperitoneal-sarcoma/), [Sarcomas (soft tissue, bone, GIST)](https://onco.cc/cancers/sarcoma/), [Soft tissue sarcoma of the extremity (localised and advanced)](https://onco.cc/cancers/extremity-soft-tissue-sarcoma/), [Synovial sarcoma](https://onco.cc/cancers/synovial-sarcoma/), [Undifferentiated pleomorphic sarcoma (UPS)](https://onco.cc/cancers/undifferentiated-pleomorphic-sarcoma/), [Uterine sarcoma](https://onco.cc/cancers/uterine-sarcoma/)
- technologies: [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/)
- companies: [Johnson & Johnson](https://onco.cc/companies/johnson-johnson/)
- terms: [Histotype-tailored therapy](https://onco.cc/terms/sarcoma-histotype-tailoring/)
- targets: [EWSR1-FLI1 fusion](https://onco.cc/targets/ewsr1-fli1/)
- key papers: [LMS-04: doxorubicin plus trabectedin followed by trabectedin maintenance versus doxorubicin alone in metastatic leiomyosarcoma](https://onco.cc/key-papers/paper-lms-04-doxorubicin-trabectedin-lancet-oncol-2022/), [Trabectedin versus dacarbazine for metastatic liposarcoma or leiomyosarcoma after anthracycline failure](https://onco.cc/key-papers/paper-trabectedin-vs-dacarbazine-demetri-jco-2016/)
- trials: [LMS-04](https://onco.cc/trials/lms-04/)

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