Trabectedin - Indications, Dosage, Side Effects and Precautions

• Neutropenic sepsis can occur during the treatment with trabectedin and patients must get their levels of neutrophils assessed before taking trabectedin and in between the treatment cycles. • Screen for neutrophil counts before initiating treatment with trabectedin and reduce the dose permanently if severe neutropenia or abnormally low levels of neutrophils are found. • Trabectedin can cause rhabdomyolysis or damage to the muscle and patients should check their levels of creatine phosphokinase before each administration of trabectedin. • Treatment with trabectedin should be temporarily stopped if the creatine phosphokinase levels are more than 2.5 times the normal level.‍‍‍‍‍‍​​​‍​​​​​​ If rhabdomyolysis occurs, treatment should be permanently stopped. • Liver function tests should be done each time before giving trabectedin injection as toxicity of the liver including liver failure can occur during the treatment. • Dose reduction, withholding the treatment temporarily or permanent discontinuation can be chosen depending on the abnormalities of liver function. • Heart parameters should be examined by taking ECG or multigated acquisition (MUGA) scan before starting trabectedin treatment and in 2 to 3 months intervals until trabectedin therapy is stopped. • Women of childbearing age should take an effective contraceptive measure during trabectedin treatment and should continue contraception for at least two months after the last dose of trabectedin to avoid pregnancy, which may result in fetal harm if any effects of trabectedin linger. • Men living with a reproductive potential female partner should follow proper contraception during the treatment and for at least five months after stopping to take trabectedin. • Leakage of trabectedin outside the vein or into the skin known as extravasation may occur and result in the death of nearby tissues; if so, the dead tissues have to be surgically removed to protect other healthy tissues.