Henry Chi Hang Fung, MD, vice chair, department of hematology/oncology, Fox Chase Cancer Center in Philadelphia, Pennsylvania, said that he sees significant, symptomatic pleural effusions in approximately 5% to 10% of his patients with leukemia.
“We are often aware of the severe cases, but not aware of the asymptomatic, mild ones,” Dr Fung said.
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In the trials assessed in this study, pleural effusions were monitored continuously in patients treated with at least 1 dose of dasatinib. However, Dr Fung pointed out that if pleural effusions are asymptomatic, they often go undetected.
“They are not harmful if they go undiagnosed and they are not getting worse,” he said.
In most cases, concern about pleural effusion would not be a reason to avoid the use of dasatinib in these patients, unless the patient had prior lung disease, was a chronic smoker, or had asthma or chronic obstructive pulmonary disease OPD, Dr Fung said.
Referring to the 28% of patients in the DASISION trial who reported drug-related pleural effusion, Dr Fung said, “In those cases, I might not use [dasatinib] because a rate of 28% is very high.”
When dasatinib was initially approved by the US Food and Drug Administration for these leukemias, it was one of the only treatment options; today, there are quite a few more medications that have since been approved by the agency, Dr Fung said.
Some available alternatives to TKIs for patients with CML are imatinib, nilotinib, bosutinib, or ponatinib.4,5
“There are many choices. You don’t need to use dasatinib in these patients,” Dr Fung said. “Finding the right treatment for these patients should include an assessment of all the potential toxicities — including financial toxicity — to determine which [medication] is the best option for the patient.”
References
- Hughes TP, Laneuville P, Rousselot P, et al. Incidence, outcomes, and risk factors of pleural effusion in patients receiving dasatinib therapy for Philadelphia chromosome-positive leukemia [published online August 9, 2018]. Haematologica. doi: 10.3324/haematol.2018.188987
- Gleevec® [package insert]. East Hanover, NJ: Novartis Pharmaceuticals Corporation; 2017.
- Tasigna® [package insert]. East Hanover, NJ: Novartis Pharmaceuticals Corporation; 2017.
- American Cancer Society. Targeted therapies for chronic myeloid leukemia. https://www.cancer.org/cancer/chronic-myeloid-leukemia/treating/targeted-therapies.html. Revised June 19, 2018. Accessed October 3, 2018.
- Canadian Cancer Society. Targeted therapy for acute lymphocytic leukemia. http://www.cancer.ca/en/cancer-information/cancer-type/leukemia-acute-lymphocytic-all/treatment/targeted-therapy/?region=on. Accessed October 3, 2018.
