How do you manage a patient who has developed a symptomatic pleural effusion while on dasatinib?
Specifically, can you rechallenge after the effusion has resolved (e.g. therapeutic thoracentesis)? If so, how long do you wait to rechallenge (especially if the patient has been in a long-term CMR)?
Answer from: Medical Oncologist at Academic Institution
A variety of approaches to dasatinib-induced pleural effusion are possible. It is common to rechallenge the patient with dasatinib once the effusion resolves. You can rechallenge with the standard dose if the grade of the initial effusion was grade 1 or 2 (by CTAE grading) or at 50 mg if...
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Answer from: Medical Oncologist at Academic Institution
My usual approach is rather than re-challenge, I switch to an alternative, such as nilotinib or bosutinib. If there are specific reasons to choose dasatinib (usually for an ABL-kinase mutation issue), then once the effusion has finally stopped recurring, I probably would try 50 mg of dasatinib...