What is the appropriate management of arthralgias associated with bosutinib?

Arthralgias have been reportedly associated with the use of all TKIs. The mechanism of this adverse event is not clear. Most of them respond to management with anti-inflammatory agents. When very severe (e.g., grade 3 or 4) transient treatment interruptions and dose reductions may be indicated. In some instances, corticosteroids may be used but this is very seldom required. Interestingly, arthralgias are the most common symptom of the withdrawal syndrome and can respond to the same management although, in a few instances re-starting TKI is the only approach that works. The mechanism for this is evidently different but also unclear.