Does Trabectedin belong to the category of targeted therapy drugs?

Trabectedin is an anti-tumor drug with a unique mechanism. It is derived from the natural components of the marine organism ascidian and is used in clinical applications after artificial synthesis and improvement. Compared with common traditional chemotherapy drugs, trabectedin does not kill tumor cells simply by inhibiting cell division, but acts on the tumor microenvironment through multiple pathways and multiple links. Therefore, it is often misunderstood as a targeted drug in terms of classification. In fact, from the strict pharmacological definition, trabectedin is not a typical targeted therapy drug.

The core feature of targeted drugs is to selectively act on a clear molecular target, such as an inhibitor of a certain type of mutated gene or protein. The mechanism of action of trabectedin is more complex. It changes the three-dimensional structure of DNA by binding to specific sites on DNA, thereby affecting transcription factors and repair pathways related to DNA. At the same time, it can also affect the inflammatory response in the tumor microenvironment and inhibit the activity of tumor-associated macrophages. This multi-level action feature makes it have the components of chemotherapy and also exhibits some precision similar to targeting, but it is not equivalent to targeted therapy in a narrow sense.

In recent years, trabectedin has often been classified in studies and guidelines as an “anticancer drug with a special mechanism” rather than a targeted drug in the traditional sense. Its clinical application is mainly focused on a few tumor types such as soft tissue sarcoma and carcinoma. In these diseases, it has demonstrated unique efficacy, especially for patients who are resistant to or relapsed with conventional chemotherapy. Because its mechanism not only directly acts on DNA, but also involves regulating the tumor microenvironment, some academics have also proposed that it is a "bridge drug" between traditional chemotherapy and new targeted drugs.

Reference materials:https://www.drugs.com/monograph/trabectedin.html