Important Safety Information
CONTRAINDICATIONS — YONDELIS® (trabectedin) is contraindicated in patients with known severe
hypersensitivity, including anaphylaxis, to trabectedin.
WARNINGS AND PRECAUTIONS
Neutropenic sepsis, including fatal cases, can occur. In Trial 1, the incidence of Grade 3 or
4 neutropenia, based on laboratory values, was 43% (161/378). Median time to the first occurrence of
Grade 3 or 4 neutropenia was 16 days (range: 8 days to 9.7 months). Median time to complete
resolution of neutropenia was 13 days (range: 3 days to 2.3 months). Febrile neutropenia (fever ≥38.5℃
with Grade 3 or 4 neutropenia) occurred in 18 patients (5%). Ten patients (2.6%) experienced
neutropenic sepsis, 5 of whom had febrile neutropenia, which was fatal in 4 patients (1.1%). Assess
neutrophil count prior to administration of each dose of YONDELIS® and periodically throughout the
treatment cycle. Withhold YONDELIS® for neutrophil counts of less than 1500 cells/microliter on the day
of dosing. Permanently reduce the dose of YONDELIS® for life-threatening or prolonged, severe
neutropenia in the preceding cycle.
Rhabdomyolysis — YONDELIS® can cause rhabdomyolysis and musculoskeletal toxicity. In Trial 1, rhabdomyolysis leading to death occurred in 3 (0.8%) of the 378 patients. Elevations in creatine
phosphokinase (CPK) occurred in 122 (32%) of the 378 patients receiving YONDELIS®, including Grade 3
or 4 CPK elevation in 24 patients (6%), compared to 15 (9%) of the 172 patients receiving dacarbazine
with any CPK elevation, including 1 patient (0.6%) with Grade 3 CPK elevation. Among the 24 patients
receiving YONDELIS® with Grade 3 or 4 CPK elevation, renal failure occurred in 11 patients (2.9%);
rhabdomyolysis with the complication of renal failure occurred in 4 of these 11 patients (1.1%). Median
time to first occurrence of Grade 3 or 4 CPK elevations was 2 months (range: 1 to 11.5 months). Median
time to complete resolution was 14 days (range: 5 days to 1 month). Assess CPK levels prior to each
administration of YONDELIS®. Withhold YONDELIS® for serum CPK levels more than 2.5 times the upper
limit of normal. Permanently discontinue YONDELIS® for rhabdomyolysis.
Hepatotoxicity, including hepatic failure, can occur. Patients with serum bilirubin levels above the upper
limit of normal or AST or ALT levels >2.5 x ULN were not enrolled in Trial 1. In Trial 1, the incidence of
Grade 3-4 elevated liver function tests (defined as elevations in ALT, AST, total bilirubin, or alkaline
phosphatase) was 35% (134/378). Median time to development of Grade 3-4 elevation in ALT or AST
was 29 days (range: 3 days to 11.5 months). Of the 134 patients with Grade 3 to 4 elevations in LFTs, 114
(85%) experienced complete resolution with the median time to complete resolution of 13 days (range:
4 days to 4.4 months). In Trial 1, the incidence of drug-induced liver injury (defined as concurrent
elevation in ALT or AST of more than three times the upper limit of normal, alkaline phosphatase less
than two times the upper limit of normal, and total bilirubin at least two times the upper limit of normal)
was 1.3% (5/378). ALT or AST elevation greater than eight times the ULN occurred in 18% (67/378) of
patients. Assess LFTs prior to each administration of YONDELIS® and as clinically indicated based on
underlying severity of pre-existing hepatic impairment. Manage elevated LFTs with treatment
interruption, dose reduction, or permanent discontinuation based on severity and duration of LFT abnormality.
Cardiomyopathy, including cardiac failure, congestive heart failure, ejection fraction decreased, diastolic
dysfunction, or right ventricular dysfunction can occur. In Trial 1, patients with a history of New York
Heart Association Class II to IV heart failure or abnormal left ventricular ejection fraction (LVEF) at
baseline were ineligible. In Trial 1, cardiomyopathy occurred in 23 patients (6%) receiving YONDELIS® and
in four patients (2.3%) receiving dacarbazine. Grade 3 or 4 cardiomyopathy occurred in 15 patients (4%)
receiving YONDELIS® and 2 patients (1.2%) receiving dacarbazine; cardiomyopathy leading to death
occurred in 1 patient (0.3%) receiving YONDELIS® and in none of the patients receiving dacarbazine. The
median time to development of Grade 3 or 4 cardiomyopathy in patients receiving YONDELIS® was
5.3 months (range: 26 days to 15.3 months). Assess left ventricular ejection fraction (LVEF) by
echocardiogram or multigated acquisition (MUGA) scan before initiation of YONDELIS® and at 2- to
3-month intervals thereafter until YONDELIS® is discontinued. Withhold YONDELIS® for LVEF below lower
limit of normal. Permanently discontinue YONDELIS® for symptomatic cardiomyopathy or persistent left
ventricular dysfunction that does not recover to lower limit of normal within 3 weeks.
Capillary leak syndrome (CLS) characterized by hypotension, edema, and hypoalbuminemia has been
reported with YONDELIS®, including serious CLS resulting in death. Monitor for signs and symptoms of
CLS. Discontinue YONDELIS® and promptly initiate standard management for patients with CLS, which
may include a need for intensive care.
Extravasation Resulting in Tissue Necrosis — Extravasation of YONDELIS®, resulting in tissue necrosis requiring debridement, can occur. Evidence of tissue necrosis can occur more than 1 week after the
extravasation. There is no specific antidote for extravasation of YONDELIS®. Administer YONDELIS®
through a central venous line.
Embryofetal Toxicity — Based on its mechanism of action, YONDELIS® can cause fetal harm when
administered to a pregnant woman. Advise females of reproductive potential to use effective
contraception during therapy and for at least 2 months after the last dose of YONDELIS®. Advise males
with female partners of reproductive potential to use effective contraception during therapy and for at
least 5 months after the last dose of YONDELIS®.
Adverse Reactions — The most common (≥20%) adverse reactions are nausea (75%), fatigue (69%),
vomiting (46%), constipation (37%), decreased appetite (37%), diarrhea (35%), peripheral edema (28%),
dyspnea (25%), and headache (25%).
The most common (≥5%) grades 3-4 laboratory abnormalities are: neutropenia (43%), increased
ALT (31%), thrombocytopenia (21%), anemia (19%), increased AST (17%), and increased creatine
phosphokinase (6.4%).
DRUG INTERACTIONS
Effect of Cytochrome CYP3A Inhibitors — Avoid using strong CYP3A inhibitors (e.g., oral ketoconazole,
itraconazole, posaconazole, voriconazole, clarithromycin, telithromycin, indinavir, lopinavir, ritonavir,
boceprevir, nelfinavir, saquinavir, telaprevir, nefazodone, conivaptan) in patients taking YONDELIS®. If a
strong CYP3A inhibitor for short-term use (i.e., less than 14 days) must be used, administer the strong
CYP3A inhibitor 1 week after the YONDELIS® infusion, and discontinue it the day prior to the next
YONDELIS® infusion.
Effect of Cytochrome CYP3A Inducers — Avoid using strong CYP3A inducers (e.g., rifampin,
phenobarbital, St. John’s wort) in patients taking YONDELIS®.
072957-170515
Please see full Prescribing Information for YONDELIS®.
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