Yondelis

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Yondelis

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Medically reviewed

Marina Burgos

Last updated on 22/12/2025

This page provides general, reference-level information compiled from official medical sources. It is not a substitute for professional medical advice, diagnosis, or treatment. For decisions about your health, please consult a qualified healthcare professional.

Overview of Yondelis

Yondelis is a specialized, prescription-only medication primarily used in the management of advanced cancers. Its therapeutic action is provided by the active ingredient, Trabectedin, which is definitively classified as an antineoplastic agent.

Property Description
Active ingredient Trabectedin
Form Lyophilized powder for solution for infusion
Pharmacological class Cytotoxic Alkylating Drug / Antineoplastic Agent
General purpose Management of advanced malignant tumors
Origin Synthetic analog of a marine metabolite

What Type of Medicine is Trabectedin? (Definition and Class)

Trabectedin is fundamentally categorized as a cytotoxic alkylating drug belonging to the pharmacological class of antineoplastic agents. This classification signifies that the substance works by being selectively toxic to rapidly dividing cells, which is the defining characteristic of tumor cells. This specialized action is clinically recognized for its role in targeting specific tumor types where its unique mechanism offers a therapeutic advantage over other chemotherapies. The compound itself is a small molecule, a highly complex chemical known as a tetrahydroisoquinoline alkaloid, distinguished by its unique mode of interaction with cellular DNA.

Is Trabectedin Natural or Synthetic, and What is its Form? (Composition, Origin, and Presentation)

The core active ingredient, Trabectedin (or Ecteinascidin 743), has a unique origin: it is a chemical analog of a compound first isolated from the Caribbean sea squirt (Ecteinascidia turbinata). Although derived from this marine metabolite, Trabectedin is now produced synthetically to ensure a high-purity, consistent, and reliable supply for therapeutic use. Yondelis is supplied as a lyophilized powder in a single-dose vial, which requires reconstitution and dilution to create a sterile solution for infusion before it is administered via the intravenous route. This presentation, as an IV infusion, is a key differentiating feature, necessitating administration in a controlled clinical setting.

What is the General Purpose of Yondelis? (General Benefit)

The general purpose of Yondelis is to slow or stop the growth of malignant tumors that are aggressive or have shown limited response to previous treatments. Its mechanism is rooted in its ability to bind specifically to the minor groove of DNA, physically bending the molecule and obstructing the necessary processes of DNA repair and transcription. This interference with the tumor cell's machinery leads to its programmed self-destruction, or apoptosis, offering a unique marine-derived antitumor agent for physicians managing complex cancer cases.

Regulatory References

  1. Yondelis (Trabectedin) EPAR

What side effects are possible with Yondelis?

Possible Side Effects and Safety Information

The safety profile of Yondelis (trabectedin) is primarily characterized by effects on the blood, liver, and muscles, as documented in regulatory sources such as the FDA and EMA.

Adverse Reactions

Very Common side effects, observed in a high percentage of patients, include myelosuppression (low white blood cell counts/neutropenia, anemia, thrombocytopenia), nausea, vomiting, fatigue, loss of appetite, and elevated liver enzymes (ALT/AST).

Serious and Clinically Significant Adverse Reactions

Serious adverse reactions can occur and may be life-threatening. These include neutropenic sepsis, severe hepatotoxicity (liver damage, including fatal liver failure), rhabdomyolysis (severe muscle breakdown), cardiomyopathy (heart muscle damage, including heart failure), and capillary leak syndrome. Specific baseline criteria regarding liver enzymes (bilirubin), muscle enzymes (CPK), and kidney function (creatinine clearance) must be met before starting treatment.

Safety Monitoring and Restrictions

Treatment with Yondelis requires mandatory and rigorous monitoring of full blood counts, liver function tests (LFTs), and Creatine Phosphokinase (CPK) levels before each cycle. Specific restrictions and limitations apply to minimize risk:

  • Contraindications include known severe hypersensitivity, concurrent uncontrolled infection, and use during breastfeeding.
  • Patients with pre-existing hepatic or renal impairment must be closely monitored, and specific dose adjustments or restrictions apply.
  • Pre-treatment with a corticosteroid (such as dexamethasone) is required for anti-emetic prophylaxis and hepatoprotection.

Treatment must be permanently discontinued for certain unresolved toxicities, such as severe rhabdomyolysis or cardiac adverse events indicative of cardiomyopathy. Once a dose has been reduced due to toxicity, subsequent dose escalation is not recommended.

Overdose and Emergency Response

Overdose and When to Seek Help — Official Regulatory Information for Yondelis

The official overdose profile for Yondelis (Trabectedin) focuses on the rapid escalation of severe, life-threatening toxicities, as documented by regulatory agencies. No specific antidote is known for overdose; therefore, management relies entirely on immediate symptomatic and supportive treatment.

Category Official Regulatory Documentation
Documented Overdose Presentations Symptoms or signs include severe manifestations of systemic toxicity, such as severe nausea and vomiting refractory to standard treatment, severe muscle pain or muscle weakness, and signs of Capillary Leak Syndrome (CLS), which may present as unexplained generalized swelling [Source 1.2, 1.4]. Extravasation at the infusion site is a documented localized event requiring intervention [Source 1.4].
Physiological Systems Affected Regulatory labels highlight severe effects on the Hepatic (liver failure), Hematologic (neutropenic sepsis), Cardiac (cardiomyopathy, heart failure), and Muscular/Renal (rhabdomyolysis leading to renal failure) systems [Source 1.4, 2.1].
When Immediate Medical Help Is Required Seek medical attention immediately is mandated for symptoms such as fever (potential neutropenic sepsis), severe muscle pain or weakness, refractory nausea and vomiting leading to fluid loss, or any signs of Capillary Leak Syndrome [Source 1.2, 2.1]. Urgent medical evaluation is required if CLS is suspected [Source 1.2].
Supportive and Procedural Measures Active supportive therapy should be started immediately to manage systemic toxicities [Source 1.2]. Management for rhabdomyolysis may include procedures like parenteral hydration, urine alkalinisation, and dialysis [Source 1.2]. Tissue necrosis resulting from extravasation may require surgery [Source 2.1].

The regulatory guidance emphasizes that patients with pre-existing hepatic impairment are at a heightened risk for severe toxicity due to increased systemic exposure. The overall profile mandates urgent medical attention based on the presence of specific, severe clinical signs that indicate the onset of a life-threatening, dose-related toxicity.

Therapeutic Uses of Yondelis

Yondelis (Trabectedin) is considered relevant as a therapeutic option used in situations involving certain distressing symptoms related to advanced malignant tumors. This medication is commonly used in two main therapeutic areas in adults.

Management of Advanced Soft Tissue Sarcoma (STS)

Yondelis is commonly used to help manage disease progression in adult patients with advanced or unresectable Soft Tissue Sarcoma (STS), especially the Liposarcoma and Leiomyosarcoma subtypes. It is generally applied in a subsequent-line setting for conditions characterized by periods of heightened symptoms due to cancer progression, after a prior anthracycline-containing regimen. The key benefit supports the patient by providing an important additional treatment option that contributes to the management of disease progression, offering a period of disease control which assists in addressing the overall symptomatic burden.

Therapy for Recurrent Ovarian Cancer

The medication is also considered relevant for women with recurrent ovarian cancer that is classified as platinum-sensitive. It is applied in combination with another anti-cancer agent, and is used for managing the recurrent manifestations of the disease. This application assists with maintaining functional stability by supporting the management of disease progression, which contributes to easing the overall symptom load and offers an important therapeutic strategy for patients navigating this complex condition.


Quick Fact: Therapeutic Context

This therapy is generally considered relevant for providing an option for managing advanced disease when standard initial treatments are no longer suitable. The medication is applied when tumor-related symptoms that interfere with daily functioning escalate, aiming to provide supportive symptom management and contribute to easing the overall symptom load in advanced cases.

Regulatory References

  1. European Medicines Agency (EMA) public overview

Eligibility and Restrictions for Use

Yondelis is officially designated for use in adult patients only. Regulatory agencies establish strict criteria for patient eligibility to ensure its safe administration.

Populations Excluded from Use (Contraindications)

Use of Yondelis is strictly contraindicated in patients who meet any of the following criteria, as documented in official labeling:

  • Known severe hypersensitivity, including anaphylaxis, to trabectedin or any excipient.
  • A concurrent serious or uncontrolled infection.
  • Breast-feeding women (contraindicated during treatment and for a period thereafter).
  • Patients receiving the yellow fever vaccine.

Condition-Specific Eligibility Rules

Treatment initiation is conditional upon meeting specific laboratory requirements, reflecting the official need for adequate organ function:

Organ System Required Baseline Criteria (Example)
Hematological Absolute Neutrophil Count ge 1,500/ mm^3; Platelet count ge 100,000/ mm^3
Hepatic Bilirubin le Upper Limit of Normal (ULN); Creatine Phosphokinase (CPK) le 2.5 x ULN

Patients with elevated baseline bilirubin levels (above ULN) must not be treated. Use is also restricted in cases of severe renal impairment where studies have not established safety or efficacy (e.g., creatinine clearance < 30 mL/ min for monotherapy).

Age and Reproductive Status

The medicine is not recommended for use in children and adolescents under 18 years because efficacy has not been established in the pediatric population. Yondelis must not be used during pregnancy due to the potential for fetal harm; female patients of childbearing potential are required to use effective contraception.

What should I know about interactions with other medicines?

Interactions with other medicines and products

Trabectedin (Yondelis) has documented pharmacokinetic interactions primarily mediated by the Cytochrome P450 3A4 (CYP3A4) enzyme system, which processes the medicine in the body. Co-administration of substances that affect this enzyme can significantly alter the drug's systemic exposure.

Pharmacokinetic and Pharmacodynamic Interactions

Classification Interacting Substance/Class Official Interaction Outcome
Strong CYP3A4 Inhibitor Ketoconazole, Ritonavir, Grapefruit Juice Increases systemic exposure of Trabectedin; risk of toxicity is heightened.
Strong CYP3A4 Inducer Rifampin, St. John's wort Decreases systemic exposure of Trabectedin (AUC reduced by 31%).
Pharmacodynamic Risk Medicines associated with Rhabdomyolysis (e.g., Statins) Increased risk of additive organ-specific toxicity (rhabdomyolysis).

Restrictions and Timing Rules

Co-administration with strong CYP3A4 inhibitors and strong CYP3A4 inducers should be avoided as officially documented. If short-term use of a strong CYP3A inhibitor is required, the label prescribes mandatory timing rules: the inhibitor must be administered one week after the Yondelis infusion and discontinued the day prior to the next infusion. The medicine is formally contraindicated for use with the yellow fever vaccine and in patients with baseline elevated serum bilirubin levels due to heightened risk in hepatic impairment.

Mechanism of Action

Yondelis, containing the active ingredient Trabectedin, exerts its specialized biological mechanism through two distinct, simultaneous modes: direct disruption of the cell's genetic maintenance systems and modulation of the tumor's supportive environment.


Disruption of DNA Repair and Integrity

Trabectedin acts as a unique alkylating agent that forms a covalent bond, or an adduct, within the minor groove of the DNA double helix . This chemical binding physically distorts the DNA, crucially trapping and poisoning the Transcription-Coupled Nucleotide Excision Repair (TC-NER) system as it attempts to correct the damage. The subsequent accumulation of unresolved DNA damage and stalled transcription activates the cell's intrinsic caspase-dependent apoptotic pathway.


️ Modulation of the Tumor Microenvironment

Trabectedin demonstrates a highly selective cytotoxic effect on specific immune cells that infiltrate tissues, primarily Tumor-Associated Macrophages (TAMs). By triggering apoptosis in these cells, the drug effectively depletes a source of critical signaling molecules that otherwise contribute to cell growth and proliferation. This action decreases the production of pro-growth and pro-angiogenic mediators (like VEGF), leading to the physiological consequence of reduced angiogenesis and decreased local tumor support signaling.

Dosage and Administration Information

How to Use Yondelis: Official Administration Guidelines


Administration Scope

Feature Official Instruction
Route of Administration Yondelis is administered exclusively via intravenous infusion (IV), with official guidelines strongly recommending use through a central venous line.
Dosing Schedule The dose is calculated based on the patient's Body Surface Area (BSA). The labeled dose for monotherapy (STS) is 1.5 mg/m^2, while the dose for combination therapy (ovarian cancer) is 1.1 mg/m^2.
Frequency & Infusion Duration The medicine is administered once every 21 days (one cycle). The infusion duration is 24 hours for monotherapy and 3 hours for the combination regimen.

Procedural and Contextual Requirements

The use protocol mandates specific procedural steps for administration. All patients must receive dexamethasone 20 mg administered intravenously approximately 30 minutes prior to the start of the Trabectedin infusion. The medicine is supplied as a lyophilized powder, which requires reconstitution and subsequent dilution into 500 mL of a specific solution before administration. The infusion must be completed within 30 hours of the initial reconstitution and requires a 0.2-micron in-line filter.

Population-Specific Adjustments

Official labeling specifies dose modifications for certain clinical scenarios. For patients with moderate hepatic impairment, the recommended starting dose must be reduced to 0.9 mg/m^2. Conversely, administration is not recommended for patients with severe hepatic impairment. Once a dose has been reduced due to toxicity, dose escalation is generally not recommended in subsequent cycles. Treatment is continued until documented disease progression.

Recent Clinical Evidence

Yondelis: Overview of Clinical Evidence


Evidence for Use in Advanced Soft Tissue Sarcoma (STS)

The research for Yondelis in advanced Soft Tissue Sarcoma (STS) was primarily based on large-scale Randomized Controlled Trials (RCTs) that compared observations between patients receiving Yondelis and those receiving a comparator treatment. The primary focus of this research was on Progression-Free Survival (PFS), which measures the time that passes until the cancer shows signs of worsening. Findings from these trials described a pattern with a measured difference in median Progression-Free Survival in the group that received Yondelis. Data related to Overall Survival (OS)—the total length of time patients lived—were also collected; however, the measurements for this outcome did not show a statistically distinct difference between the two treatment groups. Research provides context but not individual predictions.


Evidence for Use in Recurrent Platinum-Sensitive Ovarian Cancer

Research for Yondelis in recurrent ovarian cancer was conducted using pivotal Randomized Controlled Trials (RCTs). These studies focused on adult women whose cancer was classified as platinum-sensitive. The research was designed to compare the observed outcomes of the combination treatment (Yondelis plus pegylated liposomal doxorubicin) against the use of the single agent (PLD alone). Data show patterns related to a measured difference in median Progression-Free Survival in the combination arm compared to the PLD-alone arm. Differences in observed outcomes were recorded for women who had a longer gap between their initial platinum treatment and their recurrence. The trials indicated that a statistically distinct difference in Overall Survival (OS) was not observed between the groups.


What Remains Uncertain About the Research

Evidence highlights what is known—and what is still uncertain—about the long-term data. One key limitation is that comparative evidence is lacking for certain important endpoints, particularly Overall Survival, where the trials indicated that a statistically distinct difference was not observed. Also, the results apply only to the populations studied, meaning that evidence is limited for very specific or rare subtypes of sarcoma outside of the main focus. Data for certain groups remain insufficient, and research is still ongoing to collect more comprehensive data on the experience of patients who receive the medicine for many months.

Key Studies & References

  1. An Efficacy and Safety Study for Yondelis (Trabectedin) in Patients With Advanced Relapsed Ovarian Cancer (NCT00113607 - Phase 3 trial information)

Frequently Asked Questions (FAQ)

Common questions about Yondelis (FAQ)

Q: Is it normal to feel more tired than usual after a Yondelis infusion?

Tiredness, commonly called fatigue, is listed in official regulatory documents as a very common side effect of Yondelis. This feeling is reported by patients to occur both during the period of treatment and in the days immediately following the infusion. Concerns about severe or persistent fatigue should be discussed with the healthcare team.

Q: Do many people experience nausea and vomiting with Yondelis?

According to the official product information, nausea and vomiting are listed among the most frequently reported side effects for patients receiving Yondelis. Official administration guidelines include the use of pre-medication to help manage and reduce these effects. Management strategies for these symptoms are typically discussed with the prescribing healthcare professional.

Q: Why is a central venous catheter often used for Yondelis infusion?

Official administration guidelines recommend that Yondelis be given through a central venous line (a catheter placed into a large vein in the chest or arm). This is an important safety measure, as the medicine can cause damage to surrounding tissue if it leaks out of the vein, a process known as extravasation. Use of a central line is intended to minimize this potential risk.

Q: How quickly does Yondelis start to work, based on research?

Official research documents generally describe the drug's activity in terms of long-term outcomes, such as Progression-Free Survival (PFS), rather than an immediate onset of action. In the main clinical trial, the median duration of treatment observed was approximately 13 weeks. Treatment is typically continued until documented disease progression or when side effects become unacceptable.

Q: What are the common reasons a doctor might decide to stop Yondelis treatment?

Official prescribing information lists several conditions that may require permanent discontinuation of Yondelis. These include severe, unresolved adverse reactions like certain liver problems, severe muscle breakdown (rhabdomyolysis), capillary leak syndrome, and Grade 3 or 4 cardiac events. The official criteria serve as the basis for the healthcare team's decision regarding treatment continuation or permanent discontinuation.

Q: How is Yondelis related to a sea organism?

The active ingredient in Yondelis, called Trabectedin, has a unique origin. It is a synthetic copy, or analog, of a chemical compound originally found in a marine organism, the Caribbean sea squirt (Ecteinascidia turbinata). Although derived from this natural source, Trabectedin is now produced synthetically for medical use.

Q: Can Yondelis cause hair loss, and is it common?

Official safety documents list hair loss (alopecia) as a reported side effect of Yondelis. However, in clinical trials, it was generally described as being mild and was observed in a low percentage of patients. This side effect is not listed among the 'very common' reactions.

Q: What should I know about potential liver problems related to Yondelis?

Official safety information states that Yondelis may cause liver problems, including severe damage or failure. For this reason, patients are monitored with liver function tests (LFTs) before each treatment cycle. Official patient information describes potential signs of liver problems, such as pain in the upper-right stomach area or a yellowing of the skin or eyes, as important to be aware of.

Q: What does 'recurrent or metastatic soft tissue sarcoma' mean in simple terms?

In regulatory documents, the medicine is indicated for soft tissue sarcoma that is defined as unresectable or metastatic. Unresectable means the tumor cannot be removed by surgery. Metastatic means the cancer has spread from where it started to other parts of the body. This indication often covers disease that has recurrent (returned) after a patient has received prior treatment.

Q: Does Yondelis have a high risk of causing nerve damage (neuropathy)?

Nerve damage (peripheral neuropathy), often described as numbness or tingling in the fingers or toes, is listed as a potential side effect in official safety summaries. Studies indicate that this effect is often temporary and can improve after treatment is finished.

Q: Is Yondelis approved in all countries where cancer treatment is available?

Yondelis is authorized in major regulatory regions such as the European Union and the United States, as well as in other countries like South Korea and Russia. Official status can vary, and it is not universally approved in every country where cancer treatment is available.

Q: Is there a limit to the number of cycles of Yondelis a person can receive?

For the soft tissue sarcoma indication, Yondelis is typically administered every 21 days until documented disease progression or unacceptable toxicity occurs. For the ovarian cancer indication (in combination with another drug), the initial combination is for up to 6 cycles, followed by single-agent use until progression or toxicity.

Q: Are the side effects of Yondelis permanent?

The duration of side effects varies widely. Regulatory summaries note that some effects, such as elevated liver enzyme levels, typically recover before the next dose. Peripheral neuropathy is described as often being temporary and improving after treatment is complete.

Q: Can someone on Yondelis still receive vaccinations?

Official warnings indicate that the use of live vaccines is discouraged during treatment because Yondelis is classified as an immunosuppressive agent. Receiving a live vaccine while undergoing treatment may reduce the immune response to the vaccine or increase the risk of infection.

Q: Are there different brand names for Yondelis outside of the US?

The medicine's active ingredient is Trabectedin. While Yondelis is the primary brand name, regulatory documents confirm that generic versions, such as Trabectedin Accord, have also been authorized for use in the European Union.

Q: How is Yondelis supplied (e.g., powder, liquid)?

Yondelis is supplied as a lyophilized powder in a single-dose vial. This powder must first be dissolved (reconstituted) and then diluted to create a solution before it can be administered to the patient as an intravenous infusion.

Q: What is the standard regulatory approval process theme for Yondelis?

The official product was granted Orphan Drug status by both the FDA and the European Commission for its approved indications. This designation is given to drugs intended to treat rare diseases or conditions, which helps facilitate the development and review process.

Q: Are there any long-term side effects noted for Yondelis that appear years later?

Official safety documents include data from clinical trials where some patients were treated for more than one year. These documents note that the risk of certain toxicities, such as liver toxicity (hepatotoxicity), may be cumulative, meaning the risk can worsen with successive cycles over time.

Q: Are there any known potential interactions between Yondelis and herbal remedies?

Yes, regulatory documents mention an interaction with the common herbal product St. John's wort. This herbal product acts as a strong inducer of the enzyme that processes Yondelis in the body. Official warnings state it should be avoided to prevent a decrease in the drug's exposure and potential alteration of its effectiveness.

How should Yondelis be stored and disposed of?

The storage and disposal of Yondelis (trabectedin) is subject to strict regulatory requirements due to its nature as a cytotoxic drug.

Storage Requirement Official Regulatory Statement
Temperature Store the unopened vial in a refrigerator at mathbf2 C to mathbf8 C (mathbf36 F to mathbf46 F). Do not freeze.
Protection Keep the vial in the original carton to protect the contents from light.
Stability The total time from initial powder reconstitution to the end of the intravenous infusion must not exceed 30 hours.
Safety Keep this medicine out of the sight and reach of children.

For disposal, Yondelis is classified as a cytotoxic agent. This requires that all waste, including unused product, is handled and disposed of according to special procedures for cytotoxic medicinal products. Do not dispose of any part of the medicine via household waste or wastewater; disposal must comply with local, regional, and national regulations.

Attention! Always consult to a doctor or pharmacist before using pills or medicines.

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