Optimizing the use of trabectedin for advanced soft tissue sarcoma in daily clinical practice

Compared with conventional chemotherapy for advanced soft tissue sarcoma, trabectedin has several distinguishing characteristics which, when optimized, may maximize clinical benefits for patients. In this review, evidence is examined with the aim of answering some vital questions about the use of trabectedin in clinical practice. Who should be treated? When should patients be treated? For how long should patients be treated? What is the safety profile of trabectedin? How should trabectedin be administered? In brief, trabectedin has shown activity and clinical benefit in nearly all subtypes of soft tissue sarcoma. Improved efficacy outcomes are observed when trabectedin is administered as second-line therapy compared with later-line use. In line with this observation, the European Society for Medical Oncology clinical practice guidelines for soft tissue sarcoma recommend use of trabectedin in the second-line setting. Trabectedin has a role for treatment of elderly patients in whom alternatives are lacking, and can be administered for prolonged periods without cumulative toxicity. A statistically significant improvement in median progression-free survival has been observed when trabectedin is administered uninterrupted until disease progression. The flexibility of trabectedin administration in terms of dose, interval and duration allows for patient-tailored treatment optimization.