I have a 75 year old female patient who complained of a persistent dry cough and exertional dyspnea (Nov 2016). She also has intermittent nausea, which is not clearly related to food. She attributes these problems to dasatinib (currently 100mg/day).
Further tests revealed no pleural effusion clinically. PFTs showed normal spirometry, pO2, and lung volumes, but a DLCO only 50% of predicted (non-smoker). EchoCG showed mild pulmonary hypertension, PAP about 30 mmHg.
She has been on treatment for only about 9 months and achieved MMR already by 6 months. Her risk score wasn’t especially high, so she could switch to imatinib. I would do a dasatinib level if I could, with a view to decreasing the dose, but I don’t know whether there is evidence that pulm HT (like pl eff) is related to trough levels. The PAP is not very high, so I could also wait and repeat it in 3 months.
I would appreciate some further opinions on whether to switch to imatinib or lower her dasatanib dosage.