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pleural effusions persisting on BOS after DAS

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michael.mauro
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6 years 8 months ago #1407 by michael.mauro

pleural effusions persisting on BOS after DAS was created by michael.mauro

I have had a number of patients with DAS pleural effusions (+/- pericardial effusion as well ) who were then moved to BOS with a goal to retain treatment intensity/coverage but minimize risk of persistent pleural effusions. I now have seen a number of patients in whom the pleural effusion persists on BOS and I postulate it may persist long after DAS exposure irrespective of TKI used after DAS. I wanted to to see if others had similar experiences?

Jorge Cortes

6 years 8 months ago #1408 by Jorge Cortes

Replied by Jorge Cortes on topic pleural effusions persisting on BOS after DAS

I do share this observation, and it extends not only to bosutinib but also to other TKI. The risk of pleural effusion with other TKI is minimal but I see it more among those who already had pleural effusion on dasatinib. I agree that some of this may be that whatever the mechanism of action is, persists for some time after withdrawal, akin to what we see with arterio-thrombotic events where we have modeled that the risk persists for approximately 6 months after discontinuation of ponatinib.

Best,

JC

jeff lipton

6 years 8 months ago #1409 by jeff lipton

Replied by jeff lipton on topic pleural effusions persisting on BOS after DAS

I have had a couple as well. It is less likely to occur if the dasatinib-based effusion is completely resolved before starting the bosutinib, although not always. One of the things to consider is whether the original effusion is gone. I have been referred a number of patients who have effusions on other TKIs, but when you examine carefully, the original DAS-based had never completely disappeared. As Jorge pointed out, pleural and/or pericardial effusions are not limited to the src based TKIs such as DAS or BOS. If you read the product monograph for IM, you will find it there as one of the side effects of the early studies in previously TKI-naïve patients and I have definitely seen it with NIL even in patients who have not seen DAS or BOS.
Good point
Jeff

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