Трабектедин

Trabectedin is a marine natural product derived from the tunicate Ecteinascidia turbinate. With its demonstrated in vitro and in vivo activity against a range of solid tumor cell lines, human xenografts and tumor explants, this antineoplastic agent has been developed and launched for the treatment of advanced STS after failure of first-line therapy with anthracyclines or ifosfamide or in patients who are unsuited to receive these agents. Its proposed mechanism of action involves binding to the N2 position of guanine in the minor groove demonstrating a preference for sequences containing 5′-PuGC and 5′-PyGG motifs. Subsequent alkylation of DNA, via an iminium intermediate generated from an intra-molecular acid-catalyzed activation and dehydration of the carbinolamine, induces a curvature of the DNA toward the major groove that ultimately disrupts the binding of transcription factors involved in cell proliferation. Evaluation of trabectedin against the National Cancer Institute’s human in vitro cell line panel, including melanoma, non-small-cell lung, ovarian, renal, prostate, and breast cancer, demonstrated potencies ranging from 1 pM to 10 nM.

ChEBI: A tetrahydroisoquinoline alkaloid obtained from a Caribbean tunicate Ecteinascidia turbinata. Used for the treatment of soft tissue sarcoma and relapsed ovarian cancer.

The most common adverse events included nausea, fatigue, vomiting, anorexia, neutropenia, and increases in aspartate aminotransferase and alanine aminotransferase liver enzymes. To combat the nausea and vomiting, all patients must receive 20mg of dexamethasone intravenously before the trabectedin infusion. Not only does this pretreatment have an antiemetic effect, it also appears to offer a hepatoprotective benefit. Concomitant administration of potent inhibitors and inducers of CYP3A4 should be avoided since plasma levels of this CYP3A4- metabolized drug will be affected. Trabectedin is contraindicated in patients with a known hypersensitivity to trabectedin, concurrent serious or uncontrolled infection, or breast-feeding. Trabectedin should also not be administered in combination with yellow fever vaccine. Finally, there are strict criteria regarding absolute neutrophil count, platelet count, and renal and hepatic enzyme levels for permission to initiate or continue treatment with trabectedin.