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Bosutinib and Pleural Effusions

What is the current thinking about patients having had pleural effusions on dasatinib switching to bosutinib?  All that I can find in the literature is a couple of case studies that found those patients fared badly after the switch, with more pleural effusions.  It's true that dasatinib and bosutinib both inhibit the SRC kinases, but I also read somewhere (can't remember the paper) that that wasn't completely dispositive, as pleural effusions could be caused by some coupling of SRC with other factors that are present in dasatinib, but not bosutinib.  Anyway, bosutinib is about the last TKI left to me and my onc wants me to make the switch, after I reduced my dasatinib to 25 mg (50's cut in half) and STILL got another pleural effusion.  Thoughts?  INFO?

This is a recent paper on pleural effusion management:

https://www.sciencedirect.com/science/article/pii/S2152265016305687

It highlights the use of diuretics to facilitate fluid reduction. Dr. Cortes is the lead author and prescribed my current 20 mg Sprycel.

Bosutinib (Bosulif) is very popular with CML expert clinicians in the UK. Unfortunately it seems to have been under prescribed - at least in Europe -because not only was it late coming to the fore but also the first c/trials showed the main side effect for most patients is diarrhoea and this was not managed well at first so trial clinicians stopped the drug- therefore it did not reach its main trial end points. Since then it has become very clear that this effect is transitory for most and can be easily managed. However it looks like the uptake of bosutinib is rising- we think because its side effect profile is less challenging compared to other 2nd Gen TKIs. 

Sandy

 

Yes, Scuba, I read that.  The trouble is, the treatment with prednisone and diuretics for a dasatinib-triggered pleural effusion has not been well-studied, there is no protocol, and as in this article, has been met with a pretty tepid response by the medical team.  What mostly works is a drug interruption.  I only just got back on Sprycel at 25 mg and have not yet gotten back down to my previous <0.01 and I really want to give it more time.  I'm going to see a pulmonologist with this question.

Thanks, Sandy.  Do you, in Europe, have any new data on how people who have had multiple pleural effusions on dasatinib fare when they switch to bosutinib?